- by Jeff Minerd Jeff Minerd, Contributing Writer, MedPage Today March 27, 2018
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- Current menopausal hormone therapy (MHT) is associated with reduced total and visceral adiposity, but the effect is small and disappears when therapy is discontinued, according to a cross-sectional study of about 1,500 postmenopausal women 50 to 80 years of age.
- Recognize that the benefit of MHT on body composition might rapidly disappear after its withdrawal, and it is important therefore to strongly encourage women to optimize nutrition and increase physical activity when stopping MHT.
Menopausal women undergoing hormone replacement therapy tended to have less body fat, especially visceral fat, although the effect disappeared once therapy was discontinued, researchers reported from a cross-sectional study.
The mean percentage of body fat in women undergoing therapy was 34.6%, compared with 36.2% for women who had therapy in the past and 35.9% for women who never had hormone therapy (P=0.01 for trend), said Georgios Papadakis, MD, of the Lausanne University Hospital in Switzerland, and colleagues.
Mean visceral fat mass, measured as the fat deep in the abdomen around the internal organs, not subcutaneous abdominal fat, was 0.42 kg for women undergoing therapy, compared with 0.48 kg both for women with past therapy and those who never received it (P=0.01 for trend), the team reported online in the Journal of Clinical Endocrinology & Metabolism.
Similarly, the mean body-mass index (BMI) was 24.9 for current users of menopausal hormone therapy, versus 25.6 for past users and 25.8 for never users (P=0.03). All study results were adjusted for potential confounders including age, diet, physical activity, and a diagnosis of depression, Papadakis and colleagues said.
However, the benefits of therapy did not persist once it stopped. Mean visceral fat mass in women who had been off therapy for less than 2 years was 0.53 kg, and this was not significantly different in women who had been off therapy for 2-5 years (0.51 kg) or more than 5 years (0.50 kg; P=0.813). Differences in mean BMI were similarly non-significant among the three groups (P=0.985).
"In conclusion, current MHT [menopausal hormone therapy] use prevents the increase of visceral adiposity," Papadakis and colleagues said. "This finding may have important cardiovascular, metabolic, and bone implications which should be taken into account when assessing the benefit-risk ratio for MHT prescription. Nevertheless, the effect size on BMI and total fat mass is relatively small and MHT prescription cannot substitute for other interventions such as physical activity."
"Physicians should be aware that the benefit of MHT on body composition might rapidly disappear after its withdrawal and strongly encourage women to optimize nutrition and increase physical activity when stopping MHT," the study authors said.
JoAnne Pinkerton, MD, executive director of the North American Menopause Society, agreed with the authors' recommendation. "Discussions about stopping hormone therapy should include a discussion of increased gain of abdominal fat, the associated health risks, and recommendations to decrease caloric intake and increase regular physical activity to combat the weight gain seen with stopping hormone therapy," Pinkerton said in an email to MedPage Today.
The best candidates for hormone therapy are symptomatic women younger than 60 or within 10 years of menopause, Pinkerton said. "Having less increase in abdominal fat is an extra benefit beyond relief of hot flashes, night sweats, improved sleep, and less bone loss," she said.
However, "There is no one-size-fits-all approach when it comes to decisions about hormone therapy," Pinkerton added. "The risks and benefits vary depending on the woman's own characteristics as well as the type of hormone therapy, the dose used, the duration of use, type of administration -- whether it's a pill or a patch, for example – and especially age and time from menopause when therapy is initiated."
The cross-sectional, observational study included 1,053 postmenopausal women age 50-80. They were classified as current hormone therapy users (21%), past users (27%), or never users (52%). The vast majority (98%) were white. Current users had been on therapy an average of 12 years, and past users had been off therapy an average of 8.5 years. Participants were questioned about their diet, physical activity, and psychological health.
Participants underwent dual-energy X-ray absorptiometry (DXA) with body composition assessment. The main outcome was visceral adipose tissue as measured by DXA. Secondary outcomes included BMI, total fat mass, lean mass, and hand grip strength. The study found no significant differences among participants for lean mass or grip strength.
Exactly how hormone replacement therapy affects fat mass is unclear, Papadakis and colleagues said. It could have a direct effect on fat cells, or it could have behavioral effects that influence food intake and physical activity, they said.
Because the vast majority of study participants were white, the results may not be generalizable to other patient populations, they said. In addition, information on the duration of hormone therapy, as well as the type of therapy and route of administration, was self-reported, "preventing us from reliably assessing these factors," they said.