Menopause is the natural stage of life when the ovaries make less of the hormone oestrogen.¹ In recent years, researchers have started to look at how this change is linked to the gut microbiome – the community of bacteria that live in the gut.² This article looks at what current research does and does not show about menopause, gut health and these bacteria.

Can changes in oestrogen during menopause affect gut bacteria?

Research suggests that the fall in oestrogen during menopause is linked to changes in the gut bacteria.³ Some of these bacteria help the body manage oestrogen. They make an enzyme that switches oestrogen back into an active form, so the body can take it up and use it again. This group of bacteria and their genes is called the “estrobolome”.³

Some studies have found that, after menopause, the gut tends to hold a smaller range of different bacteria than before.² The mix of bacteria also shifts to look more like the mix typically seen in men.³

Oestrogen helps keep the gut lining strong. As oestrogen levels fall during menopause, the gut lining can become leakier which may let bacteria pass into the body and cause low-level inflammation.³ This relationship between oestrogen and the gut bacteria seems to work both ways: oestrogen affects the bacteria, and the bacteria affect how much oestrogen the body keeps.¹

What is the relationship between the gut microbiome and menopause symptoms?

Research links changes in the gut bacteria not only with menopause symptoms but also with the severity of symptoms.³ Menopause symptoms vary from woman to woman. They can include hot flushes, night sweats, mood changes, brain fog, sleep problems and changes in bone health.³

A study has found that women with menopause symptoms tend to have an imbalance of gut bacteria than menopausal women without symptoms.³ After menopause, changes in the gut microbiome and its functions may negatively affect metabolism and bone health, potentially contributing to a higher risk of certain diseases.³ The decrease in helpful bacteria means less oestrogen is recycled. This has been linked to changes in blood fats, memory and bone strength.¹

Problems with memory and “brain fog” are often reported during menopause, and whether gut bacteria play a part has been flagged as a question for future research.³ Most current research focuses on the link rather than proving cause and effect, and it is hard to separate the effects of menopause from the effects of getting older.³

Can probiotics or fermented foods help during menopause?

Early research suggests that probiotics and some foods (prebiotics) may help support the gut bacterial diversity during menopause, but the evidence is still limited.³ Probiotics are live bacteria that may bring health benefits when eaten in adequate amounts.²

Prebiotics and probiotics may help ease certain menopausal symptoms by supporting healthy gut bacteria.³ Prebiotics – food parts such as fibre that feed helpful bacteria – have also shown promise for some symptoms.³

Plant foods such as soya contain natural compounds called phytoestrogens. The benefits of soy phytoestrogens may depend on gut health. Some women have specific gut bacteria that convert soy compounds into equol, a substance with stronger estrogen-like effects. Studies suggest these women may experience greater relief from hot flashes.² Fermented foods such as yoghurt have also been tested in studies for menopausal symptoms.³

Hormone replacement therapy is often the first treatment offered for menopause symptoms. However, it is not suitable for everyone. Some women cannot use HRT because of certain medical conditions. Others may choose not to use it because they have experience side effects of prefer alternative treatment options ³ Findings so far are mixed, and any benefit often depends on a strain-specific type of bacteria. Larger studies are still needed to confirm whether probiotics help, so they are not yet an established treatment.²

Does menopause increase the risk of conditions such as IBS?

It is not clear that menopause raises the risk of developing irritable bowel syndrome (IBS), although symptoms may feel more severe after menopause.^4,5 IBS is a long-term gut condition that causes belly pain and changes in how often or how easily a person passes stools.⁴ IBS is more common in women than in men.⁴

One study looked at people with IBS. Women who had gone through menopause reported more severe symptoms than younger women with IBS. Older and younger men showed no such difference.⁴

After menopause, some women also report more bloating, gas and constipation than before.⁴ But research on whether menopause itself brings on or worsens IBS is limited, and the results so far are mixed.⁵ Hormonal changes may act through the gut–brain axis to affect how the gut moves, how sensitive it feels, how well its lining holds up, and how active its immune system is. ⁵ Probiotics have been studied for IBS, but a recent expert review from the American Gastroenterology Association found there was not enough strong evidence to recommend them.⁵ If gut symptoms are troubling you or do not go away, a healthcare professional can help you understand what is causing them and what might help.

What dietary approach best supports gut health during menopause?

A diet rich in plants and fibre can help support gut bacteria during menopause.³ Gut bacteria feed mainly on fibre from plant foods.³ Eating more fibre has been linked with steadier gut bacteria and a lower menopause symptom burden.² A Mediterranean-style diet of vegetables, fruit, beans, nuts and wholegrains has been linked with improvements in hormone-related and heart-health measures around menopause.² Plant foods also supply phytoestrogens (plant-based compounds that are structurally similar to estrogen, which have been studied for their potential therapeutic roles in women’s health, and a plant-rich, low-fat diet has been linked with milder hot flushes in some studies.² There’s no single ‘ideal’ gut microbiome for women in perimenopause, but a more varied and greater diversity of gut bacteria is linked with better oestrogen balance — while a less varied microbiome is tied to the inflammation behind many perimenopausal symptoms.²

Conclusion

Menopause brings a drop in oestrogen, which research increasingly links with changes in gut bacteria — and the two appear to influence each other.¹ This connection has prompted interest in whether supporting the gut could help with menopause. Non-hormonal options like prebiotics and probiotics show early promise for easing symptoms such as hot flushes, inflammation and metabolic changes — but the science is still young, and more research is needed to confirm how well they work.¹

FAQ

Q1: Why might my digestion change during menopause?

Lower oestrogen can affect how the gut works and is often linked with symptoms such as bloating, constipation and stomach pain.³

Q2: Does HRT affect gut health?

It may. Hormone replacement therapy (HRT) supplies exogenous oestrogen that the body loses at menopause. In one study, women taking HRT had more varied gut bacteria – closer to the balance seen before menopause – than women not taking HRT. This is an early finding, and more research is needed.²

Q3: Are probiotic supplements worth taking during menopause?

Some small studies suggest certain probiotics may help, but the evidence is limited and depends on the exact type of bacteria.² Talk to a healthcare professional before starting any supplement.

Q4: What can I eat to ease menopause symptoms?

Diets high in fibre, low-fat, and plant foods have been linked with a lower menopause symptom burden, and so have foods with a lower glycaemic index (those that raise blood sugar more slowly). For fibre, this may be partly because of its effect on gut bacteria.²

Q5: When should I see a doctor about gut symptoms during menopause?

If you have ongoing or worrying gut symptoms, such as lasting pain, bloating or a change in your normal bowel habits, a healthcare professional can help you find out what’s going on.

This article was written with the assistance of generative AI technology and reviewed for accuracy.

Long COVID (symptoms persisting for four weeks or more after the acute infection) and menopause can cause some of the same symptoms, and they often affect women around the same time of life¹. This article looks at how their symptoms overlap, whether COVID-19 affects the timing of menopause, how doctors try to tell them apart, and what current research does and does not show.

Can long COVID cause symptoms that overlap with menopause?

Yes – long COVID has more than 100 possible symptoms, and many of them overlap with menopause symptoms ¹. Long COVID is when symptoms continue for four weeks or more after a COVID-19 infection ¹. It can affect many parts of the body ¹. Both long COVID and menopause can cause tiredness, brain fog (problems with memory and concentration), low mood, poor sleep and joint aches ^1,2.

The two conditions also affect women of a similar age. Women aged 45 to 54 are the age group most likely to report long COVID ¹. This is also the usual age for the onset of perimenopause (the years leading up to menopause) and menopause ¹. Some women feel that having both conditions together makes their symptoms worse ¹. Having similar symptoms does not prove that one condition causes the other; it means the two can be easy to confuse ¹.

Are women who had COVID-19 more likely to experience early menopause?

The honest answer is that we do not yet know, and the evidence so far is limited ³. COVID-19 can cause short-term changes to the menstrual cycle, such as irregular, missed or heavier periods ³. In one multi-country survey in menstruating women with long COVID, about a third reported the above menstrual problems/ issues ³.

