RT Journal
A1 Rodriguez C, Calle EE
T1 POstmenopausal hormone replacement, body mass index, and quality of life
JF JAMA
JO JAMA
YR 2002
FD May 1
VO 287
IS 17
SP 2210
OP 2211
DO 10.1001/jama.287.17.2209
UL http://dx.doi.org/10.1001/jama.287.17.2209
AB 
To the Editor: Dr Hlatky and colleagues1 reported that postmenopausal hormone therapy improved
quality of life only among women who reported flushing at baseline. We suspect
that the women in this study who reported flushing were generally thinner
than those who did not; thus, we suggest that the results should be reported
stratified by body mass index (BMI). Menopausal symptoms, including flushing,
are related to the dramatic decrease of estrogen levels due to depletion of
ovarian function. After menopause, peripheral aromatization of androgens in
adipose tissue is the primary source of endogenous estrogen, and circulating
levels of estrogen in postmenopausal women increase with increasing body mass.2 Significantly lower levels of estradiol and estrone
are found in women with frequent hot flashes,2
and flushing is more likely among thin women.2