​Yes, you read the question right: I really want to know if weight and size play a role in how a woman may experience the transition to menopause. Does being bigger help shield a woman from the worst perimenopause symptoms? And does being lean help guarantee that a woman is going to have a tougher time?

Even though I am inquisitive by nature and can always think of questions to ask about almost anything, I honestly don’t think I would have arrived at this line of inquiry on my own. It wasn’t until I was at an appointment with the doctor who finally really helped me at a root-cause level that I became quite interested in this idea.

She asked me, “When did your mother reach menopause?”

“Around 57 or 58, I believe,” I said, trying to recall what my mother had told me before.

“And what size is your mother?” the doctor asked.

“Well, she is shorter than me. And, at the time, she was a larger woman,” I answered, remembering my mother being between a size 16-18 in the years before she overhauled her dietary habits in favor of plant-rich, low-fat way of eating.

“That indeed explains it!” said the doctor.

“It does?” I asked, shocked.

“Yes, you could consider gaining 30 pounds,” she responded with humor.

I was aghast, for real. Through all my months of horrible non-sleep and what I later realized were night sweats that had been going on for well over a year, it had taken me time to realize these were clear symptoms of perimenopause. But even through all my thinking, digesting and research, I had never considered the role weight or size might have played in my experience.

***

I work out regularly. My “regularly” is probably the average person’s “Are you kidding me?” I am active most days of the week. Forcing myself to have a rest day is really hard sometimes. I am the type of person who feels different and a bit incomplete if I have not powered through a good workout in the morning. It helps to set the tone for my day and is as much a part of my life as is having a cup of coffee or brushing my teeth.

For years, in addition to cardio, I also weight trained consistently. I grew in strength and confidence, and eventually lifted heavy (for a woman). I was doing deadlifts, weighted squats, snatch-and-cleans and much, much more, enjoying my time in the weight room at the gym and at home. I cut back on the rigorous weight lifting after the collateral damage from a long-ago car accident (I was rear-ended by multiple vehicles more than 20 years ago, like one among a cascade of dominoes.) resulted in me eventually ending up in the operating room, having an anterior cervical discectomy and fusion (ACDF) surgery at one vertebral level in my neck.

Though my strength is still here, I have tempered down the workouts. I no longer run or jog; it’s just too jarring. I speed walk, either outside or on the treadmill. I also do other cardio, via stair climber or recumbent bike, and I have fallen more into “resistance training” rather than “full-blast weightlifting.” Being in the OR and now with titanium in my neck, it didn’t take much to let me know I needed to dial things back to prevent future surgeries, or at least delay another one by many years, if at all.

Related to perimenopause, I never thought my active lifestyle could work against me in any way. But my doctor’s comments made wonder.

***
So imagine my surprise when the doctor told me that, perhaps, my foray into perimenopause may not have been so challenging had I been bigger. Even though I am not a small woman, the doctor told me I don’t have much body fat. I am 5’7”, and I won’t say what I weight right now because I don’t want to read this later and regret pronouncing it to the public, should I blow up (ha, ha). But I am typically a size M in letter sizes and a 10 numerically. I am pear-shaped and naturally have a slimmer waist and bigger hips.

Of course, I laughed too when the doctor told me I could gain 30 pounds. That was not in my plan, but I did wonder if I had been larger, say 15 pounds bigger, and less committed to working out, would that have made a difference?

Serendipitously, on one of the Facebook communities I belong to, a fellow member posed a similar question. She asked what size the women were and how they were faring with menopause or perimenopause. Hundreds of women responded, and a theme emerged: The lean, thin or athletically fit women almost unanimously voiced having a hard time with symptoms like insomnia, anxiety, sweating, migraine headaches and more, while the plus-sized ladies said they had no symptoms or maybe one or two that were tolerable and manageable.

***

As I attempted to explore this from a more scientific point of view, most of what I encountered was focused on women gaining undesirable weight at midlife. I guess this is a more common phenomenon or a more popular consideration – women complaining about their body shape changing or gaining weight faster than ever before. According to the North American Menopause Society (NAMS):

“Although menopause may not be directly associated with weight gain, it may be related to changes in body composition and fat distribution. Several studies have shown that perimenopause, independent of age, is associated with increased fat in the abdomen as well as decreased lean body mass. This suggests that menopause plays a role in many midlife women’s transition from a pear-shaped body (wide hips and thighs, with more weight below the waist) to an apple-shaped body (wide waist and belly, with more weight above the waist)."

This change in body composition can even negatively impact the health profile of women who remain the same weight. In the Journal of the American Medical Association (JAMA), they report that:

“The standard BMI cutoff of 25 for overweight and 30 for obesity might be too high for postmenopausal woman because their body composition changes over time. As they age, women tend to lose bone and muscle mass, which are heavier than fat. So even if a 65-year-old woman weighs the same as she did at 25 years of age, fat accounts for a larger share of her weight. And that fat isn’t distributed in her body the way it was at age 25 years.”