In another survey, half of the women with long COVID reported that their periods had stopped or changed after long COVID infection ¹. Surveys like these record women’s own experiences, but do not show whether COVID was the cause ¹. Some studies have found temporary changes in the hormones that reflect ovarian function ⁴. These include a short-term fall in anti-Mullerian hormone, a marker of ovarian reserve (healthy, age-appropriate quantity of remaining eggs) ⁴.

The virus may affect the ovaries because it can enter ovarian tissue and cause inflammation ⁴. COVID-19 has also been linked in a few studies to premature ovarian insufficiency ⁴. This is when the ovaries stop working normally before the age of 40 ⁴. However, most of these changes appear to be temporary, and the long-term effects on the ovaries are not yet known ⁴. Overall, whether COVID-19 makes menopause happen earlier is not established ⁴.

How can a doctor distinguish between long COVID symptoms and menopause?

There is no simple test that separates long COVID from menopause, so doctors need to look at the whole picture ¹. After the age of 45, menopause is usually identified from your symptoms and changes in your periods, not from a blood test ².

A doctor may consider your age and whether your periods have changed ¹. They may ask when your symptoms began, including whether they started after a COVID-19 infection ¹. Long COVID often includes symptoms that are less typical of menopause, such as breathlessness or feeling much worse after activity ^1,5,6. These can be a clue ^1,5.

As the overlap in symptoms is so close, the two can be hard to tell apart, and they can also occur together ¹. Guidelines advise that when someone has menopause-like symptoms, other possible causes should also be considered ⁷.

Should women with long COVID who are in the right age group be assessed for menopause?

For women in the usual menopause age range who have these overlapping symptoms, greater awareness of menopause in women with long COVID alongside regular checks can help ¹. This may help avoid a missed or mistaken diagnosis and lead to more suitable care ¹.

Menopause can be identified from symptoms, age and change in menstrual cycle pattern, and there are treatments that may ease menopausal symptoms ². If menopause is the cause, or part of the cause, treating it may also make day-to-day life easier ². Menopause care can often be managed by your doctor ⁷. They can refer you to experts with more experience in menopause if your situation is more complex or your symptoms do not improve ⁷.

What does current research say about the overlap between long COVID and menopause?

Research on this topic is still at an early stage with most of what we know based on small studies where women have reported their symptoms ¹. These studies show that long COVID and menopause share many symptoms, and that women often feel each condition makes the other worse, but research has not shown that one condition causes the other ¹.

In fact, it has been shown that although women were more likely than men to have long COVID, having gone through menopause did not by itself raise the risk ¹. Other research has looked at how COVID-19 affects the menstrual cycle and the ovaries, and has found mostly short-term changes ^3,4. It has been suggested that certain hormones such as oestrogen and progesterone may play a part by affecting inflammation in the body, but these ideas are not yet proven ¹. Larger and longer studies are needed before firm conclusions can be drawn ¹.

Conclusion

Long COVID and menopause can cause many of the same symptoms, and they often affect women at the same time of life ¹. This can make them hard to tell apart ¹. Current research shows this overlap, but it has not shown that one condition causes the other ¹. The evidence on whether COVID-19 affects the timing of menopause is still limited ^3,4. If you have long COVID and you are in the age range where menopause may begin, being assessed for menopause as well can help ¹. Menopausal symptoms can be treated ². A healthcare professional can look at your symptoms, age and history and advise on how to better manage your menopause journey and understand the available options for relieving symptoms ^1,2.

FAQ

1. Are long COVID and menopause symptoms similar?

Yes. Both can cause tiredness, brain fog, low mood and poor sleep ¹. Many of these are also recognised symptoms of menopause ². Since the symptoms of both are so similar, the two can be easy to confuse ¹.

2. Can COVID-19 bring on early menopause?

The evidence is limited and not clear. COVID-19 can cause short-term changes to the menstrual cycle and to ovarian hormones and, in some studies, has been linked to the ovaries stopping work early, before the age of 40 ⁴. Most of these changes seem to be temporary, and there is no firm evidence that COVID-19 makes natural menopause happen earlier ⁴.

3. Is there a test to tell long COVID and menopause apart?

No single test can separate them ¹. After the age of 45, menopause is usually identified from your symptoms and changes in your periods, not from a blood test ². A doctor will look at your age, your periods and when your symptoms started to help work out the cause, and the two can also occur together ¹.

4. Should I be checked for menopause if I have long COVID?

If you are in the usual menopause age range and have these symptoms, being assessed for menopause as well can help ¹. Menopause can be identified from your symptoms and age, and there are treatments that may ease its symptoms ². Your usual doctor can do this and can refer you to someone with more menopause experience if needed ⁷.

5. Does menopause make long COVID worse, or the other way round? Women often report that the two conditions make each other worse, but this comes mainly from what people report about their own symptoms, not from studies that prove a cause ¹. It has been shown that women were more likely than men to have long COVID but going through menopause did not by itself raise the risk ¹. Researchers say larger, longer studies are needed to understand the link ¹.

This article was written with the assistance of generative AI technology and reviewed for accuracy.

Menopause is the time when your periods stop for good, usually between 45 and 55 years of age¹. Before menopause comes a transition stage called perimenopause¹. Learning about this stage early can help you know what to expect. This article explains simple steps you can take in the years before menopause: healthy habits, useful health checks, support, what to expect, and how to find menopause care.

What can I do in my 40s to prepare for the menopause transition?

Building healthy daily habits in your 40s can ease menopausal symptoms and support your heart and bone health over time ¹. During the menopause transition, body fat tends to rise and muscle tends to fall, and this change can begin about two years before your last period ². Staying active and keeping your muscles strong are important during this time ³. Women are advised to do at least 150 minutes of moderate intensity activity each week, such as brisk walking, cycling or swimming ^{1, 2}. This can be spread throughout the week in whatever way suits you.

A balanced diet also helps: one that is low in saturated fat and salt can support your heart ¹. Getting enough calcium and vitamin D helps keep your bones strong, and adults are generally advised to get about 1000 to 1200 mg of calcium and 800 to 1000 units of vitamin D each day ⁴. This matters because bones can weaken more quickly around menopause ⁴. Keeping a healthy weight can also help reduce vasomotor symptoms, as extra weight can make them worse ².

Limiting/ reducing excessive alcohol can also help your bones, because more than two drinks a day in women has been linked with bone loss ⁴. Not smoking helps your bones and your heart, because smoking raises the risk of weak bones and heart disease ¹. The years around menopause are an important time to care for your heart, because the risk of heart problems can rise during this stage ².

Which health checks are worth having as you approach menopause?

There is no routine single test that can show exactly when menopause will happen ¹. As menopause approaches, the focus is usually on general health checks – such as your heart and bones – rather than on a test for menopause itself. After the age of 45, menopause is identified from your symptoms and the changes in your periods, not from a blood test ¹.

Cholesterol levels can rise around the menopause, while blood pressure and blood sugar tend to rise with age, so these are useful to check from time to time ². Body fat around the middle can also increase during this stage, which can affect heart health ². Heart disease is a leading cause of death in women, so it can help to care for your heart early ¹. If you have a higher chance of weak bones, a healthcare professional can advise whether a bone scan is needed ⁴. It is also important to continue with any regular health screening offered to you ³.

How can I get support to help me through the menopause transition?

Access to information, education, and support can help women better cope with the menopause transition, especially when sought early. This support is linked to faster improvements in health-related quality of life ⁵. Joining a menopause education or support group, or having one-to-one support sessions, can improve quality of life and reduce some of your symptoms ⁵. These sessions often cover the changes in your body, ways to care for your health, and how to manage everyday worries ⁵. They also give you a platform to share experiences with other people at the same stage of life ⁵.

