Obesity and menopausal transition

Abstract

Obesity is a chronic multifactorial disease influenced by biological, psychological, and
environmental determinants, with a higher prevalence in women. It is associated with
chronic inflammation, metabolic disturbances, and an increased risk of cardiovascular
diseases and cancer. In postmenopause, the hormonal changes characteristic of this
stage affect body composition and energy metabolism, promoting an increase in
visceral adiposity. Oestrogen decline favours fat redistribution towards the abdomen,
which increases insulin resistance and the prevalence of metabolic syndrome. This
process is accompanied by a reduction in resting energy expenditure and lean mass,
without significant variations in body mass index (BMI). It is important to emphasise
that body fat distribution is a more accurate predictor of cardiometabolic risk
than BMI. Additionally, obesity influences the menopausal transition, exacerbating
symptoms such as hot flushes, sleep disorders, and sexual dysfunction, as well as
increasing the risk of urinary incontinence, sleep apnoea, and cognitive impairment,
partly due to systemic inflammation induced by adipokines. Moreover, obesity
also increases the risk of cancer, particularly endometrial and breast cancer, as it
is associated with greater exposure to endogenous oestrogens. Given the increase
in life expectancy, a growing number of women will spend a significant portion
of their lives in postmenopause, a stage in which obesity is highly prevalent. This
underscores the need to address obesity as a priority public health issue due to its
impact on quality of life and the risk of chronic diseases.