Menopause and metabolism: weight, sleep, heart health and treatment options

Perimenopause and menopause: the terms

• Perimenopause: the transition, often lasting several years, when hormone levels fluctuate. Periods become irregular and symptoms often begin.
• Menopause: your final period, confirmed after 12 months without one.
• Postmenopause: the years after menopause.
• Early menopause happens between 40 and 45; premature ovarian insufficiency before 40. Both deserve medical assessment.

Common symptoms

• Hot flushes and night sweats.
• Sleep problems.
• Low mood, anxiety, irritability and "brain fog".
• Joint aches.
• Vaginal dryness, discomfort during sex and urinary symptoms (genitourinary syndrome of menopause).
• Irregular, then absent, periods.

Symptoms vary a lot. Some women have few; others find them disruptive for years.

What happens to your metabolism?

Weight and body shape

Many women notice weight gain or a change in shape, with more fat around the abdomen. Ageing, loss of muscle, poorer sleep and lower activity contribute alongside hormonal changes. Abdominal fat is linked to insulin resistance and heart disease.

Cholesterol and heart health

LDL cholesterol tends to rise after menopause, and heart disease risk increases. Blood pressure and blood sugar may also rise.

Bones

Bone loss speeds up in the years around menopause, raising the risk of osteoporosis and fractures later.

Muscle

Muscle mass and strength decline with age, and this can accelerate after menopause, affecting metabolism, balance and independence.

Looking after your health through menopause

• Strength training at least twice a week to protect muscle and bone.
• Regular aerobic activity: 150 to 300 minutes of moderate activity a week.
• Enough protein, calcium and vitamin D from your diet.
• Prioritise sleep, and manage night sweats.
• Limit alcohol, which can worsen hot flushes and sleep.
• Stop smoking.
• Check blood pressure, blood sugar and cholesterol, and keep up with breast and cervical screening.

Treatment options: an up-to-date overview

Menopausal hormone therapy (MHT, also called HRT)

MHT is the most effective treatment for hot flushes and night sweats, and it also helps protect bone. Key points from recent guidance:

• The UK's NICE menopause guideline (updated 2024) sets out benefits and risks, including for heart disease, stroke, dementia and breast cancer, to support shared decisions, and notes that MHT is unlikely to change overall life expectancy.
• In November 2025, the US Food and Drug Administration announced plans to remove the long-standing "boxed warnings" from most menopausal hormone therapy labels, reflecting a reassessment of the evidence, particularly for women who start treatment under 60 or within 10 years of menopause.
• Risks and benefits still depend on your age, the type and route of hormones, and your personal and family history. For example, women with a womb who take oestrogen need a progestogen to protect the womb lining.

MHT isn't suitable for everyone, including some women with a history of breast cancer, blood clots or certain liver conditions.

Vaginal oestrogen

Low-dose vaginal oestrogen treats dryness and urinary symptoms and is very little absorbed into the body. It can usually be used long term.

Non-hormonal options

• Cognitive behavioural therapy (CBT), recommended by NICE, can reduce how much hot flushes bother you and improve sleep and mood.
• Prescription non-hormonal medicines are available for hot flushes in women who can't or prefer not to use hormones.

Be cautious about "bioidentical" compounded hormones and supplements sold online or in salons. Quality and dosing are not well regulated.