MENOPAUSE - EFFECTS ON CARBOHYDRATE-METABOLISM

Hormone replacement therapy has clear benefits when one considers the improvement in vasomotor symptomatology and the beneficial effects of hormone replacement therapy with respect to osteoporosis and the lipid profile. However the data concerning hormone replacement therapy and its effect on parameters that affect carbohydrate metabolism-specifically fasting glucose and insulin levels, the plasma glucose and more importantly plasma insulin response to a glucose challenge-is clearly controversial. There appears to be sufficient evidence to suggest that high-dose synthetic estrogen and progestins adversely affect glucose metabolism and insulin sensitivity. The low-dose natural estrogens in general have no significant detrimental effect, and may exert a beneficial effect on carbohydrate metabolism; the addition of a progestogen may negate this estrogen effect, however. The consensus from reviewing this literature is that neither menopausal status nor combination hormonal replacement as it is currently administered contribute significantly to the development of insulin resistance and hyperinsulinemia. Factors independent of hormonal status, such as age and obesity, should be given greater consideration.