What does the menopause do to my heart and bones in the long term?
In the long run, menopause increases your risk of cardiovascular disease and bone loss, and that effect is greater with an early menopause. Hormone therapy protects your bones, but is not a preventive treatment for your heart or brain.
Menopause lowers your oestrogen levels, and that has clear long-term consequences for both your heart and your bones. After menopause, your risk of cardiovascular disease rises. You gradually catch up with the risk profile of men. With an early menopause, before the age of 40, that risk is even higher. Cardiologists now regard this as an official risk signal that belongs in a cardiac check-up, alongside severe pre-eclampsia.
Women who experience frequent hot flushes and night sweats more often have higher blood pressure and signs of disrupted heart-rate regulation. Whether that directly leads to heart disease has not yet been definitively proven. But the association is present in multiple studies and strong enough to take seriously. If you have severe symptoms, discuss them with your doctor from a cardiovascular perspective as well.
For your bones the same pattern applies. Oestrogen protects bone tissue, and when it falls away, your bone density decreases. This is most pronounced with an early menopause, because you then miss years of that protection. As a result, the risk of bone loss (osteoporosis) and fractures increases considerably.
Hormone therapy is the only treatment for which a large Cochrane analysis found real evidence that it prevents fractures1. After 5 to 7 years of therapy the number of fractures fell noticeably. However: combined hormone therapy increases the risk of heart attacks, stroke, breast cancer, thrombosis and gallbladder problems in women over 60. The absolute increase per person is small, but well established. Oestrogen without a progestogen, only possible after a hysterectomy, carries a different risk profile and actually appears to slightly lower breast cancer rates.
There are indications that starting hormone therapy early, before the age of 60 or within ten years of menopause, is more favourable for the heart2,3,4,5. This 'timing window' is biologically plausible, but has not yet been sufficiently tested in studies specifically aimed at younger postmenopausal women. One thing is certain: hormone therapy is not a preventive treatment for cardiovascular disease or dementia. In women over 65, combined hormone therapy even increased the risk of dementia in research. Use it therefore for specific symptoms and bone protection, not as a general anti-ageing pill.
The claims are based on multiple epidemiological studies and a Cochrane systematic review on hormone therapy (PMID 28093732), supplemented by guideline-related publications on cardiovascular risk in women (PMID 35210038, 35526556, 36367692, 38458215). The fracture and cardiovascular risk associated with hormone therapy comes from Cochrane data based on randomised studies. The increased cardiovascular risk with early menopause is based on observational research.
Does my weight and metabolism change during menopause?
During menopause, your body composition changes profoundly: more abdominal fat, less muscle and a lower resting metabolic rate. Exercise and nutrition demonstrably help, and discuss hormone therapy with your doctor as an additional option.
Which hormone levels are tested during menopause and what do the results mean?
During menopause, the hormones measured most commonly are FSH, LH, oestradiol, progesterone, testosterone and AMH; elevated FSH combined with reduced oestradiol (below 20 pg/ml) is the most reliable sign that menopause has begun, but always have your results explained by your doctor, as body weight and background influence reference values.
What complaints are most common during menopause?
The most common menopausal complaints are joint and muscle pain, fatigue and sleep problems; hot flushes are the most characteristic but do not top the prevalence rankings. If you recognise several of these complaints, it is worthwhile discussing them with your GP, who can consider what may help for each one.
Can you delay menopause with lifestyle or diet?
Avoiding smoking, eating less red meat, and eating more citrus fruit and oily fish appear to have a favourable influence on the age of menopause. However, evidence from controlled experiments is still entirely lacking.
Which supplements actually help with menopause?
Red clover isoflavones and black cohosh have the strongest evidence for reducing hot flashes; soy isoflavones also help to some extent. For bone health, vitamin D is well supported. The effects are modest, and for severe complaints it is best to discuss the options with your doctor.
What does pregnancy do to your hormone balance in the long term?
Pregnancy brings about hormonal changes that are partly temporary, but in the case of gestational diabetes the risk of type 2 diabetes may remain permanently elevated. If you have had this, have your blood sugar checked afterwards.