Abstract
The mid-life period is a critical window for increases in body weight and changes in body composition. In this review, we summarize the clinical experience of the menopausal transition by obesity status, and examine the evidence regarding the menopausal transition and reproductive hormones effects on body weight, body composition, or fat distribution. Mid-life obesity is associated with a different menopausal experience including associations with menstrual cycle length prior to the final menstrual period (FMP), age at the FMP, and higher prevalence of vasomotor symptoms. The menopausal transition is associated with weight gain and increased central body fat distribution; the majority of evidence suggests that changes in weight are due to chronological aging whereas changes in body composition and fat distribution are primarily due to ovarian aging. Continuous and regular physical activity during mid-life may be an efficacious strategy to counteract the age-related and menopause-related changes in resting energy expenditure and to prevent weight gain and abdominal adiposity deposition.
Highlights
Obesity is one of the most pressing threats to public health given its increasing prevalence globally [1] and its significance as a major risk factor for a variety of chronic conditions including diabetes and cardiovascular disease [2,3]
Little data exists as to whether dietary modification can affect fat distribution during the menopausal transition, evidence suggests that exercise interventions as compared to dietary interventions may be superior for the promotion of a healthy body composition profile including preservation of lean mass and greater decreases in body fat [169]
Due to the high prevalence of obesity in midlife, most women are overweight as they transition through the menopause
Summary
Obesity is one of the most pressing threats to public health given its increasing prevalence globally [1] and its significance as a major risk factor for a variety of chronic conditions including diabetes and cardiovascular disease [2,3]. 13% of adults age 18 years and older were obese (body mass index (BMI) ě 30 kg/m2 )) in 2014 [1] and the prevalence of adult obesity in the United States exceeds 34% [4] Both globally and nationally, women experience higher rates of obesity than men [1,5]. We review the most recent nomenclature for the characterization of the menopausal transition followed by standard definitions of obesity and measurement of body composition. We describe how the clinical experience of the menopausal transition (i.e., menstrual cycle length, age at the final menstrual period (FMP), and vasomotor symptoms) differs by obesity. The transition ends years after the FMP and is characterized by stabilization in reproductive hormone levels. The late reproductive stage is characterized by subtle changes in flow length as compared to previously regular cycles, the early menopausal transition is distinguished as persistent. No standard definitions exist as to what cut points define greater risk for chronic disease or mortality in women
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