Generic placeholder image

Current Vascular Pharmacology


ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Review Article

Metabolic Syndrome During Menopause

Author(s): Sezcan Mumusoglu and Bulent Okan Yildiz*

Volume 17, Issue 6, 2019

Page: [595 - 603] Pages: 9

DOI: 10.2174/1570161116666180904094149

Price: $65


The metabolic syndrome (MetS) comprises individual components including central obesity, insulin resistance, dyslipidaemia and hypertension and it is associated with an increased risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). The menopause per se increases the incidence of MetS in aging women. The effect(s) of menopause on individual components of MetS include: i) increasing central obesity with changes in the fat tissue distribution, ii) potential increase in insulin resistance, iii) changes in serum lipid concentrations, which seem to be associated with increasing weight rather than menopause itself, and, iv) an association between menopause and hypertension, although available data are inconclusive. With regard to the consequences of MetS during menopause, there is no consistent data supporting a causal relationship between menopause and CVD. However, concomitant MetS during menopause appears to increase the risk of CVD. Furthermore, despite the data supporting the association between early menopause and increased risk of T2DM, the association between natural menopause itself and risk of T2DM is not evident. However, the presence and the severity of MetS appears to be associated with an increased risk of T2DM. Although the mechanism is not clear, surgical menopause is strongly linked with a higher incidence of MetS. Interestingly, women with polycystic ovary syndrome (PCOS) have an increased risk of MetS during their reproductive years; however, with menopausal transition, the risk of MetS becomes similar to that of non-PCOS women.

Keywords: Metabolic syndrome, menopause, PCOS, surgical menopause, androgens, insulin resistance.

