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Limited data are available about the effects of menopause and HRT on prevalence of the metabolic syndrome. More data are available on the effects of menopause and HRT on various measures of central obesity but there are conflicting results. Menopause is associated with increased amounts of abdominal visceral fat and there appears to be an effect that is independent of ageing (Poehlman and Tchernof, 1998; Tchernof etal., 1998).

Some cross-sectional studies have suggested that various measures of central obesity (and therefore presumably prevalence of the metabolic syndrome) may be lower in women using HRT but this study design cannot show that this is an effect of HRT (Sites etal., 2001; Green etal., 2004). Other cross-sectional studies have not shown a relationship between measures of central adiposity and HRT use (Kanaley etal., 2001; Ryan, Nicklas and Berman, 2002)

Longitudinal study designs also have provided conflicting results. Women taking part in the in the HRT group of the Postmenopausal Estrogen-Progestin Intervention Trial, a placebo-controlled, randomized clinical trial of 3 years' duration, had an average of 1.2 cm less increase in waist girth and 1.0 kg less weight gain compared with those in the placebo group (Espeland etal., 1997). In another study, WHR remained constant in a group of women taking HRT but increased in a control group over 1 year (Reubinoff etal., 1995). In contrast, a study with a longer follow-up period (15 years) reported similar changes in WHR regardless of HRT use (Kritz-Silverstein and Barrett-Connor, 1996). Short-term follow-up studies that have assessed various measures of central obesity have provided further mixed results, with one study showing a decrease in waist area (Evans etal., 2001), three studies showing no increase in abdominal visceral fat (Haarbo etal., 1991; Gambacciani etal., 1997; Evans etal., 2001) and one study showing an increase in trunk fat mass in the HRT group compared with the placebo group (Aloia etal., 1995). Some of the discrepancies between studies may be explained by different HRT regimes but clearly further research is required to clarify the relationship between HRT use and prevalence of the metabolic syndrome.

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