As women, we often talk about our “metabolism” as if it’s a mysterious genie that controls whether we lose or gain weight. Or we think of it as an engine that runs our bodily functions. Like a shiny, sputtering machine in a cartoon, the metabolism takes in calories and spews out energy to keep the body moving and thriving.
But your metabolism isn’t one thing or one process—it’s actually multifaceted and complicated.
What Is Metabolism and How Does It Work?
The metabolism is ALL of the chemical reactions related to creating energy that occur within cells and organs throughout the body. These chemical processes use nutrients and other substances to make energy and all the building blocks that your cells and organs need to survive. (1)
Metabolism is affected by many factors including your sex, your age, what you eat and drink, your digestion, and exercise. Hormones play key roles in some organs and processes—for example, insulin that’s produced in the pancreas for regulating glucose in the blood.
What Is Metabolic Syndrome and What Are the Risk Factors?
Metabolic syndrome is different from your metabolism. It is a group of conditions that, if left untreated, raise a person’s risk of developing serious cardiovascular problems. To be diagnosed with metabolic syndrome, you need to have three or more of these five conditions: (2)
- Excess belly fat (waist >35 inches in women)
- High fasting blood sugar
- High blood pressure
- High triglyceride levels
- Low HDL (“good cholesterol”) levels
In the United States, about 40% of adults may have metabolic syndrome. (3)
How Does Menopause Affect Metabolic Health?
During your reproductive years, your circulating levels of estrogen and testosterone help regulate a healthy metabolism. But during perimenopause, estrogen levels begin to decline, setting in motion a variety of changes that may put you at metabolic risk throughout your postmenopausal years.
“Metabolic risk” translates to a higher risk of developing the individual conditions (listed above) that are associated with metabolic syndrome. In fact, according to a study of more than 12,000 women, menopause is associated with an increased risk for developing metabolic syndrome itself, which means having at least three of those conditions. (4) In another study, almost 14% of women had new-onset metabolic syndrome by their final menstrual period (which is 12 months before officially reaching menopause.) (5)
Why Does Menopause Lead to Increased Belly Fat?
During the reproductive years, estrogen tells a woman’s body, “Fat tissue should be stored under the skin on the hips and butt areas.” But as estrogen declines, that message changes, causing fat to be distributed differently. More fat is stored in the belly area as visceral fat, which is a deeper fat that surrounds organs and contributes to chronic issues like diabetes and heart disease. (4, 6, 7)
For women, a waist circumference of 35 inches or more is considered excess belly fat. (7)
How Does Menopause Affect Blood Sugar and Insulin Resistance?
Women in menopause have a higher risk of impaired glucose tolerance. (4, 6) Estrogen helps with effective glucose metabolism to keep blood sugar more stable, so the decline in estrogen leads to poor glucose metabolism in many women. (6)
Another reason is that gaining visceral fat contributes to insulin resistance, which means cells don’t respond as well to insulin the pancreas produces. Then the pancreas has to produce more and more insulin to bring the blood sugar down, but eventually they can’t keep up, and blood sugar stays elevated. (6)
A not-so-obvious contributor to elevated blood sugar in menopause is muscle loss. Muscle tissue uses glucose for energy, and that helps lower blood glucose. But as muscle mass decreases during midlife, less glucose is cleared from the blood. (6)
Why Is High Blood Pressure More Common After Menopause?
In the United States, 75% of women over age 60 have high blood pressure. That’s 3 out of every 4 women! (6, 8) High blood pressure, aka hypertension, occurs when the arteries become less flexible so they can’t expand enough when the blood flows through. So, with each pump of the heart, the pressure that blood exerts against the stiffer artery walls becomes too high. (6)
Estrogen helps in the production of nitric oxide, which keeps blood vessels open and more pliable so that blood flows easily. Lower estrogen may lead to less supple arteries and increased blood pressure. Plaque buildup in the arteries can contribute to hypertension. (6)
It’s also thought that testosterone may work with estrogen to help control blood pressure. Adequate testosterone levels may have beneficial effects on blood vessel health, the prevention of plaque formation, and body composition. (9)
How Is Menopause Associated with Cholesterol and Triglycerides?
An unfavorable lipid profile, including high triglycerides and low HDL, has often been associated with heart disease. Cardiovascular disease is the leading cause of death in women, and menopause most likely increases the risk.
