Health of adipose tissue: oestrogen matters

Menopausal women are more likely than premenopausal women to gain weight in the form of excess adipose tissue, which becomes preferentially deposited in the viscera. This body composition shift, largely driven by declining oestrogen levels, increases cardiometabolic disease risk. Oestrogens are key hormones involved in many metabolic processes, including in adipose tissue. Given the strong influence that adipose tissue health has on systemic metabolism, additional insights into mechanisms by which oestrogens affect adipose tissue phenotype and function are critical. Not only is adipose tissue affected by oestrogen signalling, adipose tissue is also a major source of circulating oestrogens, and the only appreciable source of oestrogens for men and postmenopausal women. Therefore, women with obesity have higher circulating levels of oestrogens, but whether this fact contributes to the diverse comorbidities of obesity (such as, cancer, metabolic syndrome and osteoporosis) remains unclear. Loss of the effects of oestrogen in adipose tissue later in life could underlie the tissue's functional decline and expanded mass during menopause and beyond. In this Review, we discuss the roles of oestrogens in adipose functional health, and how these functions influence obesity and metabolic disease risk.