Coronary Artery Disease is the leading cause of death among women and increases after menopause. Estrogen is protective for our blood vessels, helping them remain supple. With declining levels of estrogen and progesterone, our blood vessels constrict, our liver produces more proteins that increase the risk of blood clots in those stiff blood vessels. In addition, declining reproductive hormones can lead to cholesterol changes that can increase plaque build-up.

You may be at higher risk after menopause, if you are also: overweight or obese, physically inactive, or a current of former smoker, or you have had: long exposure to second-hand smoke, a history of high cholesterol, high blood pressure, or diabetes, or a family history of heart disease.

Menopause Hormone Therapy (MHT) has been shown to reduce the risk of cardiovascular disease and death from all causes when used by women younger than 60 and less than 9- years from their last menstrual period.

Osteoporosis is the progressive loss of bone with aging. Our bones are continuously remodeling (breaking down and building up of bone in response to many factors, including our levels of estrogen). Estrogen plays the role of slowing down the degradation of our bones. With the decline in estrogen during menopause transition, women are 4x more likely than men to develop osteoporosis. Osteoporosis leads to an increased risk of bone fractures in the spine, hip, and wrist, which in turn, can result in symptoms of pain and disability. More alarming is the statistic that upwards of 30% of adults aged 65 and over die within 12 months of a hip fracture.

You may be at higher risk after menopause, if you are also: petite body frame or weigh < 125lbs, experienced early menopause (40-45 yo) or premature menopause (< 40 yo), or have a history of smoking, chronic steroid use, or other medications such as thyroid medications, seizure medications, or other immunosuppressive drugs.

Menopause Hormone Therapy (MHT) has been shown to decrease the risk of fracture by 20-40%, and with the benefits greatest if started within 9 years from their last menstrual period.

Sarcopenia is the loss of muscle mass, strength, and function that can occur with age and contribute not only to decreased physical performance, but also to the development of  osteoporosis. Muscle and bone health are strongly connected to one another. Maintaining both are important and necessary to decrease the risks of falls and fractures.

You may be at higher risk if you are physically inactive, malnourished, or have a history of diabetes or tobacco use.

Menopause Hormone Therapy (MHT) has been shown to increase estrogen receptors in muscles, altering muscle composition and improving strength and contractility, with the benefits greatest if started within 9 years from their last menstrual period..  

Insulin-resistance can occur when our estrogen levels decline. With decreasing estrogen, our muscles do not take up glucose as well and our liver produces more glucose. This imbalance can lead to increased risk of prediabetes/diabetes, metabolic syndrome, cardiovascular disease and stroke. The effect of low estrogen levels on glucose is seen independent of a women’s age.

You may be at higher risk of insulin-resistance if you overweight or obese, physically inactive, have fatty liver, Obstructive sleep apnea, or PCOS, take certain medications such as steroids, certain blood pressure or cholesterol lowering medications, or have other chronic medical conditions such as Cushing’s disease or hypothyroidism.

Menopause Hormone Therapy (MHT) may lead to lower risk of insulin-resistance, but more research is needed before using estrogen solely for this specific purpose

Neuroinflammation in our brain or spine has been identified as a contributor to the development of Alzheimer’s dementia. Women are twice as likely to develop Alzheimer’s and evidence is mounting that dropping estrogen levels play a role. Therefore it is not surprising that low estrogen levels can manifest as brain fog and concentration issues, anxiety or mood changes, migraines, and even fatigue.

You may be at higher risk after menopause, if you also have high blood pressure, high cholesterol, heart disease or diabetes, have a family history of Alzheimer’s.

Menopause Hormone Therapy (MHT). There is some evidence that estrogen, when taken in early menopause, may be neuroprotective, especially among women who have had their ovaries removed before age 50 or are carriers of the APOE gene. 

The Genitourinary Syndrome of Menopause (GSM) affects up to 80% of menopausal women and is caused by low estrogen levels in the tissues of the urinary tract and the female genital tract.  Symptoms include vaginal dryness, painful sex, burning, urinary tract infections and general irritation of the genital area. In contrast to hot flashes and night sweats that usually improve over time, GSM generally gets worse without effective therapy. Despite the high prevalence of GSM and lack of improvement without treatment, only a minority of affected women seek help or are offered treatment by their healthcare providers

You may be at higher risk after menopause, if you are also: physically inactive, or a current or former smoker, or you have had: long exposure to second-hand smoke,  a history of excessive alcohol use, decreased sexual frequency or abstinence, or absence of vaginal childbirth.

Menopause Hormone Theraoy  (MHT). Low-dose vaginal estrogens, vaginal DHEA, systemic estrogen therapy,and ospemifene are effective treatments for moderate to severe GSM.