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THE METABOLIC SYNDROME IN WOMEN: GENDER DIFFERENCES IN ANDROGEN
RESPONSE
Vliet,E.L.
Medical Director, HER Place: Health Enhancement and Renewal For Women,
Inc. PO Box 64507,Tucson, AZ 86728, USA http://www.herplace.com/
The Metabolic Syndrome, characterized by abdominal obesity, insulin
resistance, dyslipidemia, and hypertension, affects
women progressively in greater numbers as they age.
This rise in incidence of the Metabolic Syndrome as
women move into the climacteric is related in large
part to the decline in ovarian hormone production
and altered balance between estrogens and androgens
that leads to decline in insulin sensitivity, promoting
increase central fat deposition, further insulin resistance
and other metabolic effects. Life stresses at midlife
increase cortisol output and thereby compound the
tendency to develop the Metabolic Syndrome. These
combined endocrine imbalances, with progressive relative
androgen excess, affect body composition, multiple
metabolic measures, mood and physical symptoms, as
well as long term health risks. Women with the Metabolic
Syndrome are at higher risk for diabetes, gallstones,
gastroesophageal reflux disease (GERD), all forms
of cardiovascular disease including myocardial infarction,
stroke and peripheral vascular disease, as well as
a four-to-sevenfold higher risk of breast and endometrial
cancers. In addition to the rise in Metabolic Syndrome
seen in climacteric and postmenopausal women, there
is a rising incidence in younger women. Metabolic
syndrome is seen most commonly in those with Polycystic
Ovarian Syndrome (PCOS), the most common endocrine
disorder causing infertility in reproductive age women.
With the rise in obesity in general in both adults
and children, more and more younger women have some
or all of the features of the Metabolic Syndrome.
Studies of young women with PCOS as well as studies
of midlife and postmenopausal women implicate relative
androgen excess as a causative factor in the development
of central body fat, insulin resistance and other
features of the metabolic syndrome in women. Even
menopausal women who have lower than optimal plasma
levels of estradiol and testosterone but a relative
androgen excess of adrenal origin are at higher risk
of developing the Metabolic Syndrome. The findings
in women are contrary to those discussed earlier for
men, in which lower plasma levels of total testosterone
are associated with increased risk of developing the
Metabolic Syndrome. This presentation will review
studies in women, and discuss proposed causal issues
needing further study. Studies of both PCOS and menopausal
women have found that improving the estrogen-androgen
balance can reduce central fat mass, improve insulin
resistance and glucose tolerance, improve lipid profiles,
and lower blood pressure thereby reducing the risks
of progressing to diabetes and CVD. Therapeutic hormone
interventions in both young women with PCOS and menopausal
women will be discussed. Further long-term studies
are needed to clarify the optimal types, routes of
delivery, and target levels for treatment strategies
aimed at reducing the serious health risks of the
Metabolic Syndrome.
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