Learning about your choices early can help you make decisions that are right for you when symptoms begin ⁵. Managing stress is part of preparing too, as stress can make menopause symptoms worse.⁶ Women who were upset by a stressful life event had about 21% more hot flushes and night sweats than women who had no such event ⁶. So gathering good information, arranging support, and finding ways to manage stress can all be part of getting ready.

What should I know about menopause before my symptoms start?

It helps to know that menopause is a normal stage of life, that symptoms can begin years before your periods stop, and that they are different for each person. Menopause usually happens between the ages of 45 and 55 ¹. Perimenopause is the stage before it, when periods become irregular and symptoms may start ^1,7.

In early perimenopause, the time between periods changes by about seven or more days from your usual pattern; later, periods become less frequent until they stop ¹. Symptoms can begin up to about ten years before your last period ⁷. The symptoms reported most often are hot flushes and night sweats, which affect about 70 to 80% of women ¹. Other symptoms include trouble sleeping, low mood, joint aches, problems with memory, and vaginal dryness ¹.

Symptoms last on average more than seven years, and more than a third of women have them for longer ¹. Not everyone has troublesome symptoms, and some people have very few ¹. You can still become pregnant during perimenopause, so you still need contraception until menopause is confirmed ⁷.

How do I find healthcare support from someone with menopause expertise? Menopause care can often be managed by your usual primary care provider, and you can ask to see someone with extra menopause training if your situation is more complex ⁸. You do not always need a specialist. A healthcare professional can explain your options and, if needed, refer you to someone with more experience in menopause ⁸. A professional with menopause training can look at your symptoms, your medical history and your own wishes, and help you choose what is right for you ⁸. It can help to see someone with menopause expertise if you have a health condition that affects your treatment choices, or if your symptoms do not improve ³. Whatever your situation, help and support are available, and a good first step is to speak with a healthcare professional ¹.

Conclusion

Preparing for menopause does not need to be difficult. Healthy daily habits, care for your heart and bones, good information, and support can all help you feel ready for this stage ¹. Knowing what to expect, and where to find help, means you can make a plan that suits you, together with a healthcare professional ¹

FAQ

1: When does menopause usually happen?

Menopause usually happens between the ages of 45 and 55 ¹. Before it is perimenopause, the stage when periods become irregular ⁷. Symptoms can begin several years before your periods stop ⁷.

2: Do I need a blood test to find out if I am near menopause?

If you are over 45, you usually do not need a blood test, because menopause is identified from your symptoms and your periods ¹. A blood test called FSH may be used if you are under 40, or between 40 and 45, when menopause is suspected earlier than usual ¹. A single test result is not always enough to be sure ¹.

3: Can I still get pregnant during perimenopause?

Yes. You can still become pregnant during perimenopause, so you need contraception until menopause is confirmed ⁷. Hormone replacement therapy is not a form of contraception ⁸.

4: Can changes to my daily habits help around menopause?

Yes. A healthy diet, regular physical activity, not smoking, and drinking less alcohol can ease symptoms and protect your heart and bones ¹. These habits can help at any age, and the years around menopause are a useful time to begin ².

5: What can help me cope with symptoms? Several options can help. Education and support sessions can improve quality of life and reduce some symptoms ⁵. Hormone replacement therapy can relieve symptoms, and talking therapies such as cognitive behavioural therapy (a structured talking treatment) can also help ¹. A healthcare professional can explain which options may suit you ^1,8.

This article was written with the assistance of generative AI technology and reviewed for accuracy.

Menopause is a natural part of life but it is also a turning point for heart health. Research shows that the hormonal changes of the menopausal transition are associated with an increased risk of cardiovascular disease (CVD), which remains the leading cause of death in women worldwide.^1,2 The good news is that understanding these changes early can help you and your healthcare provider take steps to protect your heart during midlife and beyond.

Why is menopause considered a turning point for heart health?

Menopause marks a significant shift in cardiovascular risk for women. Before menopause, the incidence of heart disease in women is delayed by 10 years as compared to men,^1,2 a difference that is thought to be linked to the protective effects of estrogen on blood vessels during the reproductive years.

Studies show that the rate of cardiovascular disease in women at midlife between the ages of 40 and 65 is rising, and this increase coincides with the timing of the menopausal transition.¹ Women who experience menopause before age 45 may face a higher cardiovascular risk than those who go through menopause at the typical age of around 50.^2,5

This does not mean heart disease is inevitable. But it does mean the menopausal transition is an important moment to pay attention to cardiovascular health.

What happens to your blood fats (cholesterol and triglycerides) during menopause?

Menopause is associated with significant changes in blood fat levels that may raise the risk of heart disease. Research shows that levels of LDL cholesterol (often called “bad” cholesterol), total cholesterol, triglycerides, and a particle called lipoprotein(a) tend to increase during and after the menopausal transition.^3,4

At the same time, HDL cholesterol (often called “good” cholesterol) may become less effective at protecting arteries, even when its measured level appears stable.⁴

How does estrogen normally protect blood vessels?

Estrogen plays an active role in keeping blood fats at healthy levels. It supports the liver’s ability to clear LDL cholesterol from the blood and helps blood vessels stay flexible and responsive.^1,3,4 When estrogen levels decline at menopause, these processes are disrupted, contributing to a blood fat profile that may increase the risk of plaque building up in arteries.³

Why do these changes happen at menopause and not just with age?

Studies have shown that changes in LDL cholesterol, total cholesterol, and artery structure during the menopausal transition occur independently of chronological aging alone.^1,3 Menopause itself, not just aging, seems to cause important changes in how the body processes fats in the blood. Regular lipid monitoring during and after the menopausal transition is therefore important.

Does your past pregnancy or gynaecological history affect your heart risk at menopause?

Your reproductive history may offer important clues about your future heart health. Several conditions that can occur during pregnancy are now recognised as risk factors for cardiovascular disease later in life and this is an important part of your medical history to share with your healthcare provider.

Women who experienced gestational diabetes, gestational hypertension, or pre-eclampsia during pregnancy have been found to have a higher risk of cardiovascular disease in the years following menopause.^1,5 For example, a diagnosis of gestational diabetes has been associated with a two-fold higher risk of cardiovascular events compared to women without this condition.¹ A history of pre-eclampsia has been linked to longer-term risks including hypertension, coronary artery disease, and stroke.¹

Women who experienced early menopause (before age 45) or premature loss of ovarian function (before age 40) may also face a higher cardiovascular risk, partly because they have had fewer years of estrogen’s natural protective effects.⁵

If any of these conditions apply to you, it is worth discussing your cardiovascular risk proactively with a healthcare professional.

Are hot flushes and other menopause symptoms linked to heart risk?

Some menopause symptoms may be associated with a higher cardiovascular risk though evidence is limited or inconclusive regarding a direct causal link. Hot flushes and night sweats are the most common symptoms of the menopausal transition, affecting up to 80% of women.¹ Research suggests that women who experience frequent or persistent hot flushes may have a less favourable cardiovascular profile, including unfavourable cholesterol levels and higher insulin resistance.¹

What does the research say and what does it not yet prove?

Data from large longitudinal studies, including the Study of Women’s Health Across the Nation (SWAN), suggest that women with frequent and persistent hot flushes may have an increased risk of cardiovascular events compared to those without these symptoms.¹ Sleep disturbances during menopause have been independently linked to markers of cardiovascular risk, such as increased arterial stiffness, a condition in which blood vessels become less flexible, making it harder for blood to flow smoothly and aortic calcification, which refers to calcium buildup in the aorta, the main artery that carries blood from the heart to the rest of the body.²

Depressive symptoms during menopause have also been associated with an increased risk of cardiovascular disease, including coronary artery calcification and cardiovascular mortality.²

These findings do not prove that hot flushes cause heart disease. They may, however, identify women who would benefit from earlier cardiovascular monitoring and lifestyle support. If your symptoms are frequent or severe, discussing them with your healthcare provider is a good opportunity to also check in on your heart health.

How can lifestyle changes protect your heart at menopause?

