Obesity is now a global pandemic. According to the Lancet, the prevalence of obesity has tripled in the last five decades, with a persistent rise in the numbers all over the globe including Middle and low-income countries. As per the Statistics, 13-15% of adults are obese worldwide and among them 40% are women.
Body mass index (BMI) is a person’s weight in kilograms (or pounds) divided by the square of height in meters (or feet). According to CDC BMI between 18.5 to < 23 is in the healthy range and between 23 to < 30 is overweight and > or = 30 is obese. Where do you stand?
Menopause and perimenopause
The absence of periods for more than a year is menopause. It usually happens between 45 to 55 years of age. This can happen naturally due to the ovaries stopping functioning; or can happen due to surgery to remove ovaries or uterus or an chemotherapy. Perimenopause is when the symptoms of menopause have started but the periods have not stopped. These Symptoms can last for months or years. Perimenopause is like a roller coaster ride with no lines and safety harnesses.
Common symptoms
Menopausal symptoms are mainly due to estrogen hormone deficiency. They include anxiety, mood swings, hot flushes, vaginal dryness and urinary symptoms. These symptoms can have a huge impact on quality of life, physical, mental and social health.
Symptoms of menopause
Menopause is a crucial period with a tendency towards weight gain, possibly due to fall in the estrogen hormone that plays a vital role in fat storage and distribution. Estrogen deficiency the well known reason for all menopausal symptoms can furthermore cause long-term effects on other systems like adverse cardiovascular changes, mood disorders and osteoporosis (bone weakening); all of these could theoretically be worsened in association with obesity.
In favour of this, recent evidence shows a positive correlation between the severity of menopausal symptoms and BMI as well as waist circumference especially in the urban population owing to the urban lifestyle and increased stress levels.
Over and above obesity is one of the contraindications for oral hormonal replacement therapy which is treatment op on for all kinds of menopausal symptoms, thus restricting the treatment options to lifestyle changes and non-hormonal remedies.
Ways for women with obesity/overweight to ease symptoms of menopause
While weight loss will reduce the severity of few symptoms like urinary problems, osteoporosis; few important lifestyle changes will help women in the perimenopausal period to ease the symptoms.
Plenty of rest, keeping a regular sleep routine, eating a healthy diet, calcium-rich foods like milk or yogurt or taking supplements; vitamin D supplements; relaxation techniques like yoga, meditation; exercising regularly including weight-bearing activities, etc will ease the symptoms and increase the quality of life.
Women with mood swings, low mood, anxiety will benefit from a type of talking therapy called cognitive behavioural therapy. Bothersome hot flushes can be tackled by keeping the living space cool, wearing light clothes, cool shower, cold fluids, reducing stress levels and avoiding hot drinks, caffeine, smoking, alcohol and spicy foods.
Vaginal dryness that can lead to painful intercourse, recurrent urinary tract and vaginal infections can be dealt with the use of topical vaginal lubricants and moisturisers.
If none of these lifestyle changes help, then the further options will be non-hormonal remedies or hormone replacement therapy which should be started with careful consideration weighing benefits and risks in consultation with the gynecologist. Estrogen matters; the more you know, the less you fear.
(The author, Sri Harika Bonam, is a consultant obstetrician, gynaecologist and lap surgeon, at Apollo Cradle and Children’s Hospital in Jubilee Hills.)
