Women's cardiovascular risk is significantly lower than men's during the reproductive years — an advantage attributed largely to oestrogen's endothelial protective effects. This advantage disappears rapidly post-menopause. By 5 years post-menopause, women's cardiovascular event rates approximate those of men of the same chronological age. The 2022 NICE guidelines confirm that HRT initiated within 10 years of menopause onset is associated with reduced cardiovascular events, not increased.
The Evidence-Based Response
- HRT discussion with a menopause specialist — in healthy perimenopausal and early postmenopausal women, benefits to risks increasingly favour treatment
- Resistance training 2–3 times per week — primary non-pharmacological intervention for bone density and visceral fat control
- Protein intake 1.6–2.2 g/kg — elevated requirement post-menopause due to reduced anabolic sensitivity
- Calcium 1,200 mg and vitamin D3 2,000 IU daily
- Cardiorespiratory exercise — essential for the cardiovascular risk management oestrogen previously provided passively
menopausemetabolic healthoestrogenbone densitycardiovascular riskHRTinsulin resistance