Healthy lifestyle habits are one of the most powerful tools for protecting the heart at and after menopause. Evidence supports several practical approaches that can meaningfully reduce cardiovascular risk in midlife women.^1,2

What kind of exercise is most supported by evidence?

Regular aerobic exercise such as brisk walking, swimming, or cycling aiming for at least 300 minutes per week of moderate intensity, or 150 minutes of vigorous intensity, is associated with improved cardiovascular health in perimenopausal and postmenopausal women.¹ Muscle-strengthening activities at least twice a week are also recommended.¹ Exercise improves cholesterol levels, lowers blood pressure, reduces insulin resistance, and supports a healthy body weight all of which matter for heart health.¹

Are there dietary patterns linked to better heart health in midlife women?

A diet rich in fruits, vegetables, whole grains, nuts, fish, and olive oil consistent with the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diet is associated with reduced cardiovascular risk.^1,2 Limiting processed meats, refined carbohydrates, and sweet food and beverages is also recommended.¹ Studies in postmenopausal women have found that healthier dietary patterns are linked to better cholesterol profiles and slower progression of artery changes.¹

Other important steps include stopping smoking, maintaining a healthy body weight, and prioritising good sleep quality.² Smoking is associated with a significantly higher risk of heart disease in women at midlife.¹

Can medications help and why does taking them correctly matter?

Some women may be prescribed medications to help manage cardiovascular risk factors such as elevated cholesterol, high blood pressure, or blood sugar.¹ Whether medication is right for you is a decision your doctor will make based on your individual health history, risk profile, and the results of routine tests.² It is an important conversation to have and not one to delay.¹

When a medication is prescribed, taking it as directed is one of the most important things you can do for your heart.⁵ Missing doses or stopping treatment without medical advice can reduce how well the medication works often in ways that are not immediately obvious.⁵

It is completely normal to have questions or concerns about side effects, cost, or simply remembering to take a pill every day.⁵ These are all valid topics to raise openly with your healthcare provider, who can help you find the best approach for your life. Sharing difficulties honestly is always better than stopping treatment quietly.

Conclusion

The menopausal transition is a meaningful moment for heart health, one that deserves attention and care. The hormonal changes of this period are associated with shifts in cholesterol, blood vessel function, and metabolic health that may increase cardiovascular risk. Understanding these changes, reflecting on your health history, and working with your healthcare provider to build healthy habits and an appropriate monitoring plan are all steps that evidence suggests can make a real difference. Awareness is a powerful first step and it is never too late to start.

FAQ

Q1. At what age does cardiovascular risk start to rise in women?

Cardiovascular risk in women begins to increase notably during the menopausal transition, which typically starts in the mid-to-late 40s. Studies show that rates of cardiovascular disease in midlife women aged 40 to 65 are rising in a way that coincides with the menopausal transition rather than with age alone.¹ Women who experience menopause before age 45 may see this risk increase earlier.^2,5 Discussing your cardiovascular health with your doctor during perimenopause is a good proactive step.

Q2. Does surgical menopause carry more heart risk than natural menopause?

Research suggests that surgical menopause particularly the removal of both ovaries before the age of 45 is associated with a higher cardiovascular risk than natural menopause occurring at a similar age.² This is thought to be due to the abrupt loss of ovarian estrogen production, rather than the gradual decline that occurs with natural menopause.¹ Women who undergo surgical menopause at a younger age have been found to have a higher risk of cardiovascular events compared to those with natural menopause.² If you have had or are considering this type of surgery, discussing cardiovascular risk with your doctor is recommended.

Q3. Does menopause cause changes in body fat that affect heart health?

Menopause is associated with a redistribution of body fat particularly an increase in fat around the abdomen and internal organs.¹ This change in fat distribution is associated with increased insulin resistance, unfavourable cholesterol levels, and a higher risk of cardiovascular disease.^1,4 These changes appear to be driven by the decline in estrogen levels rather than by aging alone.¹ Maintaining a healthy body weight through diet and exercise may help reduce this cardiovascular risk.

Q4. Are the cholesterol changes at menopause different from normal aging?

Yes, research has found that changes in LDL cholesterol, total cholesterol, and artery structure/ stiffness during the menopausal transition are independent of chronological aging. ² This means menopause itself drives specific changes in blood cholesterol and lipids that are distinct from the gradual increases seen with age in both men and women.⁴ The rise in LDL cholesterol during the late perimenopausal and early postmenopausal phases (around 50 years) is particularly pronounced.⁴ Regular lipid monitoring is therefore important during and after the menopausal transition.

Q5. Can I improve my cholesterol through diet alone at menopause?

A healthy diet can contribute meaningfully to better cholesterol levels at menopause. Research in perimenopausal and postmenopausal women has found that dietary patterns consistent with the Mediterranean or DASH diet are associated with improved cholesterol profiles.¹ However, diet alone may not be sufficient for all women, particularly those at higher cardiovascular risk.^3,5 Whether additional medical treatment is needed is a decision for your healthcare provider, based on your individual risk profile.

Q6. Are hot flushes a sign that my heart is at risk?

Hot flushes are not a direct cause of heart disease, but some research suggests they may be associated with a higher cardiovascular risk profile. Data from the SWAN study found that women with frequent and persistent hot flushes had an increased risk of cardiovascular events compared to women without these symptoms.¹ The connection is thought to involve unfavourable cholesterol levels and insulin resistance that can accompany vasomotor symptoms.¹ If your hot flushes are frequent or severe, this is a good opportunity to discuss your cardiovascular health with your doctor. Evidence is limited or inconclusive on whether treating hot flushes directly reduces cardiovascular events.

Q7. Does PCOS affect heart risk at menopause?

Polycystic ovary syndrome (PCOS) has been associated with a higher risk of cardiovascular disease, including ischaemic heart disease.¹ Women with PCOS often have insulin resistance, unfavourable cholesterol levels, and elevated blood pressure all of which can persist into and beyond the menopausal transition.^1,4 Women with a history of PCOS should discuss their cardiovascular risk with a healthcare professional, especially as they approach menopause.

Q8. What is Lipoprotein(a) and why does it matter at menopause?

Lipoprotein(a) also called Lp(a),is a type of fat particle in the blood that is mostly determined by genetics. Higher levels of Lp(a) are associated with an increased risk of cardiovascular disease.⁵ Research suggests that Lp(a) levels may rise after menopause, partly because estrogen appears to suppress its production.⁴ A single measurement is generally sufficient to assess Lp(a) levels, as they remain largely stable over time except during certain life transitions such as the menopausal transition.⁵ If you have not had your Lp(a) checked, it is worth discussing with your doctor, particularly if you have a family history of early heart disease.

Q9. I had gestational diabetes, what does that mean for my heart health now?

A history of gestational diabetes is associated with a significantly higher risk of developing type 2 diabetes and cardiovascular disease later in life.¹ Research suggests this risk is apparent within the first decade after pregnancy and is independent of the development of type 2 diabetes.¹ It is important to share this part of your medical history with your healthcare provider so that appropriate monitoring including regular checks of blood sugar and cardiovascular risk factors can be arranged.

Q10. How do I know if I need medication for my heart health at menopause? Whether medication is appropriate for managing cardiovascular risk at menopause is a decision that depends on your individual risk profile, health history, and the results of routine tests such as cholesterol and blood pressure measurements. Your healthcare provider is the right person to assess this, taking into account both traditional risk factors and any reproductive history that may be relevant.¹ If medication is prescribed, taking it consistently as directed is essential for it to work effectively. Do not hesitate to raise any concerns  about side effects, cost, or other aspects of your treatment with your care team.

This article was written with the assistance of generative AI technology and reviewed for accuracy.

