Association Between Metabolic-syndrome And Testosterone In Peri-postmenopausal Women

BackgroundMenopause is a physiological process that menstrual periods stops permanently due to the ovarian failure,having a symbol of delaying more than seven days in the menstrual cycle.A series of psychological and physiological changes will occur because of the decline of ovarian hormone,leading to short-term symptoms and long-term symptoms.Short-term symptoms include hot flashes,sleep disorder,mood disorder,sexual dysfunction,urinary infection and other symptoms.Long-term symptoms include bone loss,increased risk of cardiac-cerebral vascular disease and metabolic-syndrome.Worldwide,there are 1 billion menopausal women and their mean menopausal age among 49 to 52.1,2 With the development of society and improvement of medical level,life expectancy of female is increased.It is a significant problem to improve life quality and reduce the risk of potential diseases.Another important sex hormone,androgen,plays an important role in the proceeding of menopausal symptoms and long-term risks of diseases.Testosterone is the most active androgen secreted by ovarian and adrenal gland.As ovarian failure in peri-postmenopausal women,testosterone secretion diminished,and adrenal gland becomes the main source.Researches shows significant decline of testosterone from reproductive age to peri-postmenopause.Association with menopausal health,testosterone has a positive effect on preserving bone mineral density and muscle mass and preventing mood disorder as well.However,high testosterone is related to some diseases such as metabolic-syndrome.Metabolic-syndrome is a pathological status of disturbances in the metabolism of proteins,carbohydrates,and lipids.Prevalence of metabolic-syndrome in adults worldwide is about 20-25%,still rising6.It is even 40% in Americans over 40 years old.In china,the prevalence of metabolic-syndrome is 21.3%,though lower than western countries,there is still a tendency8.Significant sex differences exist in the prevalence of metabolic-syndrome with women more predisposed to metabolic-syndrome than men.According to the diagnosis of metabolic-syndrome,waist circumference,blood pressure,fasting glucose,triglycerides and high density lipoprotein-cholesterol are five important measures,which are associated with physiological changes in peri-postmenopausal women.This results in the high prevalence of metabolic-syndrome and increased risk of cardiac-cerebral vascular disease in postmenopausal women and those over 60 years old,which causes a severe problem for the quality of life.So,it is important to study the cause and related factors of metabolic-syndrome in peri-postmenopausal women so as to develop primary prevention and improve health and life quality.Testosterone is a possible factor associated with metabolic-syndrome,but its relationship between metabolic-syndrome and cardiac-cerebral vascular disease is controversial.In addition,the association between menopause status,testosterone and metabolic-syndrome remains to be defined.In this study,we investigate women aged 40-50 years old from outpatient clinic of menopause in Shanghai Jiaotong University affiliated Sixth People’s Hospital.Level of testosterone,sex hormone-binding globulin,free androgen index,estrogen,blood lipid and measures related to metabolic-syndrome are observed to analyze the relationship between testosterone and metabolic-syndrome and to provide evidence for early intervention programs for vulnerable peri-postmenopausal women.ObjectiveWe aim to observe sex hormone and measures related to metabolic-syndrome in order to analyze the relationship between testosterone and metabolic-syndrome and to provide evidence for early intervention programs for vulnerable peri-postmenopausal women.MethodsThis cross-sectional study enroll 438 participants aged 40-65 from outpatient clinic in Shanghai Jiaotong University affiliated Sixth People’s Hospital form 2014 to 2017.438 participants were eligible according to inclusion and exclusion criteria.A questionnaire was asked by trained medical graduates through face to face interview including name,age,marital status,occupation,employment status,education,income,menopausal age and status,parity,chronic diseases.Height,weight,waist circumference,blood pressure were measured and blood sample were tested for sex hormone and biochemical parameters.Metabolic-syndrome was diagnosis according to International Diabetes Federation.Statistics were analyzed by SPSS22.0(SPSS,Chicago,IL,USA).Results1.206(47.03%)participants are in postmenopausal transition and 232(52.97%)are in postmenopause.BMI within normal limits accounted for 81.50%.2.Cholesterol,triglyceride and low density lipoprotein-cholesterol increase with age(P<0.05),while estrogen and follicle-stimulating hormone decrease with age(p<0.05).Testosterone,sex hormone-binding globulin and free androgen index remain unchanged.3.Cholesterol,triglyceride and low density lipoprotein-cholesterol increase with menopause status(P<0.05),while estrogen and follicle-stimulating hormone decrease(p<0.05).Testosterone,sex hormone-binding globulin and free androgen index remain unchanged.4.Free androgen index,total cholesterol,waist circumference and fasting glucose increase with testosterone levels(P<0.05),while estrogen and follicle-stimulating hormone decrease with testosterone levels(P<0.05).5.Testosterone increase with waist circumference(P<0.05).Sex hormone-binding globulin and follicle-stimulating hormone decrease with waist circumference,blood pressure,fasting glucose and triglyceride,increase with high density lipoprotein-cholesterol,while free androgen index shows converse trend(P<0.05).6.Metabolic-syndrome is associated with older age,higher testosterone,free androgen index,follicle-stimulating hormone(P<0.05)and lower sex hormone-binding globulin,follicle-stimulating hormone,high density lipoprotein-cholesterol(P<0.05).7.Multivariate analysis shows testosterone,free androgen index and follicle-stimulating hormone are not associated with metabolic-syndrome,while age(OR=1.154 95%Cl 1.020-1.306),sex hormone-binding globulin(OR=0.963 95%Cl 0.932-0.996),compared with body mass index <25,body mass index≥25(OR=0.058 95%Cl 0.024-0.136),compared with 3000-4999 RMB,income under 1000RMB(OR=5.271 95%Cl 1.193-23.291).And independent determinations of metabolic-syndrome are age and sex hormone-binding globulin(P<0.05).Conclusions1.Testosterone and free androgen index do not change with age and menopausal status in peri-postmenopausal women.2.High level of testosterone is associated with metabolic-syndrome but is not a dependent risk.3.The prevalence of metabolic-syndrome in peri-postmenopausal women is 10.96%,and decreased sex hormone-binding globulin,older age are two risk factors.