Metabolic Syndrome and Menopause

When you reach menopause not only may you experience symptoms which affect your quality of life, but inside your body invisible changes also happening which may affect your future health. These are metabolic changes. After menopause, the risk of developing metabolic syndrome increases. Postmenopausal women have 2-3 times higher prevalence of metabolic syndrome compared to premenopausal women.

This article explains more about metabolic syndrome and menopause.

What is metabolic syndrome?

Metabolic syndrome isn’t one problem, it’s a cluster of risk factors that tend to appear together. You’re considered to have metabolic syndrome if you meet three or more of the following:

According to the new IDF definition, to have the metabolic syndrome you must have:

• Increased waist size (typically over 80 cm in women) – if your BMI is >30kg/m², central obesity can be assumed and waist circumference does not need to be measured.

Plus any two of the following risk factors

• High blood pressure – systolic BP ≥ 130 or diastolic BP ≥ 85 mm Hg or treatment of previously diagnosed hypertension
• High fasting glucose or insulin resistance – fasting blood glucose of ≥ 5.6 mmol/L or previously diagnosed type 2 diabetes (if above 5.6 mmol/L, an oral glucose tolerance test is recommended)
• Raised triglycerides – ≥ 1.7 mmol/L or on specific treatment for this lipid abnormality
• Low HDL (good) cholesterol – < 1.29 mmol/L in females or on specific treatment for this lipid abnormality

This combination of risk factors matters, because they increase the risk of type 2 diabetes, heart disease, stroke, and fatty liver disease.

What metabolic changes happen at menopause?

Oestrogen affects many metabolic processes, including how the body handles glucose, stores fat, and manages inflammation. When oestrogen levels fall, several changes happen at once:

• Change in body shape. Even if your weight stays stable, body fat redistributes from hips and thighs to the waist. Visceral fat (around the organs) is more metabolically active and drives inflammation and insulin resistance.
• Insulin becomes less effective (insulin resistance increases). This makes the body work harder to keep blood sugar in range, insulin levels may rise, insulin loves to lay down body fat, this can often lead to weight gain and higher fasting glucose.
• Muscle mass declines.
• Blood pressure tends to rise as we age. Arterial stiffness, endothelial dysfunction and changes in the sympathetic nervous system result in higher blood pressure. The risk of hypertension increases in the postmenopausal years as women age.
• A change in blood lipids. A pro-atherogenic lipid profile develops. Increase in total cholesterol, LDL-C (bad cholesterol) and triglycerides and a decrease in the function of HDL-C (good cholesterol). These changes can result in an increase in plaque in the artery walls.
• Changes in blood vessels. Oestrogen supports healthy blood vessels. It helps keep arteries flexible, reduces inflammation, improves lipid profiles, and enhances nitric oxide (NO) production (which relaxes blood vessels). When oestrogen drops arteries lose elasticity, blood vessels dilate less effectively, inflammatory activity increases and oxidative stress rises. This all results in stiffer, narrower arteries.

What is insulin resistance?

Insulin resistance develops when the body’s cells, mainly in the liver, muscles and fat tissue, stop responding properly to insulin. Insulin is made by the pancreas to help move glucose from the bloodstream into cells. When cells become less responsive, glucose stays in the blood instead of being taken up, so the pancreas releases more insulin to compensate. This leads to hyperinsulinaemia, where insulin levels run chronically high.

Over time, constantly pushing the pancreas to produce excess insulin strains the beta cells. Their function gradually declines, and eventually they can no longer keep up. When the pancreas cannot produce enough insulin to overcome the resistance, blood glucose rises, causing hyperglycaemia and ultimately leading to a diagnosis of type 2 diabetes.

Importantly, harmful changes begin long before diabetes is diagnosed. Persistently high insulin and glucose promote fat build-up inside the liver and muscles, including increased triglycerides, which further worsen insulin resistance and drive the cycle on.

What is central obesity?

Obesity is associated with insulin resistance and the metabolic syndrome. It contributes to hypertension, high serum cholesterol, low HDL-c and hyperglycaemia, and is associated with higher risk of cardiovascular disease. However, where fat is stored matters even more than total weight. Excess fat around the abdomen (easily assessed by measuring waist circumference) is a far better indicator of metabolic syndrome risk than BMI alone.

Can having metabolic syndrome increase the risk of having cardiovascular disease?

Yes, having metabolic syndrome can increase the risk of cardiovascular disease. Cardiovascular disease (CVD) refers to a broad group of disorders that affect the heart and blood vessels. It includes both congenital or inherited conditions and those that develop later in life, such as coronary heart disease, atrial fibrillation, heart failure, stroke, and vascular dementia.