Osteoporosis is often called a “silent” disease because you won’t know you have it without a test or until a bone breaks.¹ That’s why screening is crucial, especially if you have risk factors. The main test for osteoporosis is a bone density scan, usually done by a machine called DXA (dual-energy x-ray absorptiometry).² It’s a quick, painless scan (similar to an x-ray with very low radiation) that measures the thickness of your bones, typically at the hip and spine . This measurement tells you your bone mineral density (BMD) and compares it to normal values. The result is given as a T-score, which shows how far your bone density is above or below that of an average healthy young adult. A T-score of 0 means your bone density is average for a young adult; a negative score means your bones are less dense. Osteoporosis is defined by a T-score of -2.5 or lower, meaning your bones are much thinner than normal. For example, a T-score of -3.0 falls in the osteoporosis range. If your T-score is between -1.0 and -2.5, it indicates osteopenia (low bone mass, a step before osteoporosis).³ 

Who should get a bone density test? Doctors have clear guidelines for this. In general, all women age 65 and older should have a DXA scan. Postmenopausal women under 65 should be screened if they have significant risk factors (like a history of fractures, long-term steroid use, very low body weight, etc.).³ Men age 70 and older are also advised to get a bone density test, since osteoporosis in men often goes undiagnosed until a fracture occurs.⁴ Men between 50 and 69 might need testing if they have risk factors for bone loss.³ Additionally, anyone over 50 who breaks a bone should be considered for a bone density test.³ A fracture from a minor incident can be a red flag for underlying osteoporosis. 

Getting a DXA scan is straightforward. You lie on a padded table while the machine scans your hip and spine; it’s not enclosed like an MRI, so it’s not claustrophobic. The test usually takes only 10-15 minutes.⁵ Afterward, you’ll receive a report with your bone density results. Your healthcare provider will explain what your T-scores mean for your bone health.⁵ If your results show osteopenia or osteoporosis, that doesn’t mean a fracture is inevitable, but it does indicate that you and your doctor should take steps to protect your bones (through lifestyle changes and possibly medications). 

Other tools and tests: In some cases, a different type of scan (such as a quantitative CT scan) may be used, but DXA is the standard because of its accuracy and low radiation.^6,7 Portable ultrasound devices can measure bone density in the heel as a quick screening method, for example at health fairs or some pharmacies. However, an abnormal ultrasound screening should always be confirmed with a DXA scan for diagnosis, as ultrasound is not as precise in predicting fracture risk.^3,7 Doctors may also use fracture risk calculators, like the FRAX tool developed by the World Health Organization. FRAX takes into account your bone density (if available) plus clinical risk factors (age, sex, weight, family history, etc.) to estimate your chance of breaking a bone in the next 10 years. This can help guide decisions, especially if you’re in the osteopenia range – for instance, a high FRAX risk might prompt starting medication even if your T-score isn’t yet -2.5.⁸ 

More information about FRAX is available here: https://www.osteoporosis.foundation/sites/iofbonehealth/files/2020-04/FRAX-Identifying-People-At-High-Risk-of-Fractures.pdf  

Regular follow-up: If you’re diagnosed with osteoporosis or osteopenia, your doctor will likely repeat the bone density test every 1-2 years to monitor any changes.³ This helps track whether treatment is improving your bone density or if the condition is progressing. It’s important to have your scans on the same machine or at least the same facility when possible, for consistency. Remember that bone density is just one part of the picture: it doesn’t capture everything about bone strength, but it’s a very useful indicator. Together with your risk factors, it allows you and your healthcare team to make informed decisions about prevention and treatment. 

In summary, screening for osteoporosis with bone density tests can catch the disease early, before a fracture happens. If you’re at the recommended age or have risk factors, talk to your doctor about getting tested. Knowing your bone health status is empowering: it’s the first step toward taking action and keeping your bones as strong as possible.

FAQ

1. What is a bone density test and why is it important? 

A bone density test measures bone strength and helps detect osteoporosis early, reducing the risk of fractures. 

2. What is the most common test for osteoporosis? 

The DXA scan (dual-energy X-ray absorptiometry) is the standard test for measuring bone mineral density. 

3. Who should get a bone density test? 

Women 65+, men 70+, and adults over 50 with risk factors or fractures should consider screening.³ 

4. How does a DXA scan work? 

It uses low-dose X-rays to measure bone density at the hip and spine, taking about 10 to 15 minutes.⁵ 

5. What do T-scores mean in bone density results? 

A T-score of 0 is normal; -1.0 to -2.5 indicates osteopenia; -2.5 or lower means osteoporosis.³ 

6. Is a bone density test painful or risky? 

No, it’s quick, painless, and uses very low radiation, similar to an X-ray. 

7. How often should you repeat a bone density test? 

Every 1–2 years if you have osteoporosis or osteopenia, or as recommended by your doctor.³ 

8. Can men get osteoporosis and need screening? 

Yes. Men 70+ or those 50–69 with risk factors should be tested.³ 

9. What is the FRAX tool and how is it used? 

FRAX estimates your 10-year fracture risk using bone density and clinical factors.⁸ 

This article was written with the assistance of generative AI technology and reviewed for accuracy.

When people think of osteoporosis, they often picture an older woman. It’s true that postmenopausal women have the highest risk, but they’re not the only ones who need to worry about their bones.

Osteoporosis affects both women and men.¹ In fact, about 20% of osteoporosis cases occur in men, and one in five men over age 50 will suffer an osteoporosis-related fracture in his lifetime.^2,3 That’s a significant number. Men tend to develop osteoporosis a decade or so later than women, but by age 70, men catch up in risk.¹ Unfortunately, awareness is lower in men. Many men don’t realize they can even get osteoporosis.

So they may not be screened or treated until after a serious fracture.³

Men and osteoporosis: Why do men develop osteoporosis later? One reason is that men generally have larger, denser bones to begin with, and they don’t experience the rapid hormonal bone loss that women do at menopause.⁴ However, as men age (especially beyond 70), the other age-related factors can lead to significant bone thinning.⁴ Men can also have secondary causes of bone loss. For example, long-term use of corticosteroid medications (for conditions like asthma or rheumatoid arthritis) is a common cause of osteoporosis in both genders.⁴ In fact, any adult, man or woman, who has been on high-dose steroids for several months should talk to their doctor about bone health, as these drugs can accelerate bone breakdown.⁵

Other medical conditions, like low testosterone levels (in men),⁴ prostate cancer treatments that suppress hormones,⁶ chronic kidney disease,⁷ hyperthyroidism, hyperparathyroidism or digestive disorders that impair nutrient absorption, can all contribute to osteoporosis in men.⁸ Men who smoke heavily or drink excessive alcohol are at particular risk.⁹

Other populations: Osteoporosis can occur in younger adults, too, though it’s less common. Certain situations can lead to early-onset bone loss. For instance, some women in their 20s – 40s might experience osteoporosis due to amenorrhea (the absence of menstrual periods for a long time) which can be caused by extreme exercise, eating disorders, or certain hormonal disorders. Without regular menstrual estrogen, their bones may not reach a strong peak or may start losing density early.¹⁰ Young people with conditions like rheumatoid arthritis,¹¹ type 1 diabetes,⁹ or anorexia nervosa¹² also have higher osteoporosis risk because of the disease’s effects on bone or the medications used to treat it.⁸ Additionally, some very rare genetic disorders and childhood conditions can cause osteoporosis even in kids or teens, but these are exceptional cases.¹³

Race and ethnicity: Osteoporosis is a global issue and affects people of all ethnic backgrounds. However, some groups have higher or lower rates statistically.¹⁴ For example, white women in the U.S. have the highest rates of hip fractures, with a lifetime risk of 15.8% at age 50, compared to 8.5% for Hispanic women, 2.4% for Chinese women, and 6.0% for men.¹⁵ Interestingly, African American women tend to have higher bone density, which may protect against fractures, yet they face more severe outcomes after a hip fracture, including longer hospital stays and higher mortality rates. Despite lower fracture rates in minority women, fractures are still more common than breast cancer, heart attacks, and strokes combined. Unfortunately, disparities in care persist: only 5% of African American women receive bone density screening compared to 33% of white women, and fewer receive treatment even when they meet guidelines. These differences highlight the importance of personalized prevention and care for osteoporosis across all communities.¹⁵

Special situations: You might hear about osteoporosis in contexts like space travel – astronauts in microgravity lose bone density rapidly!¹⁶ That’s a reminder of how important regular stress on bones is to keeping them strong. Closer to home, another special case is pregnancy-associated osteoporosis: in very rare instances, a woman might develop osteoporosis during pregnancy or breastfeeding (often temporarily).¹⁷ And certain disabilities or long periods of immobility (for example, being on bed rest for months) can cause bone loss in both young and older individuals.¹⁸

The takeaway is that osteoporosis isn’t exclusive to one demographic. Men need to be aware that they, too, can have fragile bones, and should take preventive measures like adequate calcium/vitamin D, exercise, and possibly screening if they have risk factors. People with chronic illnesses or on bone-affecting medications should be especially proactive in discussing bone health with their doctors. By recognizing that osteoporosis crosses gender and other lines, we can ensure that everyone at risk gets proper attention. Bone health is for everybody.

