Menopause is like dropping a bomb on your body. What worked for you for decades now doesn’t work. What you eat now makes you gain weight. Cholesterol rises. Visceral fat rises. Blood sugar rises. Hair falls out. Skin loosens and wrinkles and droops.
What do studies show are the biggest menopause changes?
CHOLESTEROL CHANGES
- Cholesterol goes up “dramatically.” This is total cholesterol, LDL-C, and ApoB
- This rise occurs rapidly within a year of the final menstrual period
- It is independent of chronological aging
- HDL levels go down.
- There is a shift to small, dense LDL particles- these are the ones that cause atherosclerosis- the clogging of your arteries which leads to high blood pressure, stroke, and heart disease
- Elevated triglycerides
VISCERAL FAT INCREASES
- Lean body mass decreases
- Increased pericardial fat
- These fat distribution changes are beyond what you see with “just getting older”
- Visceral fat is a primary metabolic marker that increases across menopausal transition
INSULIN RESISTANCE
- It is thought insulin resistance is because of the increase of truncal obesity and loss of estrogen. This causes an increase in insulin levels
- Higher Type 2 diabetes risk
- Why does it occur? Theories include
- Changed adipokine production from visceral fat —> inflammation
- Decrease SHBG (sex hormone binding globulin) –>increase bioavailable testosterone, which is independently predictive of type 2 diabetes
- Estrogen has direct effects on pancreatic B-cell insulin secretion. The loss of estrogen affects these
- These changes are AGE related more than some of the others which are more menopause related
METABOLIC SYNDROME
Metabolic syndrome is a cluster of symptoms which are associated with higher risk of heart disease, stroke, and diabetes. To have metabolic syndrome, you have to have three of the following five issues:
- Abdominal obesity (waist over 40 inches in men/35 inches in women),
- high blood pressure (systolic >130 or diastolic >85),
- elevated fasting blood sugar (>100),
- high triglycerides (>150), and
- low HDL (<40 in men, <50 in women)
Metabolic syndrome rises during menopause from 15% pre menopause to 44% postmenopause.
INFLAMMATION
Systemic inflammation rises. We measure this through things like C reactive protein and glycoprotein acetyls.
Our thoughts on Menopause transition at Biohackr Health
Speaking to the choir. Two of our founders and menopausal women, and Biohackr Health came out of the changes we faced as we aged and the lack of good guidance on how to navigate it. The changes are abrupt, big, and real. Even knowing it was coming, it was still shocking.
Our recommendations?
- TEST. Where you have been for decades will change. Your cholesterol may go up 50 points (!!) in a year. Your blood sugar. Your weight likely has been creeping up a pound or two, and then you blink and you are up 20 pounds. Muscle mass declines. These are all knowable numbers.
- Cholesterol panel heart testing
- Blood sugar panel. Consider a continuous glucose monitor to see how your body processes food. blood sugar testing
- InBody scan. See what your fat/muscle percentages are and how much visceral fat you have.
- Weight
- Resting Metabolic Rate (how many calories do you burn at rest?) and VO2 max (when do you go from burning fat to burning carbs) are great insights into where you are after menopause. Your calorie needs go down as you age. VO2 test
- TREAT. Once you find out what your issues are, treat them. This may look like cholesterol medications (telehealth visit). Or a GLP to lower blood sugar and help with weight control. Or do a VO2 max test and start on creatine to help improve your muscle mass and cardiovascular health.
- HORMONES. Clearly this is a big staple of treatment. All the old advice of “hormones are bad” is OUTDATED and REFUTED medicine. The reason to do hormones is not the hot flashes. There are clear medical benefits to hormone replacement. There is a slight increase in breast cancer rates, but the protective effects of hormones on brain health, heart health, skin, hair, and bone health are massive. Please read blogs on these. Menopause info
- IMPROVE MUSCLE. Creatine and NAD
- MITOCHONDRIAL HEALTH. We love things that improve your whole body health. Mitochondria are intrinsic to aging better.
- PEPTIDES. This is a newer section, but GLPs for weight and glucose control glp page, tesamorelin (a growth hormone analog which targets visceral fat. info on tesamorelin), and more can help.