Menopause is associated with an increased risk for metabolic syndrome, a cluster of risk factors for cardiovascular disease and diabetes. New research indicates that vitamin D and estradiol may help protect against these conditions.1

Risk factors for metabolic syndrome include visceral adiposity, atherogenic dyslipidemia, elevated blood pressure, and insulin resistance, all of which increase the risk of cardiovascular disease.2 The prevalence of metabolic syndrome in the United States is higher in women compared with men (35.6% vs. 30.3%), affecting more than half of women age 60 years or older.3

Abdominal obesity and heart disease that lead to metabolic syndrome increase significantly as women age, and have been linked with estrogen loss in postmenopausal women.4 Based on these findings, researchers have looked at estradiol treatment for women who are fewer than six years postmenopausal as a means of preventing heart disease.5

Similar results have been linked to vitamin D, which has been associated with such metabolic syndrome markers as obesity, hyperglycemia, insulin resistance, and type 2 diabetes mellitus.6

In recognizing these synergistic effects, Chinese researchers looked for similar interactions on metabolic syndrome. In the cross-sectional study, researchers enrolled 616 postmenopausal women ages 49-86 years who were not taking estrogen and vitamin D/calcium supplements at the beginning of the study.

Findings suggest that higher levels of vitamin D were associated with a favorable lipid profile, blood pressure, and glucose level. Estradiol was negatively associated with cholesterol, triglycerides, and blood pressure. The results suggest that vitamin D and estradiol work together to decrease the risk of metabolic syndrome in postmenopausal women.1

JoAnn Pinkerton, MD, NCMP, executive director of the North American Menopause Society, notes that the Endocrine Society recommends vitamin D levels of 30 ng/mL for postmenopausal women.

“Whether adequate levels of vitamin D improve nonskeletal cardiovascular or cognitive benefits remains the subject of debate, and answers await randomized clinical trial data,” she states.

Patients facing menopause may be dealing with conditions associated with metabolic syndrome. Offer the following strategies on how to effectively deal with such issues:

• Reduce calories. Advise patients that women usually need fewer calories than men, especially as they age. On average, adult women need between 1,600 and 2,400 calories a day. Also, as women age, fewer calories are needed to maintain the same weight.

Encourage increased physical activity and talk about ways to decrease portion sizes, such as splitting meals or ordering lighter portions. Counsel on use of a high-fiber diet that includes flaxseeds, which may improve insulin sensitivity.

• Get active. Strength training can help women to improve body composition, increase strength, and build and maintain lean muscle. Regular physical activity helps to keep bones strong, prevent hip fracture, and reduce arthritis pain.

• Rest and relieve stress. Talk with women about the importance of getting enough sleep in order to keep hormones and appetite under control. Relaxation techniques can help patients to learn to handle stress without the use of food. Non-food stress relievers, such as walking or deep breathing, can help patients find healthy ways to combat stress.

Other heart-healthy practices include smoking cessation, blood pressure control, cholesterol and triglycerides control, and diabetes prevention.

Talk to patients about the increased risk for cardiovascular disease as they age. Cardiovascular disease is the number one cause of death for women ages 65 years and older, and the second leading cause of death among women ages 45-64 years in the United States and Canada.7

For women, a heart attack often has different signs than in men, which can lead to delays in treatment and a higher death rate. Tell patients to seek immediate medical care if they experience the following symptoms:

  • Chest pain or pressure;
  • Pain in the, arms, back, or neck;
  • Extreme fatigue;
  • Shortness of breath, nausea, and dizziness;
  • Unusual sweating;
  • Pain in the upper stomach.7

The most common heart attack symptom is chest pain or discomfort. However, women are somewhat more likely than men to experience some of the other common symptoms. 


  1. Huang H, Guo J, Chen Q, et al. The synergistic effects of vitamin D and estradiol deficiency on metabolic syndrome in Chinese postmenopausal women. Menopause 2019;doi:10.1097/GME.0000000000001370.
  2. Lovre D, Lindsey SH, Mauvais-Jarvis F. Effect of menopausal hormone therapy on components of the metabolic syndrome. Ther Adv Cardiovasc Dis 2016;11:33-43.
  3. Aguilar M, Bhuket T, Torres S, et al. Prevalence of the metabolic syndrome in the United States, 2003-2012. JAMA 2015;313:1973-1974.
  4. El Khoudary SR, Shields KJ, Janssen I, et al. Cardiovascular fat, menopause, and sex hormones in women: The SWAN Cardiovascular Fat Ancillary Study. J Clin Endocrinol Metab 2015;100:3304-3312.
  5. Hodis HN, Mack WJ, Henderson VW, et al; ELITE Research Group. Vascular effects of early versus late postmenopausal treatment with estradiol. N Engl J Med 2016;374:1221-1231.
  6. Prasad P, Kochhar A. Interplay of vitamin D and metabolic syndrome: A review. Diabetes Metab Syndr 2016;10:105-112.
  7. North American Menopause Society. Keeping your heart healthy at menopause. Available at: