IS THERE A MENOPAUSAL METABOLIC SYNDROME

Estradiol-17 beta has beneficial effects on a range of metabolic risk factors for coronary heart disease and the decline in estrogen concent rations at the menopause would be expected to have adverse effects. Re view of the literature on effects of the menopause and of estradiol-17 beta provides evidence for the following changes occuring at or after the menopause: increased total cholesterol and triglycerides; decreas ed high density lipoprotein (HDL) and HDL subfraction 2; increased low density lipoprotein, particularly in the small, dense subfraction; in creased lipoprotein (a); increased insulin resistance; decreased insul in secretion; decreased insulin elimination; increased android fat dis tribution; impaired vascular function; increased factor VII and fibrin ogen, and reduced sex-hormone binding globulin. Many of these changes will themselves have adverse effects on other metabolic risk factors. This complex of inter-correlated adverse changes in metabolic risk fac tors justifies identification of a distinct menopausal metabolic syndr ome which originates in estrogen deficiency and which could contribute to the increased risk of coronary heart disease seen in postmenopausa l women. Estrogen replacement can diminish the expression of this synd rome.