FAQ

1. Can men get osteoporosis?

Yes. About 20% of osteoporosis cases occur in men, and one in five men over 50 will experience an osteoporosis-related fracture.^2,3

2. What are the risk factors for osteoporosis in men?

Low testosterone, aging, long-term steroid use, smoking, excessive alcohol, and certain medical conditions increase risk.^4-10

3. At what age do men typically develop osteoporosis?

Men usually develop osteoporosis about 10 years later than women, but risk rises significantly after age 70.¹

4. Can younger adults get osteoporosis?

Yes. Conditions like eating disorders, amenorrhea, chronic illnesses, or certain medications can cause early bone loss.^8,9

5. Does race or ethnicity affect osteoporosis risk?

Yes. Caucasian and Asian women have the highest rates, but all ethnic groups can develop osteoporosis, especially with age.¹⁵

6. What medical conditions increase osteoporosis risk?

Rheumatoid arthritis, chronic kidney disease, digestive disorders, and hormone-related conditions can all contribute.^{6 -8,11}

7. Can osteoporosis occur during pregnancy or breastfeeding?

Rarely, pregnancy-associated osteoporosis can occur, usually temporarily, during late pregnancy or lactation.¹⁷

This article was written with the assistance of generative AI technology and reviewed for accuracy.

Staying active is one of the best things you can do for your bones. Like muscles, bones become stronger when you use them. Low-impact weight-bearing exercises (activities that make you move against gravity) help stimulate bone cells and maintain bone density.¹ Examples include walking, hiking, dancing, and climbing stairs. Swimming and cycling are not weight-bearing exercise, however.^2,5 In fact, research shows that healthy postmenopausal women who walk about a mile each day have higher bone density than those who walk shorter distances.³ Resistance and strength training (such as lifting weights or using resistance bands) is also highly beneficial for bone health.⁴ These exercises not only work your bones but also build the muscles that support and protect bones. 

Beyond building bone strength, exercise greatly improves balance and coordination. Better balance means you’re less likely to fall, which is critical in preventing fractures. Activities like tai chi, yoga, or simple balance exercises can stabilize your core and legs, reducing the risk of falls. In older adults, regular exercise helps maintain the ability to carry out daily activities and delays the loss of independence that can come with frailty.⁵ Even though exercise might not dramatically increase bone mass once you’re older, it can slow down bone loss and keep you stronger longer.⁵ 

It’s important to choose safe exercises, especially if you already have osteoporosis. High-impact workouts (like running or jumping) and exercises that bend or twist the spine (such as toe-touching or sit-ups) might need to be avoided to protect fragile bones.⁵ The good news is there are many low-impact options. Brisk walking, gentle aerobics, or water exercise can get you moving without undue risk.  

Consulting a healthcare professional before starting a new exercise program is essential. 

Ask your physical therapist or your doctor to recommend exercises tailored to your abilities. They can show you how to move and lift objects in ways that minimize stress on your bones. Always start new exercise routines slowly and use proper form. 

Consistency is key: aim to be active most days of the week, if possible. Even short daily walks or a few strength exercises every other day can make a difference over time. The NHS recommends that Adults aged 19 to 64 should do at least 2 hours and 30 minutes of moderate-intensity aerobic activity, such as cycling or fast walking, every week.² 

Remember to balance different types of exercise. Include weight-bearing cardio, muscle strengthening, and flexibility/balance training for a well-rounded routine. By “moving it” regularly, you truly can improve it, keeping your bones stronger and your body more resilient as you manage osteoporosis. 

If you’re not sure how healthy your bones are, talk to your care provider. Don’t let fear of bone fractures keep you from having fun and being active. 

FAQ

1.  Why is exercise important if I have osteoporosis? 
Exercise strengthens bones, improves posture, and reduces fall risk by enhancing balance and muscle strength.¹ 

2. What exercises are best for osteoporosis? 
Low-impact weight-bearing (walking, dancing), resistance training (weights, bands), and balance exercises (tai chi, yoga) are most effective.^1,5 Consulting a healthcare professional before starting a new exercise program is essential. 

3. Are there exercises I should avoid with osteoporosis? 
Yes. Avoid high-impact activities like running or jumping and movements that bend or twist your spine (toe touches, sit-ups, some yoga poses).⁵ 

4. Is walking enough to improve bone health? 
Walking helps maintain bone density, but it should be combined with strength and balance exercises for full benefits.⁶ 

5.  Should I consult a doctor before starting an exercise program? 
Absolutely. A healthcare provider can recommend safe exercises based on your bone health. 

This article was written with the assistance of generative AI technology and reviewed for accuracy.

Osteoporosis is best managed with a partnership between you and your healthcare providers. Good communication is key: it ensures that you understand your treatment and that your concerns are addressed. Many people with osteoporosis are cared for primarily by their family doctor, who might also refer you to specialists like an endocrinologist or rheumatologist (doctors who specialize in hormones and bone health). You may also interact with nurses, physical therapists, or nutritionists as part of your care team. Don’t be intimidated by the medical details; instead, take an active role in your bone health.

Come prepared to appointments: Doctor visits can feel rushed, and it’s easy to forget to ask important questions, especially if you’re feeling anxious¹. A great strategy is to prepare a written list of questions or points before each appointment. For example, you might ask: “What do my test results mean?”, “What are the risks and benefits of the medication you’re prescribing?”, or “Do I need any blood tests or supplements?”. Also, keep an up-to-date list of all medications and supplements you take (or bring the bottles with you). This helps your doctor check for any interactions and ensures nothing is overlooked. If you have a history of fractures or other medical conditions, make sure to discuss those as well¹.

Don’t hesitate to speak up: Remember that no question is “silly” when it comes to your health. If you don’t understand something your doctor says, perhaps a medical term like “T-score” or “RANK ligand”, ask for clarification. Doctors and nurses are used to explaining things in plain language when needed. It can help to repeat back what you heard in your own words, to confirm you’ve got it right. For example, “So my bone density went down a bit, but not enough that we need to change medications, correct?” This gives your provider a chance to affirm or correct your understanding¹.

Discuss lifestyle and concerns: Your appointments aren’t just about test results; they’re also a good time to talk about how you’re coping with daily life. If you’re afraid of falling or have stopped doing certain activities you enjoy, mention it. Your doctor or a physical therapist can suggest solutions. If you’ve been experiencing any side effects from medications (like stomach upset from a pill or soreness from an injection), let them know. There may be alternatives or ways to manage side effects, but they won’t know unless you tell them. If pain from an existing fracture is limiting you, ask about pain management or rehabilitation options. Additionally, if you feel sad or anxious about your osteoporosis (which is completely understandable), bring it up. Emotional health is part of the picture, and your provider can direct you to resources or support.

Be a team player in follow-ups: After each appointment, make sure you know the next steps. Do you need to schedule a DXA (Dual-Energy X-ray Absorptiometry) scan next year? When should you do your blood tests for vitamin D levels or kidney function (especially if you’re on certain medications)? Ensure you have a follow-up appointment on the calendar, if needed. Adherence to your treatment plan is crucial. If you have trouble with any aspect of it, discuss that openly. For instance, if the medication schedule is confusing or the cost of a drug is a burden, your healthcare team might have solutions (like simplifying dosing, switching to generics or biosimilars, or finding financial support programs). They’re on your side and want to help you succeed in managing your osteoporosis.

