How does the lipid profile change after menopause, and what can you do about it?
After menopause, the lipid profile demonstrably worsens due to the decline in oestrogen. Regular exercise and moderately eating less help to counteract this; if cholesterol remains high, also discuss cholesterol-lowering treatment with your doctor.
After menopause, LDL cholesterol (the 'bad' cholesterol) rises measurably, and this is not simply a consequence of ageing: the effect remains visible even after correcting for age. At the same time, HDL cholesterol (the 'good' cholesterol) falls, and the longer the menopause lasts, the lower HDL turns out to be. In addition, triglycerides and lipid-rich lipoproteins rise. Lipoprotein(a), an extra risk factor that few people have heard of, also increases in women after menopause. All these changes together make cardiovascular risk after menopause considerably greater.
The decline in oestrogen is the primary driver of these shifts. Women die from cardiovascular disease more often than men, and that risk increases substantially after menopause. Yet in practice, high cholesterol in women is more often recognised too late and treated insufficiently.
On the lifestyle side, a review analysis shows that moderately eating less and exercising aerobically on a regular basis can counteract the unfavourable lipid changes. There are no separate randomised trials in these sources that quantify this precisely, but the direction is clear enough to take exercise and diet seriously as a first step.
The herbal preparation black cohosh (160 mg per day, three months) showed no demonstrable effect whatsoever on cholesterol or triglycerides in a double-blind randomised study involving 310 peri- and postmenopausal women. This product therefore offers no added value for the lipid profile.
Menopausal hormone therapy showed a more favourable lipid profile in a prospective cohort study: more large HDL particles and fewer small LDL particles. Because this concerns observational research, caution in interpretation is appropriate. Actively lowering high cholesterol after menopause, preferably in consultation with your doctor, can help prevent cardiovascular disease.
Based on multiple observational studies, reviews and one randomised trial (black cohosh, n=310). No meta-analyses available in the source set. The lifestyle recommendation comes from a review conclusion without direct RCT support. The hormone therapy finding is observational (cohort study), not a randomised trial.
Does menopause increase a woman's risk of joint pain or joint complaints?
Menopause increases the risk of joint pain and osteoarthritis in most women; it helps to avoid excess weight, stay active, and take sleep and stress management seriously as contributing factors.
How does your body fat affect hormone production as you get older?
Body fat has a considerable influence on your hormonal balance as you age: more abdominal fat disrupts insulin sensitivity, and conversely, lower oestrogen or testosterone levels worsen fat accumulation around the abdomen. Exercise and maintaining a healthy weight are the most concrete levers you have within your own control.
Does my libido decline after 40, and is there anything I can do about it?
A decline in libido after 40 is normal but not inevitable. For men with a confirmed low testosterone level and associated symptoms a well-supported treatment exists, and for women around the menopause hormone therapy offers concrete help, particularly for vaginal complaints.
What exactly happens during perimenopause, and what helps with it?
Perimenopause brings a wide range of symptoms, from hot flushes and sleep problems to bone loss. Hormone therapy is the best-supported approach, especially if you are under 60. Discuss your symptoms proactively with your doctor, as treatment is in practice left aside too often.
Does menopause accelerate skin ageing?
Menopause noticeably accelerates the loss of collagen, moisture retention and skin thickness, but spots and skin cancer are almost certainly caused by sunlight. If you are experiencing skin complaints around menopause, discuss with your doctor whether HRT makes sense for you as an overall package.
What does the transition or menopause do to your gut microbiome?
Menopause is accompanied by measurable shifts in the gut microbiome, but how large these are and what they mean in practice has not yet been well established. There is currently nothing concrete you can do with this information, as proven interventions via the gut microbiome are lacking.