Obesity in women has special moments of risk and age-related characteristics. A very important medical and social problem. What role for estrogen in menopause?.
Obesity is a major medical and social problem of our time and, in some countries like the United States, is a
real medical emergency. In Europe, about 35% of the population has a form of overweight or obesity, and we know how these conditions constitute an important risk factor for many diseases such as diabetes, hypertension, cardiovascular disease and cancer. So, these individuals have an increased risk of mortality and a lower life expectancy.
Looking at the social life aspects, are impotant psychological implications. In a world where the prevailing image in advertising and in shows is that of the rangy young subject , obese feels different, not accepted and marginalized.
Age and Weight
Unfortunately, we could say that “age weighs”. During pregnancy, fetal weight greatly increases, and physiologically increases during the infantile period with a maximum acceleration during puberty. There is therefore a definite relation between age and body weight, with an increasing trend during life span. Reasons are obviously different and regard phenomena such as bone growth and increased muscle mass during young age and later regard of adipose tissue growth.
A special relationship.
In women, the incidence of obesity is greater than in men, with differences between countries.
The higher incidence in females could be explained by the presence of endocrine-metabolic risk moments as pregnancy and menopause. However, this particular relationship with women is also determined by the greater danger of fat in women than in men. It is well known that obese women have menstrual irregularities and infertility (ovulation disorder) more frequently, get sick more often of cancer (particularly breast and uterus) and have a higher incidence of cardiovascular disease.
Menopause: a time of risk.
During the menopausal period there was a significant increase in overweight and obesity cases. The reason for this phenomenon that, unfortunately, many women experience, is not clear. Several researchers talk about insulinaemic modifications, thyroid function or Growt Hormone (GH) secretion . Others have also emphasized the behavioral changes. Obesity during menopause onset has other special features that make it even more insidious for the overall health of women. In fact, fat, due to the lack of estrogen, takes on a new distribution with a prevalence on the abdomen, therefore a distribution that reflects the typical male called “androgenic”, in contrast to “estrogenic”(typical of the reproductive period) which it sees as preferential places hips and thighs. This new type of distribution as well as being particularly anti-aesthetic is linked to a higher incidence of metabolic complications (dyslipidemia, diabetes) and cardiovascular diseases (heart attack).
We have long paid particular attention to this problem. The Menopause Center has in fact an important role in driving the woman overall well-being and this being comes with a proper weight control. We think it is of strategic importance for our patients also face the problem of obesity both from the prevention, epidemiological and therapeutic point of view.
In particular, we wondered if estrogen replacement therapy (HRT), started early, could contribute positively in reducing the incidence of obesity in our patients. In a paper presented at the 7th National Congress of the Italian Menopause Society, we described the results of an observational study on 148 women, all residents in the Macerata province (IT). Our data, confirming preliminary evidence of other authors showed how estrogen therapy could significantly reduce the incidence of overweight and obesity compared to women who by their own choice had decided to abstain from treatment.
Some important points and a look to the future
The preventive effect has been demonstrated in women with BMI of less than 28, in absence of risk factors. There is too little evidence of a beneficial effect in women with a BMI greater than or equal to 28. Other centers have demonstrated a favorable effect in weight maintenance following low-calories diet. We therefore wondered if it is proposable in subjects at risk a pharmacology prevention of onset menopause obesity, and then if can be considered this specific indication in estrogen treatment decision making. In our opinion, at this state of knowledge, it can not be prescribed a replacement therapy to prevent obesity. The choice of estrogen treatment must be part of a much more general evaluation of women well-being and risk factors. Certainly, the evidence shows that we are sure taken into account of it in risk-benefit assessment.
Obesity prevention can not do without proper nutrition and adequate physical activity, and these moments are of fundamental importance in the course of any medical treatment. Obesity is a complex, multidisciplinary issue and gynecologist can play a very important role through information, prevention and estrogen replacement therapy.