Graphical Abstract
Shifren JL, Gass ML. NAMS recommendations for clinical care of midlife women working group. The north American menopause society recommendations for clinical care of midlife women. Menopause 2014; 21(10): 1038-62.
Torrens JI, Sutton-Tyrrell K, Zhao X, et al. Relative androgen excess during the menopausal transition predicts incident metabolic syndrome in midlife women: Study of women’s health across the nation. Menopause 2009; 16(2): 257-64.
UNO. United Nations department of economic and social affairs, population division World Pop Age. 2013.
Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: A joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation 2009; 120(16): 1640-5.
Katsiki N, Athyros VG, Karagiannis A, et al. Characteristics other than the diagnostic criteria associated with metabolic syndrome: An overview. Curr Vasc Pharmacol 2014; 12(4): 627-41.
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: Findings from the third national health and nutrition examination survey. JAMA 2002; 287(3): 356-9.
Anagnostis P. Metabolic syndrome in the Mediterranean region: Current status. Int J Endocrinol Metab 2012; 16(1): 72-80.
Park YW, Zhu S, Palaniappan L, et al. The metabolic syndrome: Prevalence and associated risk factor findings in the US population from the third national health and nutrition examination survey, 1988-1994. Arch Intern Med 2003; 163(4): 427-36.
Stefanska A, Bergmann K, Sypniewska G. Metabolic syndrome and menopause: Pathophysiology, clinical and diagnostic significance. Adv Clin Chem 2015; 72: 1-75.
Figueiredo Neto JA, Figueredo ED, Barbosa JB, et al. Metabolic syndrome and menopause: Cross-sectional study in gynecology clinic. Arq Bras Cardiol 2010; 95(3): 339-45.
Romaguera J, Ortiz AP, Roca FJ, et al. Factors associated with metabolic syndrome in a sample of women in Puerto Rico. Menopause 2010; 17(2): 388-92.
Khanam MA, Qiu C, Lindeboom W, et al. The metabolic syndrome: Prevalence, associated factors, and impact on survival among older persons in rural Bangladesh. PLoS One 2011; 6(6)e20259
Kwasniewska M, Pikala M, Kaczmarczyk-Chalas K, et al. Smoking status, the menopausal transition, and metabolic syndrome in women. Menopause 2012; 19(2): 194-201.
Tchernof A, Desmeules A, Richard C, et al. Ovarian hormone status and abdominal visceral adipose tissue metabolism. J Clin Endocrinol Metab 2004; 89(7): 3425-30.
Mesch VR, Boero LE, Siseles NO, et al. Metabolic syndrome throughout the menopausal transition: Influence of age and menopausal status. Climacteric 2006; 9(1): 40-8.
Wamala SP, Lynch J, Horsten M, et al. Education and the metabolic syndrome in women. Diabetes Care 1999; 22(12): 1999-2003.
Cho GJ, Lee JH, Park HT, et al. Postmenopausal status according to years since menopause as an independent risk factor for the metabolic syndrome. Menopause 2008; 15(3): 524-9.
Eshtiaghi R, Esteghamati A, Nakhjavani M. Menopause is an independent predictor of metabolic syndrome in Iranian women. Maturitas 2010; 65(3): 262-6.
Miller AM, Wilbur J, Chandler PJ, et al. Cardiovascular disease risk factors and menopausal status in midlife women from the former Soviet Union. Women Health 2003; 38(3): 19-36.
Ziaei S, Mohseni H. Correlation between hormonal statuses and metabolic syndrome in postmenopausal women. J Family Reprod Health 2013; 7(2): 63-6.
Maltais ML, Desroches J, Dionne IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact 2009; 9(4): 186-97.
Crawford SL, Casey VA, Avis NE, et al. A longitudinal study of weight and the menopause transition: Results from the Massachusetts women’s health study. Menopause 2000; 7(2): 96-104.
Poehlman ET. Menopause, energy expenditure, and body composition. Acta Obstet Gynecol Scand 2002; 81(7): 603-11.
Kim HM, Park J, Ryu SY, et al. The effect of menopause on the metabolic syndrome among Korean women: The Korean national health and nutrition examination survey, 2001. Diabetes Care 2007; 30(3): 701-6.
Lovejoy JC, Champagne CM, de Jonge L, et al. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes(Lond) 2008; 32(6): 949-58.
Donato GB, Fuchs SC, Oppermann K, et al. Association between menopause status and central adiposity measured at different cutoffs of waist circumference and waist-to-hip ratio. Menopause 2006; 13(2): 280-5.
Sowers M, Zheng H, Tomey K, et al. Changes in body composition in women over six years at midlife: Ovarian and chronological aging. J Clin Endocrinol Metab 2007; 92(3): 895-901.
Pu D, Tan R, Yu Q, et al. Metabolic syndrome in menopause and associated factors: A meta-analysis. Climacteric 2017; 20(6): 583-91.
Yamatani H, Takahashi K, Yoshida T, et al. Differences in the fatty acid metabolism of visceral adipose tissue in postmenopausal women. Menopause 2014; 21(2): 170-6.
Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15(7): 539-53.
Toth MJ, Sites CK, Eltabbakh GH, et al. Effect of menopausal status on insulin-stimulated glucose disposal: Comparison of middle-aged premenopausal and early postmenopausal women. Diabetes Care 2000; 23(6): 801-6.
