The Wider Health Consequences

Bone health — the silent consequence

Bone is living tissue that is constantly being broken down and rebuilt. Estrogen maintains this balance. When estrogen falls, bone breakdown accelerates — and this begins even before your final period.

In the first 2 years after the final period, women can lose approximately 2.5% of lumbar spine bone density and 1.8% of hip bone density per year. After the acute phase, loss continues at around 0.7–1% per year.

More in Chapter 7: Bone Health →

Cardiovascular health

Before menopause, women have significantly lower rates of cardiovascular disease than men of the same age — a protection that largely comes from estrogen. After menopause, cardiovascular disease rates rise sharply. By age 70–75, women and men have similar cardiovascular risk.

• Estrogen loss impairs endothelial function — the ability of blood vessels to dilate and contract normally
• LDL cholesterol and triglycerides tend to rise
• Abdominal fat increases, even in slim women — this visceral fat contributes to insulin resistance
• Insulin sensitivity decreases, raising the risk of type 2 diabetes

Cardiovascular risk assessment — blood pressure, fasting lipids, fasting glucose, weight — is an essential part of menopause care.

Body composition

Many women notice that weight seems easier to gain and harder to lose, with fat accumulating centrally (the abdomen) rather than in the hips and thighs. This is a genuine hormonal effect, not simply ageing or lifestyle. Central adiposity carries its own cardiovascular and metabolic risks.

Brain & cognition

Some women experience difficulties with verbal memory and concentration during perimenopause — the “brain fog” so commonly reported. Some cognitive changes during the transition may be temporary and improve after menopause is fully established.

There is significant scientific interest in whether MHT during the “critical window” might reduce long-term dementia risk — though this remains to be proven.