Bioenergetic Effects of Aging and Menopause (BEAM)

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