Menopause and the Metabolic Pathway

This afternoon Irene Lambrinoudaki presented on menopause and its metabolic implications. In previous posts we have looked at the impact of MHT on cardiovascular disease but what effect does menopause have?

Cardiovascular disease (CVD) is the leading cause of death worldwide and overall mortality rates are continuing to grow in both genders.  There is also concern about the global rise of diabetes with 1 in 10 people suffering from the condition that causes up to 15% of deaths in women. With both metabolic conditions being more prevalent in women than men it is important to analyse the impact of menopause on these conditions. As shown in the diagram below from Davis et al. menopausal oestrogen decline can have both direct effects on the vasculature and indirect effects on cardiovascular risk factors which contribute to atherosclerosis resulting in ischaemic heart disease and/or strokes.

Obesity is a risk factor that increases profoundly in women with age, this risk is added to during menopause transition which is associated with increases in fat mass and decreases in lean mass without effect in total body weight. This results in fat shifting from peripheral regions to central regions in the body. Reduction in estrogen also results in decreased resting energy expenditure, decreased physical activity and decreased energy expenditure during physical activity. Not only activity, estrogen can also have an impact on the control of eating, with lower estrogen levels linked to higher daily calorie intake as a result of satiety and emotional eating.

Therefore it is key that patients undergo exercise to counteract the metabolic implications of menopause. Exercise will increase energy expenditure, reduce inactivity, decrease chronic inflammation and oxidative stress, regenerate muscles and increase muscle mass which will increase metabolic resting rate. The Rotterdam Study (Koolhaas CM et al.) is proof that exercise can be extremely beneficial. The study showed that overweight and obese patients who engaged in a high level of physical activity expressed significantly less CHD events compared to those who engaged in a low level of physical activity. This study highlights that exercise is a more important factor than diet during menopause transition.

Menopausal transition is associated with an adverse cardiometabolic profile. As a result lifestyle modifications such as quitting smoking, routine exercise and engaging in a healthy diet are key to reducing risk from obesity, diabetes and hypertension. It is essential we all promote a healthy lifestyle to women going through menopause to combat metabolic risk!

What tips do you give patients to keep active? We’d love to hear your recommendations in the comments section below.