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.