Bioenergetic Effects of Aging and Menopause (BEAM)

Official title

Bioenergetic and Metabolic Consequences of the Loss of Ovarian Function in Women - 2018

Overview

The menopause transition is associated with increased risk for weight gain and a shift toward storing fat in the belly region, which may increase risk for cardiovascular disease and diabetes. The study will determine whether the stress hormone cortisol contributes to this shift.

Detailed description

The menopause transition is associated with increased risk for weight gain and a shift toward storing fat in the belly region, which may increase risk for cardiovascular disease and diabetes. The stress hormone cortisol is known to promote the accumulation of belly fat, and there is evidence that low estrogen is associated with higher cortisol levels. The first aim of the study is to determine whether low estrogen levels in premenopausal and early postmenopausal women increase cortisol levels in the blood and in fat tissue. When estrogen level decreases at the time of menopause, there is an increase in follicle-stimulating hormone, or FSH. Recent evidence in mice suggests that blocking FSH prevents the increase in belly fat. The second aim of the study is to determine whether decreasing the high FSH level in postmenopausal women causes a decrease in belly fat and changes other factors that are typically thought to be related to estrogen rather than FSH. Because estrogen and FSH levels fluctuate in premenopausal and early postmenopausal women, the investigators will use an approach that controls estrogen and FSH levels to address the aims. The investigators will use a drug that is typically used to treat endometriosis or uterine fibroids to reduce estrogen and FSH levels and an estrogen patch to increase estrogen in some women. The study will generate new knowledge on how menopause affects fat gain and disease risk.

Interventions

• Drug GnRH antagonist
  GnRH antagonist will be given once for premenopausal women (12-week intervention) and twice for postmenopausal women (24-week intervention)
• Drug Estrogen Product
  Estrogen patches will be worn by those randomized to the Estradiol arms in both premenopausal and postmenopausal groups. Patches will be applied weekly and will be worn for the for entirety of the intervention (12 or 24 weeks).
• Drug Placebo estradiol
  Placebo patches will be worn by those randomized to the placebo arms in both premenopausal and postmenopausal groups. Patches will be applied weekly and will be worn for the for entirety of the intervention (12 or 24 weeks).
• Drug Placebo GnRH antagonist
  Postmenopausal women randomized to the placebo injection arm will receive two placebo drug injections of normal saline (24-week intervention)

Primary outcome measures

• Change in the Microdialysis Cortisone Challenge (MCC) Index [Time frame: Baseline, week 12]
• Change in the Oral Cortisone Challenge (OCC) Area Under the Curve (AUC) [Time frame: Baseline, week 12]

Secondary outcome measures (5)

• Change in lumbar spine Bone Mineral Density (BMD) [Time frame: Baseline, week 24]
• Change in resting energy expenditure (REE) [Time frame: Baseline, week 12, week 24]
• Change in visceral fat area (VFA) [Time frame: Baseline, week 24]
• Change in flow-mediated dilation (FMD) [Time frame: Baseline, week 12, week 24]
• Change in proximal femur Bone Mineral Density (BMD) [Time frame: Baseline, week 24]

Eligibility criteria

Inclusion criteria

Volunteers will be healthy peri/postmenopausal women who are willing and able to undergo the proposed hormone manipulation and study procedures. Women will be at least 6 months but not more than 7 years past the last menstrual period (i.e., late perimenopausal or early postmenopausal) with FSH >30 IU/L. We will make a major effort to ensure that the women enrolled in this study come from all races and ethnicities and a wide range of socioeconomic and educational levels. Women will be excluded for the reasons listed below.

Exclusion criteria

• abnormal vaginal bleeding
• on hormonal contraceptive or menopausal therapy or intention to start during the period of study
• positive pregnancy test or intention to become pregnant during the period of study
• lactation
• known hypersensitivity to degarelix acetate, estradiol, or medroxyprogesterone acetate
• Center for Epidemiological Studies Depression Scale (CES-D) score <,16 (unless clinician follow-up and clinical judgement determine they are eligible (will be noted in study chart)
• current tobacco and/or vape use more than 2 times/week
• current marijuana or tetrahydrocannabinol (THC) use in any form more than 3 times/week
• regular self-reported alcohol consumption >14 drinks/week
• BMI >39 kg/m2
• use of glucocorticoids or drugs that affect glucocorticoid metabolism (e.g., ketoconazole)
• severe osteopenia or osteoporosis, defined as femoral neck or lumbar spine t-score <-2.0
• thyroid dysfunction, defined as an ultrasensitive TSH <0.5 or >5.0 mU/L; volunteers with abnormal thyroid stimulating hormone (TSH) values will be re-considered for participation in the study after follow-up evaluation by the PCP with initiation or adjustment of thyroid hormone replacement
• liver dysfunction, defined as liver function tests (AST, ALT) >1.5 times the upper limit of normal
• uncontrolled hypertension defined as resting systolic BP >150 mmHg or diastolic BP>90 mmHg; participants who do not meet these criteria at first screening will be re-evaluated, including after follow-up evaluation by the primary care provider (PCP) with initiation or adjustment of anti-hypertensive medications
• self-reported history of breast cancer or other estrogen-dependent neoplasms
• self-reported history of venous thromboembolism, pulmonary embolism, or other thromboembolic disorder
• self-reported history of cardiovascular disease

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Triple blind

Primary purpose

Basic science

Study locations

United States · 1 center

• University of Colorado - Anschutz Medical Campus — Aurora

Identifiers

NCT: NCT04043520 · 18-2483 · U54AG062319

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