WEIGHT TROUBLE IN WOMEN OVER 40

When women of normal body weight reach the age of forty, an alteration in the oestrogen-progestogen balance can promote or aggravate disturbances of eating behaviour which, frequently associated with a reduction in physical activity, may be responsible for weight gain, which is even more pronounced when the woman has a genetic predisposition towards obesity. In obese women, this alteration in the oestrogen-progestogen balance is exacerbated by increased aromatisation of androgens in the excess adipose tissues. Women presenting with weight problems occurring in the peri or post-menopausal periods therefore require investigation of the various factors involved as well as the metabolic and cardiovascular repercussions of the excess weight, which are directly correlated to the adipose tissue distribution. The therapeutic approach should therefore be guided by the results of an appropriate clinical and laboratory assessment and is designed to: - control the weight problem by classical methods: personalised dietetic prescription, physical activity, the possible use of drugs and psychotherapeutic support; - correct any hormonal imbalance, initially by means of a suitable progestogen devoid of any metabolic effects and, secondarily, combined with percutaneous oestrogen therapy. In every case. early prevention, i.e. before the age of 40 years, remains the best treatment for excess weight.