Coronary heart disease (CHD) is sometimes called ischaemic heart disease (IHD) or coronary artery disease (CAD). It occurs when coronary arteries become narrowed by a build-up of atheroma, a fatty material within their walls.

Every 16 minutes a woman in the UK is admitted to hospital due to a heart attack.

Cardiovascular disease (CVD) represents the leading cause of death and accounts for almost 50% of all deaths in women worldwide. Hypertension, hyperlipidemia and diabetes remain the most crucial risk factors contributing to cardiovascular death in women.

Is there any way of managing this?

Yes, being aware you have these metabolic changes means you have a chance to make some changes to protect your future health and midlife is a perfect time to do this. Lifestyle choices matter.

• Prioritise strength training. Two or three sessions a week is one of the best ways to reverse muscle loss and improve glucose control. If you can see a personal trainer to get you on the right track with safely introducing resistance training.
• Eat enough protein in your diet. Helps maintain muscle and reduces hunger.
• Prioritise moderate intensity exercise: aim for 150-300 minutes a week – aim to reduce your time sitting
• Choose whole foods most of the time. Vegetables, fruit, whole grains, legumes, lean proteins, nuts, and olive oil support metabolic health. The mediterranean diet is associated with health benefits. Seeing a nutritionist can help if you need advice.
• Manage stress – we can’t get away from stress but we can try and manage stress
• Prioritise good quality sleep – this is important
• Weight management – weight increases at midlife by about 0.5kg a year – it is easy not to notice this – but keeping an eye on your weight and aiming to keep it in the healthy range can help.
• Know your numbers. Waist circumference, blood pressure, diabetes blood test, and a lipid profile give a clear picture of your metabolic health. Your GP can help you arrange this.
• Know your risk. Your Dr. can check a QRISK3 assessment of risk of cardiovascular disease
• Medication. In people for whom lifestyle change is not enough and who are considered to be at high risk for cardiovascular disease drug therapy (to reduce blood pressure or to reduce cholesterol) may be needed.
• Don’t forget your bones – protecting yourself from osteoporosis is important. Have a look at the Royal Osteoporosis Society website For advice about bone health, about vitamin D requirements, about dietary calcium requirements, and have an assessment for fragility fracture risk if you have risk factors.
• Don’t forget brain health – making healthy lifestyle choices, socialising and learning a new skill can help to reduce risk of dementia.

References

1. International Diabetes Federation (2006). METABOLIC SYNDROME. [online] Available at: https://idf.org/media/uploads/2023/05/attachments-30.pdf.
2. Our vision is a world where everyone has a healthier heart for longer. UK Cardiovascular Disease Factsheet. (2025). Available at: https://www.bhf.org.uk/-/media/files/for-professionals/research/heart-statistics/bhf-cvd-statistics-uk-factsheet.pdf?rev=0759fdcb1d3248f9b9331c4039e6075c&hash=B0C8BEA1A48B306E4D2FC73C4265FBFA.
3. ‌Uddenberg, E.R., Safwan, N., Saadedine, M., Hurtado, M.D., Faubion, S.S. and Shufelt, C.L. (2024). Menopause transition and cardiovascular disease risk. Maturitas, [online] 185, p.107974. doi:https://doi.org/10.1016/j.maturitas.2024.107974.
4. ‌Mukherjee, A. and Davis, S.R. (2025). Update on Menopause Hormone Therapy; Current Indications and Unanswered Questions. Clinical Endocrinology. doi:https://doi.org/10.1111/cen.15211.
5. I. Lambrinoudaki and Armeni, E. (2023). Understanding of and clinical approach to cardiometabolic transition at the menopause. Climacteric, 27(1), pp.68–74. doi:https://doi.org/10.1080/13697137.2023.2202809.

For an appointment with Dr Carys Sonnenberg at Rowena Health to talk about this, please click here.

Updated September 2026 Dr Carys Sonnenberg

© Rowena Health | rowenahealth.co.uk

The information in this article was correct at the time of publication. This is for general information only and is not intended to be, nor should it form, individual medical advice. Always seek advice from your health professional about you medical care. Throughout the Rowena Health website, we use the term women when describing people who experience hormonal symptoms. However, we acknowledge not only those who identify as women require access to menopause and hormone health information. For example, some trans men, non-binary people, intersex people or people with variations in sex characteristics may also experience menopausal symptoms and hormonal mood changes such as PMS and PMDD.

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