So, what kinds of hormones do adipose cells produce? While some play expected roles in things like appetite, obesity and insulin resistance, other hormones are responsible for steroid metabolism. In simple terms, even though we think of the ovaries and adrenal glands as responsible for sex hormone balance, at least 50% of testosterone in premenopausal women and 100% of estrogen in postmenopausal women is regulated by adipose. Also, depending on each woman’s amount of adipose, a significant portion of estrogen can come from these cells even in premenopausal women.
Why does that matter? That means extra adipose tissue can cause hormone related issues such as unwanted hair growth on the face/body, increased acne and in some cases, even hair loss from the head. For women struggling with heavy menstrual cycles, this can be directly related to the increased estrogen because estrogen causes increased thickness of the uterine lining shed each month during the menstrual cycles. More tissue in the uterus to get rid of means heavier flow and often more cramping each month. In more severe cases, too much estrogen from adipose can even cause the menstrual cycle to stop. While this may sound exciting to some women, a lack of normal menstrual cycle can cause everything from infertility issues (no menses=no ovulation=no egg for pregnancy) to increased risk of uterine cancer (gradual buildup of uterine lining over time without shedding can predispose to cancer).
So, too big is bad, but what about too skinny? We can sometimes see problems at the other end of the spectrum as well. Super-intense athletes who have extremely low body fat and women with a very low BMI may also have issues with the menstrual cycle. If the body shifts into starvation mode because there isn’t enough body fat, then one of the functions that may stop is the menstrual cycle and ovulation.
In general, a regular menstrual cycle with normal flow can be a marker of good overall health in premenopausal women. Granted, there are always exceptions to this rule. For instance, some women may not have a cycle due to hormonal contraception, which can be normal. Also, we know that for some women who are very athletic, such as competitive weightlifters, BMI may not be the perfect measure of health. That being said, generally a healthy BMI ranges from 18.5-24.9, and the average BMI for women in the US is 29.6, which means many women are just below the threshold for obesity. So, if you’ve been having menstrual cycle issues with either heavy or irregular flow, and your BMI is elevated, especially above 35, then one of the simplest interventions to help improve your cycle may be weight loss. These normal cycles can also provide health benefits of improved fertility and decreased uterine cancer risk. By regulating your hormones on your own, then you may be able to avoid having to take synthetic hormones and in turn, also having to deal with unwanted side effects from these medications. Besides, who wants to deal with daily pills anyway?