The Importance of Weight & Metabolic Balance in Female Reproductive Health

By Leigh Lewis NMD, L.Ac., FABORM, RYT

The role of weight in all aspects of female reproduction has been validated by science for several decades with both underweight and overweight body habitus causing problems.  Being underweight has been linked with a relative hormone deficiency what can lead to thin uterine lining and irregular ovulation and menses, therefore interfering with fertility.  Adipose tissue, most notably abdominal fat, has been linked to excess production of estrogen which can also lead to issues with ovulatory and cycle irregularity and decreased fertility.  Once pregnant, body weight should increase for most patients by 25-35 pounds, however, women who are underweight at the time of conception may need to gain more, with overweight women needing to gain less or sometimes, simply maintain their pre-pregnancy weight.  Pregnant women who are underweight are at a higher risk for having a miscarriage, an underweight baby or a preterm birth.  Being overweight confers an increased risk for miscarriage, gestational diabetes and hypertension, preeclampsia, C-section, and an overweight baby. There are also increased risks to the baby born to an overweight mother: diabetes and metabolic syndrome (high cholesterol, blood sugar imbalances, hypertension, overweight) in child- and adulthood. In a recent study, the CDC concluded that 50% of American women gain too much weight in pregnancy.  Oftentimes, excessive weight gain during pregnancy is difficult to lose in the post-partum and can be further compounded by subsequent pregnancies. Finally, many women gain weight during the months or years of hormonal fertility treatments…this weight can be the most difficult to lose.

In general, recommendations are for women to maintain a “normal body weight” as indicated by a body mass index between 18.5-25, although individual variability may dictate otherwise.  This would be a weight between 120-140 for a woman who is 5’6”. However, there are individual issues that might change this recommendation; for example, a female body builder will have a higher muscle to fat ration and since muscle weighs more than fat, she would likely have a higher healthy body weight. Your provider can help determine your ideal weight range.

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Diet and exercise are often the first recommendations made to women and while this is typically good advice, many women are frustrated because usually they have tried it all before.  An important and often neglected first step is to make sure there aren’t any underlying metabolic issues that might predispose one to having weight issues.  Lab analysis of Vitamin D, thyroid function, cholesterol, glucose and insulin can provide insight to underlying factors that could make weight loss or gain more difficult.  Radical diets may help one achieve initial goals, but are difficult to maintain for the long-term and may lead to nutritional deficiency.  In fact, most current research suggests that a sensible, whole-food, Mediterranean-style diet is the best for promoting and maintaining both a healthy weight as well as general health, including fertility and pregnancy.  Some individual variations may be necessary; women with PCOS for instance often fair better with a higher protein/lower carb diet.

In general, one does not have to even achieve a “normal” body weight to see improvement in ovulation, menses and fertility, including improving the success of in vitro fertilization treatments: improvement can be seen with as little as 5-10% weight change.  This is good news, but can seem daunting to many nonetheless, and getting assistance from a team of professionals at least initially may be the best course.  As many of us know, what to eat is only part of the issue for most…we all know less sugar and alcohol and more fruits and vegetables would be beneficial, portion size matters, exercise is important. You likely have heard it all before and could probably tell your best friend or daughter or mom the keys success. The issue isn’t so much how to eat better and exercise more, it is why can’t we implement what we already know we should be doing.  There are several studies that illustrate the positive impact individual or group therapy can have in changing lifestyle behaviors is a way that can have long-lasting health impacts.  In addition, while it may seem like a luxury to have a personal trainer, a series of 4 weekly sessions or joining small group trainings geared for women can set you up to have success with your workouts instead of just grinding out miles on the treadmill.  Some trainers can also help set up individual meal plans.  Finally, stress, both physical and mental can play havoc with the hormones that affect both weight and fertility, adding a mind/body practice to any regimen is a great place to start, whether it be as part of a group or as a home practice.

The bottom line is if you are concerned that your weight may be negatively impacting your reproductive health and fertility or you simply are trying to re-establish your pre-pregnancy weight for general health reasons, consider making an appointment to discuss your individual goals with one of the practitioners here at ilumina and please see resources below for other specialists offering programs to help you meet your goals.


Farrah Hauke, PsyD – offering individual therapy and a 4-week workshop series on psychological strategies to lose weight & keep it off. 480.659.5107; www.arizonapsych.com

Lindsey Cusey & McKenzie Smalley - Personal Trainers/Nutrition Consultants *offers a discount to ilumina patients; www.fithappygirl.com

Donation-based Yoga + Mindfulness classes for women @ Kinfolk Chiropractic, Tuesdays 6:30pm, to RSVP email leighklewis1@gmail.com