Menopause, Hormone Replacement Therapy (HRT) and Obesity

Menopause is associated with a rapid increase in fat mass and a redistribution of body fat from the periphery to the abdomen, resulting in a transition from a gynoid to an android pattern of fat distribution. In postmenopausal women, increase in body mass index (BMI) and proportion of visceral fat are strongly correlated with the development of hypertension, dyslipidemia, insulin resistance and with a number of metabolic risk factors for cardiovascular disease (CVD). Central adiposity and visceral adiposity could influence the distribution of cardiovascular fat, defined as the fat surrounding the heart and arteries, and are correlates with CVD risk. Adipose tissue could be an ‘insulator’ and interfere with normal thermoregulatory mechanisms of heat dissipation. Women with higher abdominal adiposity, particularly subcutaneous adiposity, report an increase of vasomotor symptoms (VMS) during the menopausal transition and in early post menopause. Healthy weight in midlife women early in the menopausal transition may help to prevent VMS. Overweight women may suffer from psychosocial consequences, with a significant impact on self-esteem and general well-being: obese postmenopausal women have lower health-related quality of life, in physical functioning, energy, and vitality compared with normal-weight women. Obesity is also a major risk factor for pelvic floor dysfunction, some cancers (endometrial, breast and colon) and musculoskeletal disorders, especially osteoarthritis (a highly disabling degenerative disease of the joints). It could be necessary to encourage lifestyle measures in addition to therapeutic interventions throughout the menopausal transition in order to controlling menopausal obesity and to manage menopause- related symptoms, with minor side effects.