Lipid changes during the menopause transition in relation to age and weight: the Study of Women's Health Across the Nation

Abstract

Few studies have prospectively examined lipid changes across the menopause transition or in relation to menopausal changes in endogenous hormones. The relative independent contributions of menopause and age to lipid changes are unclear. Lipid changes were examined in relation to changes in menopausal status and in levels of estradiol and follicle-stimulating hormone in 2,659 women followed in the Study of Women's Health Across the Nation (1995-2004). Baseline age was 42-52 years, and all were initially pre- or perimenopausal. Women were followed annually for up to 7 years (average, 3.9 years). Lipid changes occurred primarily during the later phases of menopause, with menopause-related changes similar in magnitude to changes attributable to aging. Total cholesterol, low density lipoprotein cholesterol, triglycerides, and lipoprotein(a) peaked during late peri- and early postmenopause, while changes in the early stages of menopause were minimal. The relative odds of low density lipoprotein cholesterol (> or =130 mg/dL) for early postmenopausal, compared with premenopausal, women were 2.1 (95% confidence interval: 1.5, 2.9). High density lipoprotein cholesterol also peaked in late peri- and early postmenopause. Results for estradiol and follicle-stimulating hormone confirmed the results based on status defined by bleeding patterns. Increases in lipids were smallest in women who were heaviest at baseline.

Figure 1.

Adjusted within-woman change in lipids attributable to changes in menopausal status, age, estradiol, and follicle-stimulating hormone during the transition from pre- to late perimenopause, Study of Women's Health Across the Nation, 1995–2004. LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; Lp(a), lipoprotein(a); E2, estradiol; FSH, follicle-stimulating hormone. The statistical significance of within-woman changes is shown. Bonferroni correction for multiple comparisons was applied.

Figure 2.

Adjusted mean (standard error) of total cholesterol (A), low density lipoprotein cholesterol (LDL-C) (B), and triglycerides (C), by menopausal status stratified on baseline weight tertile, Study of Women's Health Across the Nation, 1995–2004. Weight tertiles: first (37.6–62.4 kg); second (62.5–78.0 kg); third (78.1–175.4 kg). P values for differences by menopausal status within specific weight tertiles: in A, P < 0.0001 for tertiles 1 and 2 and P < 0.01 for tertile 3; in B, P < 0.0001 for tertiles 1 and 2 and P < 0.01 for tertile 3; in C, P < 0.0001 for tertiles 1 and 2 and P = not significant for tertile 3. For A, B, and C, the interaction of baseline weight tertile and menopausal status was P < 0.0001.

Figure 3.

Estimated relative odds of low density lipoprotein cholesterol (≥130 mg/dL) for peri- and postmenopausal compared with premenopausal women, full sample and stratified by baseline weight tertile, Study of Women's Health Across the Nation, 1995–2004. Weight tertiles: first (37.6–62.4 kg); second (62.5–78.0 kg); third (78.1–175.4 kg).