Women nearing menopause who are obese experience an increase in menopause symptoms over others, according to a recent study. Not just that, the study suggests that women with obesity are less likely to experience symptomatic relief after either systemic and/or localized Menopause Hormone Therapy (MHT).
Researchers at The Menopause Society in Philadelphia presented their five-year study involving 119 per-menopausal and postmenopausal women. The findings of the study were presented at the recent 2023 Annual Meeting of The Menopause Society in Philadelphia.
Even as hormone therapy remains the most viable solution for helping women manage severe menopausal symptoms, researchers led by Dr Anita Pershad, from Eastern Virginia Medical School in Norfolk threw light on the efficacy of menopausal hormonal therapy in obese women with menopause or perimenopause.
When menopausal symptoms get worse, unmanageable and severe, it can decrease the quality of life drastically. Most of these severe symptoms such as severe hot flashes, burning sensation, vaginal dryness, depressive thoughts, irritability, mood swings and low sex drive can be managed with menopause hormone therapy (MHT), say experts.
The link between obesity and menopausal symptoms
The study had a cohort of 119 perimenopausal and postmenopausal women. It aimed to investigate the association of obesity and self-reported efficacy of HT in these women.
This study categorized any woman with a body mass index of greater than or equal to 30 as obese. Dr. Stephanie Faubion, medical director for The Menopause Society has said, “Considering that more than 40% of women over the age of 40 are classified as obese according to the CDC, these results could be meaningful to a large percentage of patients transitioning through menopause,” as quoted in the press release.
The results indicated a lower efficacy of HT in women with obesity than the ones without obesity.
In her reaction to the study, Dr Suruchi Desai, Senior consultant, Obstetrics and Gynaecology, Nanawati Max Super Specialty Hospital, Mumbai explains, that not all menopausal women who are obese will have severe menopausal symptoms.
All about menopausal hormone therapy
Dr Sushma Tomar, Obstetrician-Gynecologist, Fortis Hospital, Kalyan, Mumbai recommends MHT in the following forms:
- MHT or combined estrogen and progestin hormones is administered to perimenopausal and menopausal women in low to high doses.
- For those menopausal or perimenopausal women with hysterectomy, estrogen is the only hormone recommended in low to high doses.
Both the forms of MHT are advised depending on the symptoms of every woman and the therapy is suggested for not more than 3 months to one year.
How does obesity affect the MHT efficacy
Dr Desai adds, “the low efficacy of MHT on obese menopausal women can be a blanket statement and may require further investigation across the universe.” She further rationalizes, “Going by the body mass index 30 and above, the female population in different countries such as India will mostly be in obese category.”
Dr Desai explains, “the drugs in MHT are generally administered based on a woman’s weight. That does not mean that obese women are never recommended MHT, unless there is an impending cancer or undiagnosed vaginal bleeding. Multiple factors need to be considered when administering hormone therapy.
Obesity and MHT: Tests that women must do
Dr Desai suggests the following tests are mandatory before administering MHT for obese women:
- Liver test
- Ultrasonography of the pelvis
After these tests, if the obese menopausal woman qualifies for MHT, it should be the lowest dose and shortest duration (3 months), explains Dr Desai.
MHT and obesity can cause an imbalance
“The excess body fat in obesity gets converted into estrogen in the adipose tissue. The circulating estrogen in the obese body does not need MHT further,” says Dr Desai. Instead, it could lead to an excess of estrogen in the body increasing the risk of endometrial hyperplacia, or excess thickening of the uterine lining,” she warns.
Dr Tomar cautions that MHT must always be the last resort for any woman. In obese women, the first line of treatment must be duet, exercise and weight loss. Next, if MHT is administered, it must include progestin hormones to prevent the endometrial thickening.
According to a new study, there is a positive association between obesity in women and worsening of menopausal symptoms. Besides, the researchers also have found out that the menopausal hormonal therapy (MHT) has been proven to be of less efficacy in women with obesity. Doctors add that obesity can affect the efficacy of MHT, but this does not prevent obese women from taking MHT. Also, MHT can be helpful when administered along with lifestyle changes, food modifications and drugs.