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.
The Real Peri Meno is devoted to all things perimenopause - the science, treatments, care, understanding, personal experiences, relationships, culture and more. The brain child of Keisha D. Edwards, The Real Peri Meno developed out of her own shock-and-awe experience with perimenopause and navigating the disjointed U.S. medical system in search of answers, support and relief.
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