Do changes in sex steroid hormones precede or follow increases in body weight during the menopause transition? Results from the Study of Women's Health Across the Nation.
BACKGROUND
Whether menopause-related changes in sex steroids account for midlife weight gain in women or whether weight drives changes in sex steroids remains unanswered.


OBJECTIVE
The objective of the study was to characterize the potential reciprocal nature of the associations between sex hormones and their binding protein with waist circumference in midlife women.


METHODS
The study included 1528 women (mean age 46 yr) with 9 yr of follow-up across the menopause transition from the observational Study of Women's Health Across the Nation.


METHODS
Waist circumference, SHBG, testosterone, FSH, and estradiol were measured.


RESULTS
Current waist circumference predicted future SHBG, testosterone, and FSH but not vice versa. For each SD higher current waist circumference, at the subsequent visit SHBG was lower by 0.04-0.15 SD, testosterone was higher by 0.08-0.13 SD, and log(2) FSH was lower by 0.15-0.26 SD. Estradiol results were distinct from those above, changing direction across the menopause transition. Estradiol and waist circumference were negatively associated in early menopausal transition stages and positively associated in later transition stages (for each SD higher current waist circumference, future estradiol was lower by 0.15 SD in pre- and early perimenopause and higher by 0.38 SD in late peri- and postmenopause; P for interaction <0.001). In addition, they appeared to be reciprocal, with current waist circumference associated with future estradiol and current estradiol associated with future waist circumference. However, associations in the direction of current waist circumference predicting future estradiol levels were of considerably larger magnitude than the reverse.


CONCLUSIONS
These Study of Women's Health Across the Nation data suggest that the predominant temporal sequence is that weight gain leads to changes in sex steroids rather than vice versa.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Room 1309, Bronx, New York 10461, USA. rachel.wildman@einstein.yu.edu
Rachel P
RP
Wildman
Ping G
PG
Tepper
Sybil
S
Crawford
Joel S
JS
Finkelstein
Kim
K
Sutton-Tyrrell
Rebecca C
RC
Thurston
Nanette
N
Santoro
Barbara
B
Sternfeld
Gail A
GA
Greendale
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D015331:Cohort Studies; D004522:Educational Status; D004958:Estradiol / Q000097:blood; D005006:Ethnicity; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D008137:Longitudinal Studies; D008593:Menopause / Q000502:physiology*; D008598:Menstruation / Q000502:physiology; D008875:Middle Aged; D047648:Perimenopause / Q000502:physiology; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D012907:Smoking / Q000453:epidemiology; D013739:Testosterone / Q000097:blood; D014481:United States; D055105:Waist Circumference / Q000502:physiology; D015430:Weight Gain / Q000502:physiology*; D014930:Women
D012739:Gonadal Steroid Hormones; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D004958:Estradiol; D005640:Follicle Stimulating Hormone