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Review Article

Understanding weight gain at menopause

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Pages 419-429 | Received 12 Jun 2012, Accepted 25 Jun 2012, Published online: 15 Sep 2012
 

ABSTRACT

Objective The aim of this review was to summarize the literature regarding the impact of the menopause transition on body weight and body composition.

Methods We conducted a search of the literature using Medline (Ovid, 1946–present) and PubMed (1966–2012) for English-language studies that included the following search terms: ‘menopause’, ‘midlife’, ‘hormone therapy’ or ‘estrogen’ combined with ‘obesity’, ‘body weight’ or ‘body composition’.

Results Whereas weight gain per se cannot be attributed to the menopause transition, the change in the hormonal milieu at menopause is associated with an increase in total body fat and an increase in abdominal fat. Weight excess at midlife is not only associated with a heightened risk of cardiovascular and metabolic disease, but also impacts adversely on health-related quality of life and sexual function. Animal and human studies indicate that this tendency towards central abdominal fat accumulation is ameliorated by estrogen therapy. Studies mostly indicate a reduction in overall fat mass with estrogen and estrogen–progestin therapy, improved insulin sensitivity and a lower rate of development of type 2 diabetes.

Conclusion The hormonal changes across the perimenopause substantially contribute to increased abdominal obesity which leads to additional physical and psychological morbidity. There is strong evidence that estrogen therapy may partly prevent this menopause-related change in body composition and the associated metabolic sequelae. However, further studies are required to identify the women most likely to gain metabolic benefit from menopausal hormone therapy in order to develop evidence-based clinical recommendations.

Conflict of interest During the past 2 years, Professor S. R. Davis has had a financial relationship (member of advisory boards and/or consultant or investigator) with Bayer-Schering Pharma, Warner Chilcott, Biosante and Trimel Pharmaceuticals; Professor R. E. Nappi has had a financial relationship (lecturer, member of advisory boards and/or consultant) with Bayer-Schering Pharma, Eli Lilly, Merck Sharpe & Dohme, Novo Nordisk, Pfizer Inc; Professor P. Villaseca has had a financial relationship (member of advisory board) with GlaxoSmithKlein; Professor C. Castelo-Branco has had a financial relationship (lecturer and/or consultant or investigator) with Pierre Fabre Labs, Merck Spain, Amgen and Isdin; Dr D. Shah has had a financial relationship (member of advisory board) with Elder Pharmaceuticals, India. Professor M. A. Lumsden is currently an advisor to Abbott Pharmaceuticals.

Source of funding Nil.

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