Oestrogen, Progesterone and Adipose Tissue
Previous works have clearly demonstrated that female sex hormones influence adipose tissue metabolism differently in various fat depots (37). The typical female adipose tissue in the femoral-gluteal region in premenopausal women tends to accumulate fat, particularly during pregnancy, which can then be mobilized efficiently during lactation. These findings suggest a specific female function for this depot, to provide a reserve of energy for lactation purpose. In contrast, lipolytic responsiveness and sensitivity are higher in subcutaneous abdominal adipocytes.
The disappearance of this typical metabolic pattern with menopause and its reappearance with hormonal substitution indicate that sex steroid hormones exert an important influence here (38). The specific role of oestrogen and progesterone is, however, not fully clarified.
Furthermore, current data are from in vitro studies and there is no evidence relating to the effect of female sex hormones on adipose tissue in vivo, as there is in men.
Previous studies have demonstrated that increasing androgenicity in women, as reflected by low SHBG concentration, or an increase in the percentage of free testosterone, is associated with visceral obesity (7,39). Menopause seems to be associated with increasing body fat and with an increasing proportion of abdominal body fat distribution (40). It may be conceivable that these changes in body fat and its distribution are related to the marked decrease in oestrogen and progesterone levels associated with menopause. Consequently, it may therefore be hy-
TREATMENT: HORMONES Table 32.3 The effects of hormone replacement therapy on body composition
Body composition (vs. baseline)
Lean body mass
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