What does the menopause do to my heart and bones in the long run?
The menopause accelerates bone loss, and hormone therapy measurably reduces that loss. At the same time, hormone therapy increases the chance of a stroke and a blood clot.
Hormone therapy clearly protects your bones. Combined therapy (oestrogen and progesterone together) reduces the number of fractures after 5.6 years from around 111 down to 79 to 96 in every 1,000 women. Oestrogen alone works in the same direction: from 141 down to 92 to 113 in 1,000 after 7 years. This is the one benefit for which the evidence is most convincing.
For the heart, the picture is more complicated. On heart attacks themselves, hormone therapy probably makes little to no difference. However, it does increase the chance of a stroke and of a blood clot in a vein. With combined therapy, the risk of such a clot rises from 2 to between 4 and 11 in 1,000 women per year. The risk of a stroke rises from 6 to between 6 and 12 in 1,000 after 3 years. With oestrogen alone, the numbers are similar. Using hormone therapy as protection against heart and vascular disease makes no sense: no benefit for that purpose has been shown.
Beyond the heart and bones, there are other risks that influence the decision. Combined hormone therapy probably increases the risk of breast cancer: from 19 to between 20 and 30 in 1,000 women after 5.6 years. Oestrogen alone (after removal of the uterus) does not show a measurable increase in that risk. In women over 65, combined therapy also increases the risk of dementia. Both forms additionally raise the chance of gallbladder problems that require surgery.
A large Danish study found a slightly lower overall death rate among women using hormone therapy, but that link has not been shown to be a direct cause-and-effect relationship. In women who had both ovaries removed before the age of 55, hormone therapy was strongly linked to a lower risk of death, although that group was small. Whether you benefit from hormone therapy depends heavily on your situation: your age, which type of hormone therapy, and whether you have symptoms or a particular medical history. Always discuss it with your doctor.
This answer draws on several combined summaries of dozens of studies, including studies in people. The researchers rated the certainty of the evidence as moderate for most outcomes (stroke, blood clots, breast cancer, heart attack) and low for some others, such as the overall fracture risk with oestrogen alone. Moderate certainty means that the effect found is probably close to reality, but some uncertainty remains. The finding on bone protection was confirmed by several independent combined summaries and has the strongest support of all the outcomes examined.
Does my weight and metabolism change during the menopause transition?
During the menopause transition, your body composition changes profoundly: more fat mass, less muscle and more dangerous abdominal fat. Your total weight on the scale may barely shift, yet something genuinely significant is taking place.
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.
Which hormone levels are tested during menopause?
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.
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 genuinely help with menopause symptoms?
Soy isoflavones and phytoestrogens from red clover have the strongest support for menopause symptoms, particularly hot flushes. For vitamin D there is moderate evidence that it helps prevent bone fractures, which is especially relevant during and after menopause.
What does pregnancy do to your hormone balance in the long run?
Pregnancy and breastfeeding bring measurable, sometimes long-lasting hormonal changes, of which the genital and urinary complaints caused by oestrogen loss are the best documented. Knowing what to expect makes it easier to talk about these issues and seek help.