Menopausal Women With Obesity Endure Worse Symptoms, Less HT Relief

Kristen Monaco,
Kristen Monaco,
6 Min Read

PHILADELPHIA — Women with obesity may experience worse menopausal symptoms and see less relief from hormone therapy (HT), according to a pilot study.

When compared with women without obesity, those with a BMI of 30 or greater were significantly more likely to report menopause-related vasomotor symptoms like hot flashes and night sweats (74% vs 45%, P=0.002), reported Anita Pershad, MD, of Eastern Virginia Medical School in Norfolk, Virginia.

Women with obesity were also more likely to report other bothersome symptoms of menopause, such as genitourinary and vulvovaginal symptoms (60% vs 21%, P<0.001), mood disturbances like anxiety and depression (11% vs 0%, P=0.018), and decreased libido (29% vs 11%, P=0.017).

And women with obesity were less likely to feel symptom relief after using menopausal HT compared with women without obesity (OR 0.07, 95% CI 0.01-0.64, P=0.006), Pershad explained at The Menopause Society annual meeting.

“Given that more than 40% of women over the age of 40 are classified as obese according to the CDC, these results could be meaningful to a large percentage of female patients transitioning through menopause,” Pershad told MedPage Today. “Especially to diverse patient populations who are burdened by the social determinants of health, and are not often represented in women’s health studies.”

This was true regardless of HT type, too. As for those on systemic HT, seven out of eight women without obesity said they felt symptoms relief whereas only one in 12 of women with obesity did. Similarly, eight in nine women without obesity treated with localized HT felt relief, while only 11 in 24 with obesity felt the same.

Pershad added that there were no statistically significant differences between the two groups of patients relative to age, duration of menopause, or use or acceptance of HT. “Women with obesity, however, were more likely to self-identify as Black [71% vs 38%], report the presence of hot flashes, genitourinary/vulvovaginal symptoms, mood disturbances and decreased libido,” she noted.

Despite these findings, it’s still unclear if HT is necessarily less effective in women with obesity overall, said Pershad, or if the expected efficacy can be achieved with alternative design and administration routes.

“Our research group is actively looking into this area for further elucidation of this topic,” she noted. “A potential mechanism of action for the observed decreased effect could be due to adipose tissue acting as a heat insulator, promoting the effects of vasomotor symptoms.”

Stephanie Faubion, MD, MBA, director of the Mayo Clinic’s Center for Women’s health in Jacksonville, Florida, and Rochester, Minnesota, suggested this could be due to clinicians undertreating these patients with obesity.

Faubion, who wasn’t involved with the study, told MedPage Today that it’s her theory that these women were not being put on adequate doses potentially because of their obesity and other cardiovascular risk factors. “Maybe the practitioners were concerned about the dose and maybe they got underdosed…because people are afraid of hormone therapy,” said Faubion, who is medical director of The Menopause Society

The discrepancy in relief felt by women wasn’t seen with non-HTs, which included selective serotonin reuptake inhibitors/serotonin0norepinephrine reuptake inhibitors, trazodone, or clonidine, or lifestyle management:

  • Non-hormonal medications: 10 in 13 without obesity saw relief vs 15 in 20 with obesity
  • Lifestyle: 10 in 17 without obesity saw relief vs 5 in 16 with obesity

The study used self-reported data from patients who presented with a primary complaint of menopausal symptoms between 2018 and 2022. This included 47 women without obesity and 72 women with obesity. The average age was about 56 and most were postmenopausal.

The most commonly used type of localized HTs were topical estradiol 10 mcg (26% of those with obesity vs 19% of those without), followed by the transdermal estradiol patch 0.0375 g (4.2% vs 0%), and topical conjugated estrogens 0.625 mg/g (2.8% vs 0%). The most common systemic HTs used were conjugated estrogens with progesterone 0.625 mg to 100 mg (4.2% vs 13%) and conjugated estrogens-medroxyprogesterone 0.625 mg to 5 mg (13% vs 4.3%).

“More research is needed to examine how women with medical comorbidities are uniquely impacted by menopause and respond to therapies,” Pershad added. “This can be achieved by actively including more diverse patient populations in women’s health studies, [who are] burdened by the social determinants of health and medical comorbidities such as obesity. This will help better tailor care and counseling to improve menopausal care for all patients, across all demographics.”

Disclosures

Pershad disclosed no relationships with industry. Co-authors disclosed relationships with TherapeuticsMD, Astellas Pharma, Scynexis, Pharmavite, and Pfizer.

Primary Source

The Menopause Society

Source Reference: Pershad A, et al “Self-reported efficacy of hormone therapy and symptom burden in menopausal patients with obesity” Menopause Society 2023; S-13.

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