Leverage other resources: Doctors are central, but remember pharmacists can be extremely helpful too. They can explain how to take your medications properly (e.g. taking a pill with a full glass of water first thing in the morning, then staying upright for 30 minutes) and alert you to side effects. Don’t hesitate to ask them questions about injections, supplements or over-the-counter products. If you’re part of an osteoporosis support group or online community, you might also gather good questions to ask your doctor from others who have similar experiences (while always following your own doctor’s advice for medical decisions). In short, good communication means you and your healthcare team work together smoothly. Prepare, ask questions, and share your experiences. Being informed and engaged in your care will help you feel more in control and ensure that you get the maximum benefit from treatments. Remember, you are the most important member of your own care team. Your voice and your choices matter.

FAQ

1. What is the best way to communicate with my osteoporosis doctor?

Prepare questions in advance, bring a medication list, and clarify anything you don’t understand during your visit.

2. Who is part of an osteoporosis care team?

Your team may include a family doctor, endocrinologist, rheumatologist, nurses, physical therapists, nutritionists, and pharmacists.

3. What questions should I ask my doctor about osteoporosis?

Ask about test results, medication risks and benefits, lifestyle changes, and follow-up plans.

4. Why is communication important in osteoporosis care?

Clear communication ensures you understand your treatment, manage side effects, and stay engaged in your bone health.

5. How can I prepare for an osteoporosis appointment?

Write down questions, bring your medication list, and note any symptoms or concerns to discuss.

6. Can I talk about emotional health with my osteoporosis doctor?

Yes, emotional well-being is important. Share feelings of anxiety or sadness so your doctor can suggest support resources.

7. What lifestyle concerns should I discuss with my doctor?

Mention fears of falling, activity limitations, pain, or medication side effects to get personalized advice.

8. How often should I follow up with my osteoporosis care team?

Follow-up depends on your treatment plan, but typically includes regular DXA scans, blood tests, and medication reviews.

9. What role do pharmacists play in osteoporosis care?

Pharmacists can explain medication instructions, check for interactions, and advise on supplements or side effects.

This article was written with the assistance of generative AI technology and reviewed for accuracy. 

Menopause is a natural stage in every woman’s life, but it can bring changes that go well beyond hot flushes and sleep difficulties. One of those changes involves blood pressure. Research suggests that the years around menopause may be associated with a rise in blood pressure for some women, and this is something worth taking seriously for long-term heart health^1-4.
This article will help you understand what the science currently says, what to watch for, and most importantly, when and how to talk with your doctor.

Can menopause cause high blood pressure?

Menopause itself does not directly “cause” high blood pressure. However, the hormonal and physical changes that accompany menopause, including increased abdominal fat, changes in body composition and greater arterial stiffness, can increase the risk of developing high blood pressure.^2,3 

Before menopause, the hormone estrogen helps keep blood vessels flexible and supports healthy nitric oxide production, a substance which causes blood vessels to relax. When estrogen levels drop at menopause, these protective effects are reduced. After menopause, changes in hormone levels may make blood vessels less flexible and less able to relax, while also increasing activity in the sympathetic nervous system, changes that can contribute to higher blood pressure.^2,3 

The role of ageing and why it is hard to separate the two

It is still unclear whether menopause or reduced estrogen directly causes an increase in blood pressure. This is because menopause often happens alongside aging, making it hard to separate their effects. In addition, menopause and blood pressure share common influencing factors such as body weight, diet, smoking, and socio-economic status.³ 

The years around menopause represent a critical window for blood pressure surveillance: up to 41% of women develop hypertension following menopause, almost double the prevalence seen in premenopausal women and the prevalence of hypertension in late menopausal transition is nearly six times higher than in early menopausal transition.⁴ Indeed, 30-50% of women develop hypertension before the age of 60, with symptoms such as palpitations, hot flushes, headaches, and chest pain that are often mistakenly attributed to menopause itself, underscoring the importance of heightened blood pressure monitoring during the late 40s to early 50s.² 

Other contributing factors

Various changes that commonly occur during menopause can also contribute to higher blood pressure:

• Weight gain, particularly around the abdomen, is common after menopause and is independently linked to higher blood pressure.^3,4 
• Changes in lipid (fat) profiles, with higher LDL cholesterol and triglycerides and lower HDL cholesterol.^2,4 
• Increased sensitivity to salt due to lower estrogen levels affecting how the body handles salt and water.² 
• Metabolic syndrome, a cluster of risk factors including abdominal obesity, high blood sugar, and abnormal lipids, becomes more common after menopause.^3,4 

Understanding these overlapping factors helps explain why blood pressure tends to rise in midlife women and why lifestyle plays such a significant role in managing it. 

Should blood pressure be monitored more closely during menopause?

Yes. It’s a good idea to keep a closer eye on your blood pressure during and after menopause. Experts recommend assessing blood pressure and cardiovascular risk factors such as lipid levels during menopause.² 

The reasoning is straightforward: blood pressure can rise gradually and without obvious symptoms. Many women only discover elevated readings during a routine check.⁷ The earlier a rise is detected, the sooner lifestyle changes or, if needed, medical treatment under a doctor’s supervision can be started.⁶ 

Who especially benefits from closer monitoring?

While all women benefit from regular checks, some groups face a higher underlying risk and may benefit from even more vigilant monitoring: 

• Women who experienced high blood pressure or pre-eclampsia during pregnancy this history is associated with a significantly higher risk of cardiovascular disease and hypertension later in life.² 
• Women with a history of gestational diabetes.² 
• Women with premature ovarian insufficiency (POI): Menopause before age 40 who face an extended period of estrogen deficiency and a higher cardiovascular risk profile.^1,2 
• Women with polycystic ovary syndrome (PCOS) or other chronic gynecological conditions associated with increased cardiovascular and metabolic risk.² 

Your doctor or nurse can advise you on how frequently your blood pressure should be checked based on your personal history. Home blood pressure monitoring can also be a valuable tool, particularly for women with a history of pregnancy-related hypertension and should be discussed with a healthcare professional (HCP).² 

What symptoms might suggest my blood pressure has changed since menopause?

This is one of the most important points to understand: high blood pressure is often called a “silent” condition because most people have no symptoms.⁷ This is why regular measurement matters so much more than waiting for symptoms to appear. 

That said, some symptoms which can also overlap with menopause symptoms may occasionally be linked to blood pressure changes. These symptoms are worth discussing with your doctor: 

• palpitations,  
• hot flushes,  
• headaches,  
• chest pain,  
• pain between the shoulder blades,  
• tiredness  
• and sleeping disturbances² 

Research suggests that women who have more intense menopause symptoms, like hot flashes and night sweats, may also have a higher risk of heart-related issues. This may be linked to the body being in a more “stressed” state (overactivity of the nervous system).² 

What can you do to keep blood pressure healthy during menopause?

