I am 48 years old and suddenly gaining weight around my midsection. My doctor mentioned “metabolic syndrome” and its health risks. What is that?
Your Menopause Clinical Quandary: I am 48 years old and suddenly gaining weight around my midsection. My doctor mentioned “metabolic syndrome” and its health risks. What is that?
Our Response: The metabolic syndrome represents a cluster of adverse biologic events characterized by alterations in lipids, elevated blood sugar, and increased cardiovascular risk. The greatest health risk of metabolic syndrome is cardiovascular disease. But, this risk also is age related. Sixty percent of postmenopausal women are affected by metabolic syndrome, whereas only 22% of the general population meet these criteria. These differences in prevalence underscore the dramatic physiologic changes that occur as a woman enters menopause.
The menopause transition now is formally defined as the three‐to‐five‐year period leading up to this new stage of life. This transition often is characterized by increased fat deposition, especially in the intraabdominal area (visceral fat) with little change in muscle mass. Visceral fat cells, with direct access to portal blood entering the liver, are a significant source of many of the inflammatory proteins felt to be responsible for cardiovascular heart disease. The appearance of these inflammatory proteins results from the natural decline of ovarian estradiol, a hormone that in the reproductive years provides antiinflammatory protection.
Visceral fat also has a direct effect to increase appetite and reduce energy expenditure. Transdermal estradiol supplementation in these women reverses these changes. Moreover, in clinical studies, energy expenditure in obese women with metabolic syndrome is reduced but improves once transdermal estradiol supplementation is instituted.
Obesity, especially in the menopause transition, appears to be the primary clinical target for lowering the risk from the metabolic syndrome. Reducing one’s dietary carbohydrates followed by daily exercise is central to this effort. Moreover, hormone supplementation with transdermal estradiol capitalizes on the benefits of estradiol to increase insulin sensitivity, reduce abdominal fat, and rebalance intestinal satiety peptides.
James Woods | 10/28/2020
