menopause and metabolic syndrome

Do you know when women are at an increased risk of metabolic syndrome? You've got it: menopause and postmenopause. The prevalence of this condition is believed to be at least partly responsible for the significantly higher risk for cardiovascular disease among women postmenopause. What do you need to know about menopause and metabolic syndrome?

What is metabolic syndrome?

Metabolic syndrome is a combination of abdominal obesity, insulin resistance, and dyslipidemia, which is abnormally high cholesterol and lipids (fats). It is not a single number that is off. It is a cluster, and the count matters. According to the National Institutes of Health, and to the harmonized criteria agreed by the International Diabetes Federation, the National Heart, Lung, and Blood Institute, the American Heart Association, the World Heart Federation, the International Atherosclerosis Society and the International Association for the Study of Obesity (Alberti KGMM and colleagues, Harmonizing the Metabolic Syndrome, Circulation, 2009), a woman is diagnosed with metabolic syndrome when she has three or more of these five:

• Increased accumulation of body fat around the abdominal area resulting in a waist measurement of at least 35 inches (88 cm)
• High levels of triglycerides in the bloodstream: 150 milligrams per deciliter (mg/dL) or greater, or taking medication for raised triglycerides
• Low levels of good cholesterol (high-density lipoprotein, HDL) of less than 50 mg/dL, or taking medication for low HDL
• Fasting blood sugar (glucose) of 100 mg/dL or higher, or taking medication for raised blood sugar
• Blood pressure of 130/85 mmHg or higher, or taking medication for high blood pressure

Two of those glucose numbers float around and they get mixed up constantly, so it is worth sorting out which is which. 100 mg/dL is the fasting glucose cutoff for the metabolic syndrome component. 126 mg/dL or higher, confirmed on a second test, is the level at which the American Diabetes Association diagnoses diabetes. They are different thresholds answering different questions. A fasting glucose of 110, for example, counts toward metabolic syndrome and is not diabetes.

A correction we owe you. This page used to say that having at least one of these five was usually enough to be diagnosed with metabolic syndrome, and it gave the fasting glucose cutoff as 126 mg/dL. Both were wrong. The 2009 harmonized criteria require three or more of the five, and the glucose cutoff for the metabolic syndrome component is 100 mg/dL. If you read this page before and came away thinking one raised number meant you had metabolic syndrome, that is not what the criteria say. Take all five numbers to your doctor and go through them together.

This cluster of conditions places women at greater risk of stroke, heart disease, and type 2 diabetes.

What is the association between menopause and metabolic syndrome?

A greater understanding of the association between menopause and metabolic syndrome can help the medical community identify better ways to avoid metabolic syndrome and the consequences women face during menopause and postmenopause. Yet exactly how estrogen changes are related to metabolic syndrome is not clear. It's also unclear whether going through menopause raises the risk of cardiovascular disease in all women going through menopause or just those who develop signs of metabolic syndrome.

Here's a sample of what investigators have found thus far. In a Canadian study, for example, it was shown that the chance of developing metabolic syndrome is up to 38 percent among postmenopausal women. This highly significant percentage is one great reason why all women in their menopausal years need to take actions to protect themselves against metabolic syndrome and its consequences.

In a study appearing in the Journal of the American Medical Association, more than 900 women free of metabolic syndrome were followed for nine years, from premenopausal years through menopause. After they transitioned into menopause, the women were nearly 25 percent more likely to develop the syndrome than they were before.

Researchers believe among the most significant factors that contribute to a high risk of metabolic syndrome in postmenopausal women are the increased percentage of overall body fat, a loss of lean muscle tissue, and a redistribution of fat in the abdominal area. All of this is partly but not completely associated with the dramatic decline in estrogen.

How can you manage metabolic syndrome naturally?

Preventing and managing metabolic syndrome requires lifestyle changes. The sooner women begin to make those changes, the better. Here are some of the suggestions.

• The dramatic decline in estrogen levels is often accompanied by an increase in visceral fat, a persistent fat that is stored in the abdominal area. This type of fat is more difficult to lose than subcutaneous fat, which is more common before menopause. To help prevent or reduce abdominal visceral fat, it's important to avoid gaining weight and to increase physical exercise.
• Cut out simple carbs, such as white flour products, refined grains, fried foods, alcohol, and anything with added sugar. Three suggested diet plans are the Mediterranean diet, DASH, and flexarian, three of the top rated diets for heart and overall health.
• Get at least 30 minutes of physical exercise daily. If you can't find time to do 30 minutes at one time, break it up into two or three sessions during the day. A brisk walk or jog, using the stairs, a spin on a stationary bike, or jumping rope can be done in short spurts.
• Lose weight if you need to. Even a 7 to 10 percent reduction in weight can help reduce both your blood sugar and blood pressure levels.
• Practice stress reduction activities daily. In addition to yoga, deep breathing, visualization, massage, and tai chi, try writing in a journal, starting a new fun hobby, spending time in nature, or taking dance or singing lessons. Such activities can also help boost your self-esteem and creativity, which in turn can enhance your mood.
• Add soluble fiber, which may help support steadier blood sugar levels.

When to see your doctor

The factors involved in metabolic syndrome can be challenging for some women to manage. If you have not had your yearly physical or seen a doctor to have your blood pressure, blood sugar, or complete blood count done, you should do so as soon as possible.

Bottom line

Metabolic syndrome affects a significant number of women who are transitioning from menopause to postmenopause. You can take steps to help prevent and reduce the impact of the factors that can affect your cardiovascular and overall health.