TORONTO — As women age, they face several health risks related to the menopause transition. Treating these risk factors, which include obesity and high blood pressure, can reduce the risks for diabetes, cardiovascular disease (CVD), and other health problems.
These risks also can be driven by age-related changes that occur around the time of menopause, said Marie K. Christakis, MD, MPH, assistant professor of obstetrics and gynecology and menopause and mature women’s health at the University of Toronto in Toronto, during a presentation at the Diabetes Canada and Canadian Society of Endocrinology and Metabolism (CSEM) Professional Conference 2025.
“Women at midlife are in what I term a cardiovascular storm,” she said. “More than 42% of American women between ages 40 and 59 years have a BMI over 30, and the prevalence of obesity is higher among women between ages 40 and 59 years. Generally, menopause occurs naturally between ages 46 to 54 years, and central adiposity is a particular issue.”
Target Symptoms
While diet and exercise play an important role in achieving and maintaining a healthy weight, Christakis pointed out that menopausal women may face barriers to losing weight such as lack of sleep, stress, and new medications.
Sleep disturbances can also result from menopause-related symptoms such as vasomotor changes — hot flashes and night sweats — or mood changes.
“So, even in women who say, ‘I don’t have hot flashes or night sweats, but I have this independent sleep concern,’ there is still value in targeting these symptoms to improve their overall cardiometabolic profile,” said Christakis.
Cognitive behavioral therapy can be helpful for women who experience vasomotor symptoms and mood disturbances, as well as sleep disturbance, she said.
When counseling women about menopause, it’s important to talk about overweight and obesity as a biologically-driven metabolic disease, not as a choice, she added.
Overall, she said, “Menopause could be reframed as a moment of opportunity for prevention.”
Early Menopause, Higher CVD Risk
Early menopause is associated with a higher CVD risk in certain groups, including Black or Hispanic women, women who had a later onset of menses, women who have been pregnant fewer times, those with a history of smoking, and those who had worse CV health during their reproductive life.
However, it’s not clear if earlier menopause causes this “cardiovascular storm,” or if certain women have a genetic predisposition to both earlier menopause and higher CV risk, Christakis said.
Furthermore, she added, iatrogenic menopause — menopause that’s caused by some form of treatment — also is associated with higher CV risk.
“It’s important to note that hormone therapy is protective in these situations,” she said.
Hormone therapy may also reduce the risk for new-onset type 2 diabetes, according to a meta-analysis in Diabetes, Obesity and Metabolism. The analysis of 107 randomized controlled trials also found that the therapy led to reductions in abdominal fat, blood pressure, and lipids in postmenopausal women.
But despite supportive evidence about the potential benefits of hormone replacement therapy for CV health, Christakis thinks that decisions need to be more nuanced.
“A woman who is concerned about her cardiovascular profile but is not planning to go on hormone therapy for the reduction of menopause symptoms or for her bone health really should not be recommended to go on hormone therapy,” she said, “because it is not a favorable benefit-to-risk profile.”
Nevertheless, the US FDA recently removed a “black box” warning on hormone replacement therapy for menopause and approved two new drugs “to expand treatment options for menopausal symptoms.”
Blood Vessel Elasticity
“Estrogen production helps maintain the elasticity in blood vessels, reduces low-density lipoprotein (LDL) cholesterol, promotes high-density lipoprotein [HDL] production, and controls metabolism, appetite, fat distribution, and energy expenditure,” Sheryl Ross, MD, a women’s health expert at Providence Saint John’s Health Center in Santa Monica, California, told Medscape News Canada. “Losing these heart-health benefits increases the risk for CVD in menopausal women.
“Taking estrogen replacement therapy can help by bringing back the benefits of elasticity in blood vessels, reducing LDL levels, and promoting HDL levels, which support heart health,” she said. Therefore, for optimal CV benefits, it is suggested that a woman start estrogen replacement therapy upon entering menopause.
Jennifer Wong, MD, medical director of noninvasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California, agreed that early treatment with medications can help mitigate the effects of risk factors such as hypertension and dyslipidemia, whereas a heart-healthy diet, exercise, and adequate sleep can significantly reduce the chances of developing them.
Christakis and Wong reported having no relevant financial relationships. Ross is the CMO of Menopause Hormone Therapy at QuickMD and a Menopause Certified Practitioner.
Shawn Radcliffe is a freelance health and science journalist based in Ontario, Canada, with more than 15 years writing about general health, medical research, mental health, and other topics for print and online publications. He previously performed laboratory and clinical research and research administration at universities in Philadelphia and Portland, Oregon. He has a master’s degree in science education from Drexel University.
