01483 454 016
info@thesurreyparkclinic.co.uk
Sovra Whitcroft and Anne Herriot
The Surrey Park Clinic, Guildford, UK
Correspondence: Sovra Whitcroft MBChB FRCOG, Clinic Director, The Surrey Park Clinic, Stirling House, Stirling Road, Guildford, Surrey GU2 7RF, UK.
Insulin resistance (IR) is associated with a number of metabolic abnormalities including glucose intolerance, dyslipidemia and central obesity (the metabolic syndrome), which predispose to cardiovascular disease, diabetes mellitus and some cancers. The incidence of many of these conditions increases after the menopause, a time when IR also increases. Medical intervention to help alleviate menopausal symptoms, frequently vasomotor in origin, usually involves hormone replacement therapy (HRT), but some women may only experience partial symptom relief.We have hypothesized that this may be due to concurrent IR. Our approach is therefore to manage menopausal symptoms in conjunction with the treatment of any concurrent IR, achieved through a combination of hormone replacement, dietary intervention and, if necessary, an insulin sensitizer.We suggest that this approach may not only improve symptom relief but may also reduce the risk of developing more serious health complaints in the future.
Keywords: insulin resistance, menopause, hormones, vasomotor symptoms, metabolic syndrome, HRT
Introduction
Insulin resistance (IR) is a condition where there is reduced biological effect for any given concentration of insulin;
1 compensatory hyperinsulinemia occurs in an attempt to maintain normo-glycaemia.2 It is associated with a number of metabolic abnormalities including glucose intolerance, dyslipidemia, endothelial dysfunction, hemodynamic changes and increased androgenic effects. Clinical conditions associated with IR include type 2 diabetes, cardiovascular disease (CVD), polycystic ovary syndrome (PCOS), non-alcoholic fatty liver, sleep apnoea and certain cancers.3 It is also a prominent feature of the metabolic syndrome. The most recent diagnostic criteria of the syndrome include elevated waist circumference (80 cm for Europoid women), elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, elevated blood pressure and elevated fasting glucose,4 all features of IR. The prevalence of the metabolic syndrome increases with estrogen deficiency after the menopause, along with the emergence of many of its features, and this may in part explain the increase in CVD risk in women after this time.5Source: Menopause International