As I went down the rabbit hole trying to find any research connected to larger size leading to fewer menopause symptoms, I predictably came across many articles about how to lose weight in the 40s and beyond, often with a focus on intermittent fasting, keto dieting, clean eating and weight training. I also came across sources saying that obesity is connected to worse menopause symptoms, not fewer. Also, total body fat also increases the risk of breast cancer.

The University of Rochester offers this interesting take on the estrogen-fat connection:

“Paradoxically, in menopause, a woman’s estrogen levels are inversely related to her weight. In a study of newly menopausal healthy women over a four-year period, women showed an increase in weight and body fat (primarily as visceral adipose tissue), which coincided with a drop in estradiol [the main type of estrogen in women] levels and a decrease in physical activity and energy expenditure . . . Studies have shown that estrogen incorporates crucial elements into the DNA responsible for weight control."

***

So, it’s hard to find a clear answer.

While my doctor seemed convinced that having more body fat leads to a less symptomatic perimenopause, and while legions of women in social media seem to agree based on their personal anecdotal experience, it’s hard to find corresponding research.

Most of what I found related to body fat and perimenopause or menopause was highly cautionary: metabolic syndromes, increased body fat leading to decreased muscle mass, higher breast cancer incidence, poorer cardiovascular health and other terrifying impacts.

I guess I will continue doing what I’ve been doing for years – working out more often than not and eating a pretty clean diet, save for special occasions, as there appear to be more upsides to staying the course than going off the rails.

But if an extra 15 pounds would have staved off the type of insomnia or night sweats I experienced, I would have signed up years ago.
 
 
 
 
 
 
 

​Meet K.E. Garland of Jacksonville, Fla., a mother of two daughters (ages 19 and 22) and loving wife of 25 years. As if preserving a marriage for a quarter century and raising a family were not enough, K.E. is also a published author, educator and the creator of the menopause awareness site, NavigatingtheChange.

I recently had the privilege of contacting Ms. Garland, who altruistically agreed to answer some behind-the-scenes questions about her experience through “the change.” The 48-year-old Garland is still in perimenopause, not actual menopause, as she has not yet gone a full 12 months in a row without menstruating.

Now for the Q-and-A!

Many people think there’s a connection between when women started their periods and when they go through menopause, though there isn’t much science to back this claim. How old were you when you started your period? And how would you describe your menstrual cycles?

I started my period when I was TEN years old! It took me a while to figure out what was going on, even though my father explained it to me. My periods were always predictable; if I didn’t have a period, it was because I was pregnant.

How would you characterize your pregnancies? Were they uneventful, difficult on in between?

My pregnancies were very normal. For both, I was almost fully dilated and didn’t know it until I went to the last appointment. For my second pregnancy, I had to have a C-section because, instead of feeling the baby’s head, the OB/GYN felt her feet (breech position).

What do you recall experiencing as your earliest perimenopause symptoms, and when?

I think I was around 44 or 45. The biggest issue I had initially were periods every other week! It was the most distressing thing I’ve ever gone through. The first time it happened, I had on white pants and was headed to work, which is 60 miles from my home. I just happened to have to use the bathroom, and that’s when I found out I was having another period, even though I’d just had one two weeks’ prior. This is one of the sure signs of perimenopause – irregular periods.

What have been the most challenging symptoms, and how have you gone about trying to relieve them?

Later, I began having hot flashes, night sweats and insomnia. After doing a little research, I found that drinking alcohol, especially wine, and having sugar at night right before bed increases hot flashes and night sweats, and that can also cause insomnia. I stopped drinking wine or anything right before bed. Also, I’ve switched to a plant-based diet, which includes more vegetables and fruits, and less meat. Some of the meals I enjoy are veggie tacos or coconut curry-chickpea-type recipes.

Is anything off limits, as far as what you will do to get relief for symptoms?

So far, I haven’t had to do anything too crazy, but usually if a new symptom comes up, I try to first do something natural, like change my diet, and then seek other ways.

What have your encounters with the medical community been like, particularly in dealing with perimenopause?

Doctors have been NO HELP to me. My gynecologist told me I was “going through menopause,” and she could prescribe birth control to alleviate the symptoms. I didn’t even understand why she would suggest birth control. But now I do . . . it’s all hormonal. In fact, my experience with doctors is part of the reason I began the website, NavigatingtheChange. I was researching so much that I figured I’d include what I found in order to help other women who may be struggling.

Is your experience of (peri)menopause anything like that of your mother, as far as you know? Have you talked to other female elders or relatives about their experiences?

My mother died when I was 16, and I did talk to my grandmother, who will be 95 in October. She said, “I only had a little sweating!” So, yeah, no one in my family full of women had said a word to me about this very important time period, not one word.

