The menopause shift: how obesity can change the experience

The menopause is a natural, biological stage of life for women. It usually takes place between the ages of 45 to 55 years although both the age and experience of menopause can vary from person to person. Nearly half (43%) of women going through menopause live with obesity, and the two are more closely linked than people may think. As part of the biological process, many women experience a shift in their weight during the menopause; those that already live with obesity may find that their symptoms of menopause are made worse and may find it more difficult than others to manage their weight.

Nova Bjerregard and Birthe Christiansen, Living with obesity, Denmark

It is important for women experiencing menopause to understand this relationship with obesity, as the way in which our bodies carry weight can have implications on our long-term health. Without education on the topic, women could miss out on support that potentially helps to achieve sustainable weight management and a healthy a future.

Despite the need to talk about this topic more, particularly with professionals, alarming statistics from a UK study shows that currently, nearly half (45%) of women have not spoken to their doctor about their menopause symptoms. For women living with obesity, experiences of weight stigma can reduce the likelihood of talking to a healthcare professional – resulting in feelings of isolation and avoiding professional support, which can have health implications beyond what may be expected from going through menopause generally.

This article aims to break down the link between obesity, menopause and heart disease, to help women and their loved ones feel more equipped and empowered to make informed choices about their long-term obesity care.

Typically, menopause is broken down into the following stages:

1. Premenopause: this simply refers to the time a woman experiences regular menstrual cycles, which typically begins during teenage years and lasts until the start of the perimenopause stage
2. Perimenopause: the stage when women are mostly likely to experience symptoms. This can last for several years, and comes to an end approximately 12 months after the final menstrual period
3. Menopause: the point at which a woman has not had a menstrual cycle for 12 months
4. Postmenopause: the stage that women will remain in after the menopause has occurred. While menopause symptoms may reduce, this stage is associated with other health risks that are important to be aware of

It is during perimenopause and postmenopause when major changes to the body occur, and the impact on overall health is greatest. We’ll focus on these stages…

Perimenopause is the result of a physiological change inside the body, whereby the ovaries release less of the hormone oestrogen. Oestrogen is the female sex hormone, best known for regulating the menstrual cycle although it has many other health benefits that people may not be as familiar with.

Lower levels of oestrogen in the body often interferes with the brain’s ability to regulate feelings of hunger and fullness (controlled by the hormone such as leptin and ghrelin ). Therefore, for women experiencing perimenopause, this can make it feel more difficult to manage weight effectively. In fact, studies have shown that the rate at which fat is gained during the menopause doubles, meaning the changes that take place inside the body are often felt outside of the body too.

For people living with obesity, another common hormonal imbalance can take place on top of this – resistance to leptin. As leptin controls feelings of hunger and fullness, resistance to it can make long-term weight management difficult without the right support. That is why, during perimenopause, living with obesity can make symptoms of both menopause and obesity feel worse and can impact emotional wellbeing as well as physical health.

There are other factors at play that can influence the experience of perimenopause and hormonal imbalances, often resulting in a cycle that can be difficult to break. For example, sleep disturbances, feelings of low mood and fatigue can all stand in the way of positive and healthy routines that help to regulate the hormones that contribute to weight management. More specifically, lack of sleep (which can be a symptom of perimenopause) can dysregulate the hormone leptin – meaning a symptom of perimenopause can exacerbate what has been described already above. Similarly, feelings of fatigue can prevent people from exercising regularly, which is encouraged to keep the body functioning as it should. Further weight gain can affect sleep, feelings of low mood and fatigue or ability to exercise regularly, and so the cycle begins again.

Many women experiencing perimenopause will be familiar with the direct impact to mood, although not everyone may make this link between mood, obesity and menopause. Noting that the experience of menopause can vary from person to person, it could also be that some people may not experience any, or many, symptoms.

A common misconception is that symptoms come to an end once the ‘menopause’ stage has ended. The truth is the changes that the body has gone through during perimenopause/menopause can impact women for the rest of their lives. This is often referred to as postmenopause, put simply as the stage you remain in after menopause.

During postmenopause, the body is now producing very little of the oestrogen hormone, which can have an unexpected but significant impact on the body. One benefit of oestrogen it its ability to manage levels of LDL (bad) cholesterol, and HDL (good) cholesterol. Without oestrogen, postmenopausal women often produce a higher level of the bad cholesterol, which in turn can increase the risk of high blood pressure.

High blood pressure is a major risk factor for heart disease, which may help to explain why nearly 80% of women over the age of between 60-79 years are affected by heart disease.

During menopause, the imbalance of hormones can cause the fat that normally lives under the skin (subcutaneous fat) to move and sit around the stomach, surrounding the vital internal organs (visceral fat). An increase in visceral fat can be a great risk of heart disease.

This all means that the normal process of menopause can increase the risk of heart disease, with or without obesity, although there are extra risk factors if a woman lives with obesity.

If you are worried about the impact of obesity on your heart, a good tool to help assess your risk of heart disease is the Waist-to-Height Ratio calculator. The calculator offers a ration between 0 and 1 based on an input of waist circumference and height. A general rule is to aim for a result of less than 0.5. Check your risk here. 

Despite being a natural stage of life that impacts all women, stigma and misconceptions are often associated with menopause, which creates a reluctance for people to seek support. Living with obesity may add an extra layer to avoiding important medical discussions, as obesity can carry external and internal weight bias and stigma that prevents people from discussing sensitive health topics.

The positive news is that studies have confirmed the benefit that seeking support from healthcare professionals can have when managing menopause-related body changes. Getting support from a doctor can improve mood and sleep, reducing menopause-related irritability and wider aspects of mental health, such as anxiety. For people living with obesity, keeping menopause-related symptoms at bay can play an important role in weight management, thereby preventing menopause from having an even greater impact on weight and weight-related health implications, such as the risk of heart disease.

If you have noticed changes in your body during the menopause and would like to manage its impact to your overall health, your doctor can support you.