Does the menopause trigger an increase in abdominal obesity in women?
- Evidence supports an increase in abdominal adiposity with the menopausal transition in women. Cross-sectional comparisons of women across menopausal stages show greater waist size across stages.
- Prospective cohort studies indicate an increase in total fat mass and a disproportionate increase in abdominal fat that are related to both chronologic and ovarian age, with the most rapid increases in abdominal fat occurring in perimenopausal women.
- Women who had an oophorectomy before age 40 years had greater waist size compared with women who did not have an oophorectomy. Studies treating premenopausal women with gonadotropin-releasing hormone agonists to suppress sex hormones show fat mass gains of 1 to 2 kg in 4 to 6 months, with a disproportionate increase in central body regions.
- Finally, several randomized controlled trials (RCTs) have shown that postmenopausal women treated with estrogens with or without progestins gain less weight and have less increase in waist size compared with placebo-treated women. The effects seem to be slightly larger with unopposed estrogens.
- Recent studies in animals suggest a possible role for an increase in FSH as a mechanism for the increase in adiposity. Animals treated with an FSH antibody had a marked reduction in adiposity that was more pronounced in the abdominal visceral region.
- It has not yet been determined whether estrogens and/or blocking the increase in FSH specifically prevent or attenuate intraabdominal fat accumulation.
