Chair and Department of Endocrinology, Diabetology and Metabolic Diseases, Medical University of Lublin, Lublin, Poland.
Endokrynol Pol. 2023;74(6). doi: 10.5603/ep.96679. Epub 2023 Nov 23.
The health of post-menopausal women has become of paramount concern due to the aging of the world's population. Concurrently, the prevalence of obesity among postmenopausal women is expected to increase, presenting a significant public health challenge. Although weight gain during menopause is a well-observed phenomenon, its underlying causes and mechanisms remain incompletely understood. This manuscript reviews the literature to explore potential hormonal factors and pathomechanisms contributing to obesity during perimenopause, aiming to identify pathogenic factors that can guide treatment selection. Menopause-induced hormonal changes, including hypoestrogenaemia, hypergonadotropinaemia, relative hyperandrogenaemia, growth hormone deficiency, leptin resistance, and chronic stress affecting the hypothalamic-pituitary-adrenal axis, have been implicated in the onset of obesity in perimenopausal women. These hormonal fluctuations, alongside lowered daily energy expenditure, lead to metabolic alterations that elevate the risk of developing metabolic disorders and cardiovascular diseases. Weight gain in perimenopausal women is associated with higher total and abdominal adipose tissue and lower lean body mass. Addressing this issue requires individualized behavioural management, supported by effective pharmacological therapy, and, when warranted, complemented by bariatric surgery. Modern obesity treatment therapies have demonstrated safety and efficacy in clinical trials, offering the potential to reduce excess body fat, improve metabolic profiles, lower cardiovascular risk, and enhance the quality and longevity of women's lives. In addition to standard obesity therapies, the article examines different treatment strategies based on obesity's pathogenic factors, which may offer promising options for treating obesity with or without complications in perimenopausal women. One such potential approach is menopausal hormone therapy (MHT), which hypothetically targets visceral obesity by reducing visceral adipose tissue accumulation, preserving metabolically active lean body mass, and improving lipid profiles. However, despite these reported benefits, gynaecological and endocrinological societies currently do not recommend the use of MHT for obesity prevention or treatment, necessitating further research for validation. Emerging evidence suggests that visceral obesity could result from hypoestrogenaemia during perimenopause, potentially justifying the use of MHT as a causal treatment. This highlights the importance of advancing research efforts to unravel the intricate hormonal and metabolic changes that occur during perimenopause and their role in obesity development.
由于世界人口老龄化，绝经后妇女的健康已成为重中之重。同时，预计绝经后妇女肥胖的患病率将会增加，这是一个重大的公共卫生挑战。尽管绝经期间体重增加是一种观察到的现象，但其潜在的原因和机制仍不完全清楚。本文综述了文献，探讨了围绝经期肥胖的潜在激素因素和发病机制，旨在确定可以指导治疗选择的发病因素。绝经引起的激素变化，包括低雌激素血症、高促性腺激素血症、相对高雄激素血症、生长激素缺乏、瘦素抵抗和影响下丘脑-垂体-肾上腺轴的慢性应激，与围绝经期妇女肥胖的发生有关。这些激素波动，加上日常能量消耗降低，导致代谢改变，增加了发生代谢紊乱和心血管疾病的风险。围绝经期妇女体重增加与总脂肪和腹部脂肪组织增加以及瘦体重减少有关。解决这个问题需要个体化的行为管理，辅以有效的药物治疗，必要时补充减肥手术。现代肥胖治疗疗法在临床试验中已证明其安全性和有效性，有可能减少多余的体脂肪、改善代谢谱、降低心血管风险，并提高妇女生活的质量和寿命。除了标准的肥胖治疗方法外，本文还探讨了基于肥胖发病因素的不同治疗策略，这些策略可能为治疗围绝经期妇女的肥胖及其并发症提供有前途的选择。一种潜在的方法是绝经激素治疗（MHT），它通过减少内脏脂肪组织的积累、保持代谢活跃的瘦体重和改善血脂谱来假设靶向内脏肥胖。然而，尽管有这些报道的益处，妇科和内分泌学会目前不建议将 MHT 用于肥胖的预防或治疗，这需要进一步的研究来验证。新出现的证据表明，围绝经期低雌激素血症可能导致内脏肥胖，这可能证明使用 MHT 作为因果治疗是合理的。这突出了加强研究努力的重要性，以揭示围绝经期发生的复杂激素和代谢变化及其在肥胖发展中的作用。
