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Date of release: 12 November, 2008

Metabolic syndrome in the menopausal transition


Metabolic syndrome (MetS) is a constellation of metabolic risk factors for cardiovascular disease in one individual. The more risk categories identified, the higher the potential risk. The diagnosis of MetS is based on the presence of three or more risk categories found in the same person [1]. Assessment and management of MetS become an important cornerstone in primary prevention of cardiovascular disease.


Two recent publications from SWAN (Study of Women’s Health Across the Nation) investigated the prevalence of MetS in the menopausal transition. In the first study [2], 949 healthy, non-users of hormone replacement therapy (HRT) were recruited when they were premenopausal or early perimenopausal and were followed throughout their menopausal transition. By the final menstrual period, 13.7% of the women had new-onset MetS. The main components of the MetS which showed an adverse change during follow-up were: systolic blood pressure, triglycerides and waist circumference. An increase in bioavailable testosterone or a decrease in sex hormone binding globulin levels increased the odds of developing MetS. The second study [3] looked into possible correlations between MetS and the serum levels of various sex hormones. The cohort included 1862 women, aged 42–52 years, who were followed for 5 years. There were 257 new cases of MetS diagnosed during the menopausal transition. Estradiol (E2) and total testosterone (T) levels declined by 12% and 3% per year, respectively, leading to a 10% per year increase in the T/E2 ratio and creating a state of relative androgen excess. Incident MetS correlated with a higher baseline T/E2 molar ratio and its rate of change over time during follow-up. As testosterone progressively dominates the hormonal milieu during the menopausal transition, the prevalence of MetS increases, independent of aging and other important covariates.

Comment

The association of estrogen deficiency in the menopause with alterations in various metabolic parameters, on the one hand, and that of estrogen replacement, on the other hand, has been thoroughly investigated throughout the past decades. However, the role of the androgenic hormones in this context has received less attention, perhaps because androgen therapy in postmenopausal women was often regarded as being inappropriate or even dangerous. Recent studies put postmenopausal androgen therapy back into clinical focus [4]. Androgens have beneficial effects, but may be associated with adverse reactions. My recommendation would be that, prior to prescribing androgens in postmenopausal women, an individual risk–benefit assessment should be implemented.

Comentario

Amos Pines
Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel

    References

  1. Cabré JJ, Martin F, Costa B, et al. Metabolic syndrome as a cardiovascular disease risk factor: patients evaluated in primary care. BMC Public Health 2008;8:251. Published July 22, 2008.

    http://www.ncbi.nlm.nih.gov/pubmed/18647383

  2. Janssen I, Powell LH, Crawford S, et al. Menopause and the metabolic syndrome: the Study of Womens Health Across the Nation. Arch Intern Med 2008;168:156875. Published July 28, 2008.
    http://www.ncbi.nlm.nih.gov/pubmed/18663170

  3. Torréns JI, Sutton-Tyrrell K, Zhao X, et al. Relative androgen excess during the menopausal transition predicts incident metabolic syndrome in midlife women: Study of Womens Health Across the Nation. Menopause 2008;October 27 [Epub ahead of print].
    http://www.ncbi.nlm.nih.gov/pubmed/18971793

  4. Davis S, Moreau M, Kroll R, et al. Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med 2008;359:200517. Published November 6, 2008.
    http://www.ncbi.nlm.nih.gov/pubmed/18987368