Muscelli E, Kozakova M, Flyvbjerg A, et al. The effect of menopause on carotid artery remodeling, insulin sensitivity, and plasma adiponectin in healthy women. Am J Hypertens 2009; 22(4): 364-70.
Otsuki M, Kasayama S, Morita S, et al. Menopause, but not age, is an independent risk factor for fasting plasma glucose levels in nondiabetic women. Menopause 2007; 14: 404-7.
Golden SH, Ding J, Szklo M, et al. Glucose and insulin components of the metabolic syndrome are associated with hyperandrogenism in postmenopausal women: The atherosclerosis risk in communities study. Am J Epidemiol 2004; 160(6): 540-8.
Kavanagh K, Espeland MA, Sutton-Tyrrell K, et al. Liver fat and SHBG affect insulin resistance in midlife women: The study of women’s health across the nation (SWAN). Obesity 2013; 21(5): 1031-8.
Nestler JE, Jakubowicz DJ. Decreases in ovarian cytochrome P450c17 alpha activity and serum free testosterone after reduction of insulin secretion in polycystic ovary syndrome. N Engl J Med 1996; 335(9): 617-23.
McQueen MJ, Hawken S, Wang X, et al. Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): A case-control study. Lancet 2008; 372(9634): 224-33.
Nikolic D, Katsiki N, Montalto G, et al. Lipoprotein subfractions in metabolic syndrome and obesity: Clinical significance and therapeutic approaches. Nutrients 2013; 5(3): 928-48.
Anagnostis P, Stevenson JC, Crook D, et al. Effects of gender, age and menopausal status on serum apolipoprotein concentrations. Clin Endocrinol (Oxf) 2016; 85(5): 733-40.
Anagnostis P, Karras S, Lambrinoudaki I, et al. Lipoprotein (a) in postmenopausal women: Assessment of cardiovascular risk and therapeutic options. Int J Clin Pract 2016; 70(12): 967-77.
Anagnostis P, Stevenson JC, Crook D, et al. Effects of menopause, gender and age on lipids and high-density lipoprotein cholesterol subfractions. Maturitas 2015; 81(1): 62-8.
Mesch VR, Siseles NO, Maidana PN, et al. Androgens in relationship to cardiovascular risk factors in the menopausal transition. Climacteric 2008; 11(6): 509-17.
Stevenson JC, Crook D, Godsland IF. Influence of age and menopause on serum lipids and lipoproteins in healthy women. Atherosclerosis 1993; 98(1): 83-90.
Derby CA, Crawford SL, Pasternak RC, et al. Lipid changes during the menopause transition in relation to age and weight: The Study of women’s health across the nation. Am J Epidemiol 2009; 169(11): 1352-61.
Carr MC, Kim KH, Zambon A, et al. Changes in LDL density across the menopausal transition. J Investig Med 2000; 48(4): 245-50.
Santamarina-Fojo S, Haudenschild C, Amar M. The role of hepatic lipase in lipoprotein metabolism and atherosclerosis. Curr Opin Lipidol 1998; 9(3): 211-9.
Auro K, Joensuu A, Fischer K, et al. A metabolic view on menopause and ageing. Nat Commun 2014; 5: 4708.
Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: A report from the american heart association. Circulation 2017; 135(10): 146-603.
Staessen J, Bulpitt CJ, Fagard R, et al. The influence of menopause on blood pressure. J Hum Hypertens 1989; 3(6): 427-33.
Zanchetti A, Facchetti R, Cesana GC, et al. Menopause-related blood pressure increase and its relationship to age and body mass index: The SIMONA epidemiological study. J Hypertens 2005; 23(12): 2269-76.
de Kat AC, Dam V, Onland-Moret NC, et al. Unraveling the associations of age and menopause with cardiovascular risk factors in a large population-based study. BMC Med 2017; 15(1): 2.
Zhou Y, Zhou X, Guo X, et al. Prevalence and risk factors of hypertension among pre- and post-menopausal women: A cross-sectional study in a rural area of northeast China. Maturitas 2015; 80(3): 282-7.
Lima R, Wofford M, Reckelhoff JF. Hypertension in postmenopausal women. Curr Hypertens Rep 2012; 14(3): 254-60.
Cifkova R, Pitha J, Lejskova M, et al. Blood pressure around the menopause: A population study. J Hypertens 2008; 26(10): 1976-82.
Coylewright M, Reckelhoff JF, Ouyang P. Menopause and hypertension: An age-old debate. Hypertension 2008; 51(4): 952-9.
Casiglia E, Tikhonoff V, Caffi S, et al. Menopause does not affect blood pressure and risk profile, and menopausal women do not become similar to men. J Hypertens 2008; 26(10): 1983-92.
Wassmann S, Baumer AT, Strehlow K, et al. Endothelial dysfunction and oxidative stress during estrogen deficiency in spontaneously hypertensive rats. Circulation 2001; 103(3): 435-41.
Atsma F, Bartelink ML, Grobbee DE, et al. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: A meta-analysis. Menopause 2006; 13(2): 265-79.
Muka T, Oliver-Williams C, Kunutsor S, et al. Association of age at onset of menopause and time since onset of menopause with cardiovascular outcomes, intermediate vascular traits, and all-cause mortality: A Systematic review and meta-analysis. JAMA Cardiol 2016; 1(7): 767-76.
Ossewaarde ME, Bots ML, Verbeek AL, et al. Age at menopause, cause-specific mortality and total life expectancy. Epidemiology 2005; 16(4): 556-62.
Rivera CM, Grossardt BR, Rhodes DJ, et al. Increased cardiovascular mortality after early bilateral oophorectomy. Menopause 2009; 16(1): 15-23.
