Changes in female sex hormones that occur during the menopause are directly related to a decline in cardiovascular health, new research has found.

While previous studies have shown that menopause is associated with heart-disease promoting levels of metabolites, this is the first to link the shift with hormonal changes.

To avoid this negative metabolite shift, women going through menopause should pay attention to the quality of fat in their diet and ensure they are getting sufficient exercise, the authors say. Hormone Replacement Therapy (HRT) is also likely to partially ameliorate these effects.

The researchers looked at what changes occur in metabolite levels during the menopausal transition

The research looked at data from 218 perimenopausal women not using Hormone Replacement Therapy (HRT) at baseline.

Levels of 180 metabolites (lipids, lipoproteins and amino acids) and two hormones (oestradiol and FSH) were obtained from blood samples at baseline and every three to six months until early postmenopause (defined as no periods for over six months and elevated FSH levels on at least two consecutive occasions).

Women were also asked to complete menstrual diaries in order to assess ‘menopausal state’. Blood follicle-stimulating hormone (FSH) levels were also taken.

The researchers then carried out detailed statistical analyses to determine what changes occur in metabolite levels during the menopausal transition and whether these changes related to the shift in sex hormone levels.

They also tested whether the metabolite trajectory varied between HRT users and non-users. In total, 35 women (15%) started HRT during the study.

Levels of bad cholesterol rise during menopause, and 10% of this increase is due to shifts in sex hormones

Menopause was associated with a statistically significant change in levels of 85 metabolites, and an explanatory analysis showed that the menopausal hormonal shift directly explained the change in 64 of these metabolites.

These included low-density lipoprotein (LDL) cholesterol, triglycerides, fatty acids. and amino acids.

The analyses were adjusted for age at baseline, duration of follow up, education level, smoking status, alcohol use, physical activity, and diet quality.

A second exploratory analysis revealed that HRT was associated with increases in high-density lipoprotein (“good”) cholesterol and reductions in LDL (“bad”) cholesterol

Study author Dr. Eija K. Laakkonen of the University of Jyväskylä, Finland, said: “This study links hormonal changes during menopause to metabolic alterations that promote heart disease. Previous studies did not confirm menopausal status with hormone measurements, meaning that they could not differentiate menopausal effects from ageing."

Women considering HRT should discuss it with a healthcare professional

However, she warns that the study is observational and the results should therefore be interpreted with caution. This is because the links with sex hormones and HRT were found in exploratory analyses, she explains. They will therefore need confirming in future research.

“Nevertheless, our findings indicate that initiating HRT early into menopause, i.e. during the menopausal transition, offers the greatest cardioprotective effect.

“Women considering HRT should discuss it with their healthcare professional since there are numerous choices and some potential contraindications such as cancer or stroke history that need to be considered,” she concludes.