Estrogen helps maintain the health of blood vessel walls and heart muscle. Decreased estrogen during menopause leads to inflammation in blood vessel walls, and a stiffening in the heart muscle tissue may cause problems with the heartbeat. (6)
On top of that, many women have negative changes in their blood lipid profiles during perimenopause and menopause. (4, 10, 11) LDL cholesterol and triglycerides can rise, while HDL (the “good” cholesterol) may decline. (6, 11) These changes in a cholesterol profile increase risk for cardiovascular disease, and they make up two of the three criteria for a metabolic syndrome diagnosis.
Can Bioidentical Hormone Replacement Therapy (BHRT) Support Metabolic Health?
We know that menopause is associated with an increased prevalence of metabolic syndrome. (4, 5, 12) But hormone therapy may help.
Studies show that hormone therapy can be associated with a lower prevalence of metabolic syndrome in postmenopausal women. (12) Some studies suggest that hormone therapies may even positively affect each component of metabolic syndrome, so a personalized approach may be best. (12)
At Belmar Pharmacy, our pharmacists create compounded bioidentical hormone replacement therapy (BHRT) just for you. Your doctor may specify estradiol or biest (a combination of estradiol and estriol) to replenish the estrogen loss that could be contributing to your metabolic symptoms. Then we customize the dose and form—such as oral capsules, topical creams, or sublingual tablets—based on your provider’s prescription.
If you’re concerned about metabolic syndrome or any of its components, talk with your doctor to see if BHRT may be a potential asset in your wellness plan.
References:
1. de Nava ASL, Raja A. Physiology, metabolism. StatPearls. 2025. Last updated September 12, 2022. Accessed December 8, 2025.
Link: Physiology, Metabolism – StatPearls – NCBI Bookshelf
2. Levy SM, Nessen M. Quick Facts: Metabolic Syndrome. Merck Manual Consumer Version. Revised October 2025. Accessed December 7, 2025.
Link: Metabolic Syndrome – Disorders of Nutrition – Merck Manual Consumer Version
3. Liang X, Or B, Tsoi MF, Cheung CL, Cheung BMY. Prevalence of metabolic syndrome in the United States National Health and Nutrition Examination Survey 2011-18. Postgrad Med J. 2023;99(1175):985-992. DOI: 10.1093/postmj/qgad008
4. Christakis MK, Hasan H, De Souza, LR, Shirreff L. The effect of menopause on metabolic syndrome: cross-sectional results from the Canadian Longitudinal Study on Aging. Menopause. 2020;27(9):999-1009. DOI: 10.1097/GME.0000000000001575
5. Janssen I, Powell LH, Crawford S, Lasley B, Sutton-Tyrrell K. Menopause and the metabolic syndrome: the Study of Women’s Health Across the Nation. Arch Intern Med. 2008;168(14):1568-75. doi: 10.1001/archinte.168.14.1568
6. Gersh F, Perella A. Menopause: 50 Things You Need to Know. Callisto Publishing, 2021.
7. Visceral fat. Cleveland Clinic. Updated August 22,2025. Accessed January 11, 2026.
Link: What Is Visceral Fat & How To Get Rid of It
8. Lima R, Wofford M, Reckelhoff JF. Hypertension in postmenopausal women. Curr Hypertens Rep. 2012;14(3):254-60. doi: 10.1007/s11906-012-0260-0
Link: Hypertension in Postmenopausal Women – PMC
9. Mauvais-Jarvis F, Lindsey SH. Metabolic benefits afforded by estradiol and testosterone in both sexes: clinical considerations. J Clin Invest. 2024;134(17):e180073. doi: 10.1172/JCI180073
10. Anagnostis P, Stevenson JC, Crook D, Johnston DG, Godsland IF. Effects of Menopause, Gender and Age on Lipids and High-Density Lipoprotein Cholesterol Subfractions. Maturitas. 2015;81(1)62-68. doi:10.1016/j.maturitas.2015.02.262
11. Nie G, Yang X, Wang Y, et al. The Effects of Menopause Hormone Therapy on Lipid Profile in Postmenopausal Women: A Systematic Review and Meta-Analysis. Front. Pharmacol. 2022;13:850815. https://doi.org/10.3389/fphar.2022.850815
12. Ou, Y.J.; Lee, J.I.; Huang, S.P.; Chen, S.C.; Geng, J.H.; Su, C.H. Association between Menopause, Postmenopausal Hormone Therapy and Metabolic Syndrome. J. Clin. Med. 2023, 12, 4435.
Link: Association between Menopause, Postmenopausal Hormone Therapy and Metabolic Syndrome | MDPI
