Metabolic Syndrome

Background

Most women spend almost a third of their lives living with a hidden, unaddressed, yet regular experience, known as menopause. At least 60% of women have mild symptoms, 20% have severe symptoms, and 20% have none. However, with a lack of awareness into what menopause truly entails and how to help reduce its impact, many women find themselves with increased emotional distress due to its symptoms and subsequent disruptions to different areas of daily life, such as the workplace. For example, in a survey of 300,000 staff conducted by major UK banks, approximately 13% were women over the age of 50. This means that more than 100,000 employees could be experiencing menopause. Many organisations are currently not providing support for women going through menopause, which holds them back from attaining top positions and undeniably limits gender equality. Consequently, menopause must be understood to help improve quality of life, remove the stigma and myths that surround it, and bring awareness of the options available to effectively manage and control its symptoms.

Firstly, what is menopause? Menopause is when a woman stops having periods and is no longer able to conceive. In the UK, the average age for a woman to become menopausal is 51. However, some women can experience menopause before the age of 40, which is known as premature menopause. Common symptoms include hot flushes, night sweats, reduced libido, trouble sleeping, and mood disturbances. While these symptoms are mild and seen as a minor burden to daily life, they can lead to comorbid conditions.

This article introduces the combination of metabolic defects before, during, and after menopause and their associated symptoms and disorders. This collection of conditions is known as the Metabolic syndrome (MetS). The article will also focus on treatment options and what is urgently needed to help prevent this syndrome for women who are peri‑menopausal.

What is MetS?

After reaching menopause, many women are likely to develop MetS, a combination of an imbalance of various components in the body, including increased blood pressure, belly fat, cholesterol, lipids, and blood sugar. These symptoms can lead to an additional risk for cardiovascular disease (CVD). Evidence suggests that after menopause, over 38% of women have a higher risk of MetS occurring. Therefore, it is vital that there is an awareness about this syndrome to help aid women’s health, lifestyle, and comfort.

Menopause begins with a deficiency in the hormones oestrogen and progesterone. This reduction causes many changes in how the body operates and influences all the components connected with MetS:

  1. Fat migrates to the middle of the body, causing an increase in abnormal cholesterol and lipid levels.
  2. A resistance to insulin in the blood leads to a condition called hyperinsulinemia. Insulin is a hormone that helps regulate blood sugar, and abnormal levels can further lead to conditions such as type 2 diabetes, which is also a risk factor for CVD.
  3. Hypertension and chronic inflammation are also associated with MetS; high blood pressure can lead to further changes such as an increase in inflammatory mediators, further causing a cascade of other reactions that lead to CVD, if unmanaged.

Due to these changes, some disorders categorised as menopausal metabolic complications are obesity, dyslipidaemia, polycystic ovary syndrome, and type 2 diabetes.

With unknown pathways behind MetS, there is a strong need for research to identify how these can be managed to reduce further health complications that menopausal women are likely to experience. So, what are some strategies to prevent and manage the risk factors linked with this condition?

Menopausal Hormone Therapy (MHT)

The way to develop treatments for MetS is to focus on reversing the symptoms. A reduction in hormone levels is thought to be one of the numerous causes of these imbalances; therefore, menopausal hormone therapy is a solution that can increase leptin, oestrogen, and other needed compounds to reduce inflammatory cascades and lure the system back to metabolic homeostasis. However, despite multiple studies which have shown beneficial effects of MHT, it is currently not recommended as a prevention strategy for metabolic disorders in menopause because of its associated greater risk of breast cancer, stroke, and blood clots.

Lifestyle Changes

Alongside medical treatments for MetS, prevention of risk factors is also recommended to women before, during, and after menopause. As some of the risk factors allude to obesity and increased lipid and sugar levels, lifestyle changes can help control that aspect. Adding more physical activity in combination with healthy eating, sleeping, and other healthy lifestyle choices (avoiding smoking and alcohol) can be the first step to help reduce some of the risk factors associated with MetS. However, this is not sufficient to tackle most of the conditions associated with METs alone. Additional pharmacological treatment of insulin resistance, obesity, dyslipidaemia, or hypertension are still required.

A Lack of Awareness

Although there are options for treatment, it seems that there is still insufficient knowledge available to curb MetS fully in women with menopause. This lack of information is also why research is still needed, with many women not fully understanding what the disease involves. 45% of women surveyed in the UK stated that they did not know the differences between the various stages of menopause. Meanwhile, 73% also indicated that they were not presently addressing their menopausal symptoms due to lack of information, fear, and distractions from daily living. Many women also feel the need to hide their condition from their employers; in a survey from Vodaphone, a third of their employees admitted to concealing symptoms and feeling a stigma around openly talking about it.

Policies

Two laws apply to menopause. The Equality Act of 2010, and the Health and Safety at Work Act of 1974. Both protect women from discrimination and are intended to assist employers in prioritising a healthy and safe workplace. However, because menopause is typically considered as a disability claim rather than a gender claim, many instances of discrimination brought forward by women have failed. There are no effective laws requiring employers to protect employees undergoing menopause, nor is there legal protection for companies affected by their employees’ symptoms restricting their ability to work. Advocation is needed for menopause to be recognised by the law in the same way as pregnancy rights; the absence of legal support and advice for women suffering from menopause in the workplace is disappointing.

The Value of Research

Consequently, funding is necessary to overcome the gap in menopausal research quickly and effectively, which will help us gain more information about this condition, thus reducing the chances of:

  • Stigmatisation and marginalisation of the condition
  • Lack of safer treatment
  • Mortality worries
  • Unplanned admissions to the hospital due to the consequences of unmanaged MetS

Without MHT, many women have not had an accessible treatment option to address the impacts of menopausal metabolic syndrome. There is an increasing unmet need, and many women, including myself, need conversations on this topic to continue and expand for additional research to occur. It only needs a little bit of attention and care from all of us, and perhaps in the future, we will be able to manage the symptoms of menopause effectively and regulate it in a way that makes us more unrestrained as women.

To learn more:

  • Menopause and Me is a site dedicated to supporting women going through menopause, with tailored information about all stages of menopause and the tools/support needed to make informed choices when it comes to managing symptoms https://www.menopauseandme.co.uk/
  • The British Menopause Society (BMS) offers education, information, and guides to healthcare professionals on menopause and all aspects of post-reproductive health. https://thebms.org.uk/
  • You can also be part of raising awareness on World Menopause Day (18th October 2021)
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