The good news is that your daily habits can really help manage blood pressure during and after menopause. Staying active, eating well, maintaining a healthy weight, drinking less alcohol, and not smoking can all make a difference and they’ll support your overall health too, not just your blood pressure.⁸ 

Exercise regularly

Regular exercise can help lower blood pressure in women during and after menopause. Research suggests that combining aerobic activities (such as walking or cycling) with strength training (like light weights or resistance exercises) is especially effective, leading to greater improvements than either type of exercise alone.⁵  

Eat well and manage weight

Eating a heart-healthy diet can help keep blood pressure under control. This means choosing plenty of vegetables, fruits, whole grains, and lean protein, while cutting back on fatty foods, refined sugar, and salt.⁹ 
After menopause, reducing salt is especially important, as the body becomes more sensitive to it, which can lead to fluid build-up and higher blood pressure.^2,4 

Population-based studies suggest that much of the blood pressure increase seen during the menopausal transition can be attributed to weight gain and changes in body composition, underscoring the value of weight management.⁴ 

Limit alcohol and avoid smoking

During the menopause transition, avoidance of smoking and alcohol consumption is an important part of cardiovascular risk reduction. Smoking accelerates the onset of menopause, worsens vasomotor symptoms, and is associated with higher cardiovascular risk. Stopping smoking during midlife reduces cardiovascular risk, lowers blood pressure, and improves overall health, even if some weight gain occurs.¹⁰ 

Alcohol intake also requires caution: Alcohol disrupts hormonal balance and may increase estrogen levels, influencing reproductive health and breast cancer risk. Heavy drinking is also linked to earlier menopause, bone loss, and higher fracture risk.¹⁰ 

A final word

Menopause is a natural transition, and being aware of how it may affect your blood pressure puts you in a stronger position to protect your long-term heart health. Regular monitoring, a heart-healthy lifestyle, and open conversations with your doctor are the three pillars of managing this risk. Each person’s experience of menopause is different, so your care should be tailored to you. 

If you are going through menopause and have not had your blood pressure checked recently, speaking with your doctor is a simple and important first step. 

This article is for general informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional for guidance specific to your health situation. In a medical emergency, contact your local emergency services immediately. 

FAQ

1. Does every woman develop high blood pressure after menopause? 

No, not every woman develops high blood pressure after menopause, but the risk does increase. Research estimates that up to 41% of women develop hypertension, which is nearly twice as common as in women before menopause.⁴  

2. Can hot flushes affect blood pressure? 

Hot flushes (vasomotor symptoms) and blood pressure are linked in complex ways. Research has found that women with more severe hot flushes may have a less favourable cardiovascular risk profile.² However, hot flushes alone cannot be used to diagnose or exclude high blood pressure only a proper blood pressure measurement can do that. Speak to your doctor if you are concerned about the relationship between your menopausal symptoms and your cardiovascular health. 

3. Is weight gain after menopause linked to blood pressure? 

Yes, weight gain, particularly the accumulation of fat around the abdomen that is common after menopause, is a significant contributor to blood pressure rise and cardiovascular risk.^3,4  

4. I had high blood pressure during pregnancy. Does this increase my risk after menopause? 

Yes, a history of hypertensive disorders in pregnancy (including gestational hypertension and pre-eclampsia) is associated with a significantly increased long-term risk of hypertension and cardiovascular disease. Pre-eclampsia has been linked to a four-fold increase in the risk of heart failure and a two-fold increased risk of cardiovascular deaths and stroke.²  

If you have this history, it is particularly important to inform your doctor, maintain regular blood pressure monitoring, and address modifiable risk factors such as weight, diet, and exercise.² 

5. What is premature ovarian insufficiency (POI) and does it affect blood pressure? 

Premature ovarian insufficiency (POI) is defined as the loss of normal ovarian function before age 40. It results in earlier and more prolonged estrogen deficiency compared to natural menopause, and is associated with a higher risk of cardiovascular disease, including hypertension, coronary artery disease, and stroke.^1,2  

Women with POI benefit from early assessment of cardiovascular risk factors including blood pressure, lipids, and blood glucose.² Specialist medical care is important for women with POI, and this should include advice on cardiovascular health monitoring and management.² 

6. Can reducing salt in my diet make a difference to blood pressure after menopause? 

Yes, sodium sensitivity (the degree to which salt intake raises blood pressure) increases during the menopausal transition, making dietary salt reduction particularly relevant for postmenopausal women.^3,9 

This article was written with the assistance of generative AI technology and reviewed for accuracy.

Managing osteoporosis isn’t just about doctors and medications: it’s also about how you live day to day. Adopting certain healthy habits can help protect your bones and improve your overall well-being as you navigate this condition.

Quit smoking and limit alcohol:¹ Smoking is harmful to your bones (among many other things). If you smoke, make a plan to quit. Smoking accelerates bone loss and also interferes with blood supply to the bones.² Similarly, excessive alcohol intake can weaken bones and increase the risk of falls. It’s best to drink only in moderation (no more than one drink per day for women, or two for men). By avoiding tobacco and keeping alcohol to a minimum, you remove two significant risk factors for osteoporosis-related fractures.³

Stay on top of medical check-ups: Ensure you see your healthcare provider regularly and keep up with any tests or screenings they recommend. Routine check-ups are an opportunity to monitor your bone density, review your medications, and discuss any new symptoms (like pain or balance issues).⁴ If you’ve been prescribed osteoporosis medication, take it exactly as directed and inform your doctor of any side effects. Consistency with medication and supplements is key to getting their full benefit.

Practice good posture and body mechanics: Protecting your spine in everyday activities can prevent painful injuries. Try not to hunch or slouch: keep a good posture whether you’re sitting or standing. When lifting objects, bend at your knees and hips (not at your waist) and keep the load close to your body.⁵ Avoid lifting very heavy objects altogether if you can. If you have spinal osteoporosis (thinning in the vertebrae), ask a physical therapist to teach you safe ways to bend, reach, and exercise without putting undue strain on your spine.⁶ They can show you modifications for daily tasks (like how to tie your shoes or pick things up) that reduce the risk of compression fractures in your back.

Find support and stay positive: Osteoporosis can be challenging, both physically and emotionally. It’s normal to feel anxious about your fracture risk or frustrated by lifestyle changes. That’s why it’s important to be kind to yourself. Remember that your condition is just one part of who you are. Practice self-compassion and patience: take things one day at a time, and acknowledge the efforts you’re making to care for your health. Many people find it helpful to connect with others who have osteoporosis, whether through support groups (online or in person) or simply talking with friends and family about what you’re going through. Staying socially engaged and doing activities you enjoy can boost your mood and help you feel more in control.⁷ Stress management techniques, like meditation, deep breathing, or gentle exercise, can also improve your mental and emotional well-being.

Keep moving safely: While you should avoid hazardous activities (like climbing ladders or high-impact sports on hard surfaces), staying active with osteoporosis is crucial. Regular exercise, as discussed earlier, strengthens your muscles and bones and improves balance. Just make sure the activities are safe for your condition. Low-impact exercises (walking, swimming, tai chi) are generally good choices.⁸ If you’re uncertain about an activity, consult your doctor or a physiotherapist who understands osteoporosis. They can advise you on how to exercise safely and which movements to avoid. Remember, using assistive devices (like a cane) or asking for help with certain tasks is not a sign of weakness: it’s a smart strategy to prevent accidents and preserve your independence.

Conclusion

In summary, living well with osteoporosis involves a mix of medical care and mindful lifestyle choices. By avoiding bone-harming habits, nurturing your body with the right diet and exercise, and taking precautions in daily activities, you can maintain a good quality of life. Equally important, maintain a positive outlook and lean on others for support when you need it. Osteoporosis is manageable, and with healthy habits in place, you can continue doing many of the things you love while keeping your bones as safe as possible.

FAQ

1. How can healthy habits help manage osteoporosis?

Healthy habits like quitting smoking, limiting alcohol, exercising safely, and maintaining good posture can protect bones and reduce fracture risk.^2,3,5

2. Why should I quit smoking if I have osteoporosis?

Smoking accelerates bone loss and reduces blood supply to bones, increasing the risk of fractures. Quitting smoking is crucial for bone health.²

3. Does alcohol affect osteoporosis?

Yes. Excessive alcohol weakens bones and increases fall risk. Limit intake to one drink per day for women and two for men.³

4. What exercises are safe for people with osteoporosis?

Low-impact activities like walking, swimming, and tai chi are generally safe.⁸ Always consult your doctor before starting a new exercise routine.

5. What posture tips help prevent fractures?

Maintain good posture, avoid slouching, and bend at the knees and hips when lifting.⁵ Ask a physical therapist for safe movement techniques.

This article was written with the assistance of generative AI technology and reviewed for accuracy.