What do you most wish you had known beforehand?

I really wish there would have been some type of ceremony or something. Wouldn’t it be cool if all of the elders would give you one thing that could help you? For example, I’d give my daughters turmeric or ginger tea because it helps settle your stomach and your nerves (bloating and anxiety are symptoms of menopause). It would be a coming-of-age box.

For some women, perimenopause is so hard that it’s difficult to envision the future. If you’re able to think 20 years into the future, what do you envision?
​
Twenty years from now, I hope to be done with all this menopause brouhaha! All of the crones say that phase is very liberating, so it sounds like a much more relaxing time. I hope that in 20 years, I’m walking around like one of those so-called crazy-looking women with wild hair, who could care less what others think about anything. I think I’m almost there! 

If you're reading this, chances are you're middle-aged and may not even realize it.

​Perimenopause frequently strikes women in their prime, at the midlife point, just as they are in their 30s or 40s and life is starting to settle and make more sense.

Gone are the late-night escapades at the bar or club. And we’re often past the point of aimless dating, financially indulgent shopping or being way too undisciplined with our nutrition and fitness.

By their late 30s or early 40s, many women are rather settled in their line of paid employment or staying busy in the home, with spouses, children, hobbies, many obligations and perhaps some volunteer or civic commitments in the community or neighborhood.

At the same time, however, there is a reluctance to imagine that by 35 or 40, someone has reached midlife. The 40-something or 50-something year-old woman today typically does not engender the same image of women the same age from half a century ago. They don’t look, act or present like our grandmothers, great-grandmothers or great aunts, if we’re fortunate enough to have seen them alive.

Today we seem younger, more youthful. We see women like Nicole Murphy, Angela Bassett, Cindy Crawford and Elizabeth Hurley and feel certain that the needle has moved in the other direction – away from aging and toward a sort of suspended state of beauty, potential and timelessness. Indeed, “What Age Is Considered Old Nowadays?” shows that as time marches on and people live longer, ideas about what constitutes being elderly or middle-aged continue to shift.

But the truth is that, from your mid-30s through your mid-50s, you are middle aged. In the United States, the average life expectancy is 77.3 years. Half of 77.3 is 38.65. But what your “midpoint” is, is in part influenced by your demographics. For Black Americans, the life expectancy is 71.8. For Hispanics, it’s 78.8. Note that life expectancy fell across most groups as of 2020, due in part to the pandemic.
​
If you reach the halfway point of your projected life expectancy, then that is the point at which one reaches the midlife category. This is true even for the Millennials, the generation covered so extensively by the media. The oldest members of the Millennial generation are now in their late 30s and early 40s, and Millennials themselves agree that middle age occurs between 35-50 years old.

Midlife Produces Health Changes, Including Perimenopause

This age range is also when common health problems start to pop up. The most frequent chronic illnesses in middle age are high blood pressure, high cholesterol, arthritis, heart disease and depression. This time of life is when people may notice their blood pressure creeping up, their knees sounding like a band warm-up and their ability to perform athletically declining. And, yes, this is also when women start to experience the warning signals of a menopause that may be 10-15 years away.

The 30s and 40s is when women may begin to have night sweats, hot flashes or strange menstrual changes (like a cycle that seems lighter than usual, longer than typical or heavier than normal). They may notice changes in their emotional state, feeling on edge for no reason or tearful for all the wrong reasons.

Even though these women may look youthful, in shape and “good for their age,” they are, in fact, possibly entering that critical perimenopausal stage. Perimenopause is certainly a midlife phenomenon, a flag signaling declining reproductive capacity and hormonal changes that affect entire body systems.

At the same time, there is a paradox in this situation: Women who are experiencing a range of perimenopausal symptoms right on time for their 30s or 40s may be told by their doctors that they are too young to be experiencing perimenopause. This leads to all sorts of problems, including delayed treatment, denial of coverage (by insurance) for certain treatments, a compromised quality of life and, at worst, misdiagnoses and treatments for conditions women don’t even have.

It’s Okay to Be Middle-Aged

The idea of being perimenopausal catches some women by surprise. Many just cannot believe it and will not admit to it. Even if they have every textbook symptom at 45 years old, some women simply refuse to attribute their condition to perimenopause or aging. Ridiculously, some find more peace in thinking they have a thyroid problem or an autoimmune disease than being in the symptomatic twilight years before official menopause.

It’s hard to blame them. In a society where many doctors are under-educated or miseducated about perimenopause and when it happens, and in a culture that prioritizes youth above all, it can be hard to wrap one’s mind around aging and the reality of mortality.

As more women, like actress Gabrielle Union, come clean about perimenopause and change notions of what middle age looks like, maybe things will change.

Actress Sharon Stone said, “It’s not like 50 is the new 30. It’s like 50 is the new chapter.”