Mendelsohn ME, Karas RH. Molecular and cellular basis of cardiovascular gender differences. Science 2005; 308(5728): 1583-7.
Mikkola TS, Gissler M, Merikukka M, et al. Sex differences in age-related cardiovascular mortality. PLoS One 2013; 8(5)e63347
Woodard GA, Brooks MM, Barinas-Mitchell E, et al. Lipids, menopause, and early atherosclerosis in study of women’s health across the nation heart women. Menopause 2011; 18(4): 376-84.
Chen Y, Zeleniuch-Jacquotte A, Arslan AA, et al. Endogenous hormones and coronary heart disease in postmenopausal women. Atherosclerosis 2011; 216(2): 414-9.
Soleimani A, Pourmoghaddas A, Sadeghi M, et al. Risk and age of cardiovascular event in women with metabolic syndrome: Menopause age in focus. Metab Syndr Relat Disord 2018; 16(3): 127-34.
van Herpt TT, Dehghan A, van Hoek M, et al. The clinical value of metabolic syndrome and risks of cardiometabolic events and mortality in the elderly: The Rotterdam study. Cardiovasc Diabetol 2016; 15-69.
Gurka MJ, Vishnu A, Santen RJ, et al. Progression of metabolic syndrome severity during the menopausal transition. J Am Heart Assoc 2016; 5(8) pii: e003609.
Tao XY, Zuo AZ, Wang JQ, et al. Effect of primary ovarian insufficiency and early natural menopause on mortality: A meta-analysis. Climacteric 2016; 19(1): 27-36.
Kim C, Edelstein SL, Crandall JP, et al. Menopause and risk of diabetes in the diabetes prevention program. Menopause 2011; 18(8): 857-68.
Brand JS, van der Schouw YT, Onland-Moret NC, et al. Age at menopause, reproductive life span, and type 2 diabetes risk: Results from the EPIC-Interact study. Diabetes Care 2013; 36(4): 1012-9.
LeBlanc ES, Kapphahn K, Hedlin H, et al. Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women: Findings from the women’s health initiative. Menopause 2017; 24(1): 64-72.
Wilson PW, D’Agostino RB, Parise H, et al. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 2005; 112(20): 3066-72.
Cameron AJ, Zimmet PZ, Soderberg S, et al. The metabolic syndrome as a predictor of incident diabetes mellitus in Mauritius. Diabet Med 2007; 24(12): 1460-9.
Ford ES, Li C, Sattar N. Metabolic syndrome and incident diabetes: current state of the evidence. Diabetes Care 2008; 31(9): 1898-904.
Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: A summary of the evidence. Diabetes Care 2005; 28(7): 1769-78.
Gurka MJ, Guo Y, Filipp SL, et al. Metabolic syndrome severity is significantly associated with future coronary heart disease in Type 2 diabetes. Cardiovasc Diabetol 2018; 17(1): 17.
Colditz GA, Willett WC, Stampfer MJ, et al. Menopause and the risk of coronary heart disease in women. N Engl J Med 1987; 316(18): 1105-10.
Rocca WA, Grossardt BR, de Andrade M, et al. Survival patterns after oophorectomy in premenopausal women: A population-based cohort study. Lancet Oncol 2006; 7(10): 821-8.
Lobo RA. Surgical menopause and cardiovascular risks. Menopause 2007; 14(3): 562-6.
Shoupe D, Parker WH, Broder MS, et al. Elective oophorectomy for benign gynecological disorders. Menopause 2007; 14(3): 580-5.
Morelli M, Venturella R, Mocciaro R, et al. Prophylactic salpingectomy in premenopausal low-risk women for ovarian cancer: Primum non nocere. Gynecol Oncol 2013; 129(3): 448-51.
SGO. Clinical practice statement: Salpingectomy for ovarian cancer prevention. Available at
Jacoby VL. Hysterectomy controversies: Ovarian and cervical preservation. Clin Obstet Gynecol 2014; 57(1): 95-105.
Zhao D, Guallar E, Ouyang P, et al. Endogenous sex hormones and incident cardiovascular disease in post-menopausal women. J Am Coll Cardiol 2018; 71(22): 2555-66.
Gunning MN, Fauser B. Are women with polycystic ovary syndrome at increased cardiovascular disease risk later in life? Climacteric 2017; 20(3): 222-7.
Anagnostis P, Tarlatzis BC, Kauffman RP. Polycystic ovarian syndrome (PCOS): Long-term metabolic consequences. Metabolism 2018; 86: 33-43.
Armeni E, Stamatelopoulos K, Rizos D, et al. Arterial stiffness is increased in asymptomatic nondiabetic postmenopausal women with a polycystic ovary syndrome phenotype. J Hypertens 2013; 31(10): 1998-2004.
Polotsky AJ, Allshouse AA, Crawford SL, et al. Hyperandrogenic oligomenorrhea and metabolic risks across menopausal transition. J Clin Endocrinol Metab 2014; 99(6): 2120-7.
Schmidt J, Landin-Wilhelmsen K, Brannstrom M, et al. Cardiovascular disease and risk factors in PCOS women of postmenopausal age: A 21-year controlled follow-up study. J Clin Endocrinol Metab 2011; 96(12): 3794-803.
Pinola P, Puukka K, Piltonen TT, et al. Normo- and hyperandrogenic women with polycystic ovary syndrome exhibit an adverse metabolic profile through life. Fertil Steril 2017; 107(3): 788-95.
Khatibi A, Agardh CD, Shakir YA, et al. Could androgens protect middle-aged women from cardiovascular events? A population-based study of Swedish women: The women’s health in the lund area (WHILA) study. Climacteric 2007; 10(5): 386-92.

Rights & Permissions Print Export Cite as
© 2023 Bentham Science Publishers | Privacy Policy