One of the most frustrating changes associated with the menopausal transition is the accumulation of fat in places where it wasn’t before! The decline in estrogen is associated with greater resistance to insulin which results in the accumulation of visceral fat and what our mid-section has come to know as the “menopot”.

Women often seek therapy for this and other related symptoms of the menopausal transition such as hot flashes, mood swings, muscle wasting and declining libido. Hormone therapy has been shown to be a very effective treatment for some of these experiences, but could it also make other symptoms worse?

In this November issue of “Menopause”, TV Dam et al. published one of the few double-blinded, randomized placebo-controlled trials exploring the impact of estrogen therapy (ET) on body composition and metabolic metrics in late peri-menopausal/early menopausal women undergoing a 12 week supervised resistance training program. Here we review and discuss the findings of this article, Estrogen modulates metabolic risk profile after resistance training in early postmenopausal women: a randomized control trial.

The results for the main outcomes of this study were as follows:

  • The placebo group showed a greater loss of total fat mass, visceral fat mass, and femoral subcutaneous adipose tissue when compared to the ET group.
  • The ET group improved their metabolic profile with a reduction in LDL, blood glucose and hemoglobin A1C (a measure of blood glucose over an extended time period) when compared to the placebo group.

When considering these results and applying them to our own circumstances there are a few things to consider.

  • The women in this study were “untrained” women. It is uncertain if these same observations would be seen in avid recreational and elite-level athletes.
  • The study used estrogen therapy as the study treatment. Many forms of estrogen therapy include the addition of progesterone. Interestingly, previous studies cited by the authors investigating combined estrogen and progesterone did not see the same results as the present study. This raises the question of whether the results would have been different if the investigators used combined estrogen/progestin therapy rather than estrogen alone.
  • The study used transdermal (skin-absorbed) estrogen rather than oral estrogen therapy. This is an important point as many forms of hormone therapy are oral therapies subject to the effect of liver metabolism which has a well-known impact on many metabolic parameters.

Sometimes studies like these raise more questions than answers. However, when considering whether hormone therapy is right for you, these studies can provide additional data points to consider when discussing your specific circumstances with your provider. ■