If you’re overweight and perimenopausal or postmenopausal, you might worry that your body weight will make your menopausal symptoms worse.

The good news first: According to a new study, there’s no link between body weight and many common menopausal symptoms including mood issues, exhaustion, sleeping problems, vaginal dryness or sexual problems.

Now the bad news: The most common complaint, hot flashes, is linked to body weight.

Background: Menopause researchers used to believe that extra body fat might actually protect women from hot flashes. After all, body fat itself produces a small amount of estrogen, and it’s the lack of estrogen that is a key trigger for hot flashes—and other menopausal symptoms. But recently, evidence has been emerging that suggests that the opposite may be true.

Study: Researchers from Brazil included 749 women between the ages of 45 and 60—the average age was 52—in a questionnaire-based study. About two-thirds (68%) were postmenopausal, with the rest either premenopausal (16%) or perimenopausal (16%). Participants were asked very detailed questions about their health, including menopausal symptoms, and about their education, marital status, lifestyle habits and more. Symptoms of menopause were assessed using an 11-point “Menopause Rating Scale” that included hot flashes, sleep problems, joint problems, irritability, anxiety, vaginal dryness and others.

Results: Just three out of the 11 symptoms were found to be related to body mass index (BMI), a measure of body fatness. But one of these was hot flashes (and their nighttime equivalent, night sweats).

Compared to normal-weight or slightly overweight women, women who were obese (BMI of 30 or above) reported that hot flashes were much more likely to interfere with daily activities, impair their efficiency at work, interrupt sexual activity and decrease their ability to engage in leisure time activities. (Regarding sex, it’s worth noting that obese women were no more likely to complain of vaginal dryness or sexual problems than other women—it’s just that hot flashes were more likely to be severe enough to interrupt sexual activity.)

The two other common menopausal symptoms that were also more likely to bother overweight and obese women were joint/muscle pain and urinary problems such as urge incontinence. But obesity can contribute to both conditions, so that result wasn’t unexpected.

Surprising finding: Women who were overweight or obese were less likely than women of normal BMI to have sleep disturbances. (Unfortunately, the study didn’t shed light on why this may be true.)

Bottom line: This study supports the “thermoregulatory model,” which holds that higher BMI makes hot flashes worse because body fat tissue acts as a strong heat insulator. Insulation makes it more difficult for heat to dissipate, causing obese women to suffer more severe hot flashes and night sweats.

Can weight loss help? This study was an observational snapshot, so it can’t answer that question. But other research suggests that the answer is “yes.” In one American study of more than 17,000 postmenopausal women, those who were overweight (average weight, 175 pounds) and lost 10% or more of their body weight had a substantial reduction in menopausal symptoms such as hot flashes.

One clue to how weight loss helps: Belly fat is particularly associated with hot flash severity—and when you lose even a modest amount of weight, some of that will be belly fat.

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