When we hear the word “metabolic health,” the word “metabolism” might come to mind – that biological process which we know isn’t the same as it was when we were 16. But beyond that? Metabolic health can be a bit of an enigma. The thing is, it’s actually super important, especially for women’s health during menopause and midlife years when our metabolism changes and we’re at risk for metabolic diseases. We’re here to demystify metabolic health and break down what it means for women during menopause and perimenopause.
What is metabolic health?
Now, metabolic health actually lacks a clear scientific definition but is thought of as the absence of metabolic syndrome (or MetS). In other words, if you don’t have a MetS, you are in metabolic health.
MetS is a group of five factors that contribute to an increased risk of heart disease, type 2 diabetes, as well as polycystic ovarian syndrome (PCOS) and sleep apnea. MetS is not considered a disease though – tricky, we know. We can think of it more as a collection of biomarkers, or risk criteria, that are evaluated as a whole. Some of these factors include…
1. Abdominal obesity
Also referred to as high belly fat, abdominal obesity contributes to the risk of insulin resistance and diabetes, both of which are risk factors for cardiovascular disease (CVD). How does this work? Well, fat around the liver and abdominal organs – or visceral fat – is super metabolically active, meaning it releases fatty acids, inflammatory substances, and hormones. These byproducts can eventually cause higher cholesterol, triglycerides, blood glucose, and blood pressure. (More on those guys in a bit.)
Now, abdominal obesity is not the same as general obesity because the former is focused on adipose tissue, aka body fat, around the stomach (as opposed to overall body weight, which is the focus for general obesity). According to the American Heart Association criteria, a waist circumference above 35 inches in women is classified as abdominal obesity, and that includes women who otherwise have a “normal weight” BMI (body mass index). So the number on the scale isn’t necessarily the whole picture.
RELATED: Yes, “Menopause Belly” Is Normal. Here’s What You Can Do About It.
2. Blood glucose (high blood sugar)
Glucose is the primary source of energy for most of our body’s cells. Our bodies have several functions for keeping our blood glucose levels in a healthy range, including insulin. This hormone is responsible for regulating blood sugar levels and moving glucose from the bloodstream into our cells. When our cells don’t respond as they should to insulin though, which we call insulin resistance (or IR), the pancreas starts to produce even more insulin to compensate. IR can be caused by excess fat, low physical activity, poor diet, and some medications.
In cases of IR, over time the pancreas may not be able to keep up and produce the amount of necessary insulin, which can lead to higher-than-normal blood sugar, prediabetes, and eventually diabetes. The end result is that glucose just hangs out in the bloodstream, which can cause damage to our body over time. With IR, that increase in insulin can also lead to excess fat storage, and because our cells aren’t getting the energy they need, we end up feeling hungry and tired. It’s a cascade of physiological events that gets stuck in repeat, leading to weight gain.
3. Hypertension (high blood pressure)
Hypertension is when the force of the blood pumping through the arteries is too high. Over time, this can cause damage to the arteries, which can then lead to serious heart problems, damage to the brain and kidneys, and more. There are typically no warning signs for high blood pressure, so we recommend having a clinician measure it — we’ll dive into ideal measurements in a bit.
4. Dyslipidemia (high cholesterol)
There are actually two types of cholesterol: high-density lipoprotein (HDL), also referred to as “good” cholesterol and low-density (LDL), aka “bad” cholesterol. LDL is considered bad because it can contribute to plaque formation in the arteries, otherwise known as atherosclerosis, which can disrupt blood flow. HDL, on the other hand, helps absorb that bad cholesterol in the blood and transport it to the liver, where it can be flushed from the body. We generally want to see high HDL and low LDL.
5. Elevated triglycerides
Triglycerides are a type of fat found in the body that are derived from the foods we eat, like butter and oils. When we consume extra calories, alcohol, and sugar, our body turns them into triglycerides, which are stored in fat cells for later use. While we need them, excessively high levels of triglycerides can increase our cardiovascular disease risk.
Triglycerides are often discussed in connection with cholesterol because they are both lipids, but cholesterol is not fat. Like LDL, having high levels of triglycerides doesn’t usually result in symptoms, so it’s important to do blood tests, which we’ll dive into in a moment.
What if I only have one of the risk factors?
Some of us may experience one, or even two of the factors above, but that doesn’t mean we have MetS. Currently, the criteria for a MetS diagnosis is at least three out of the five factors.
What tests should I get to assess my risk?
These days, there are so many tests out there, but here are a few we recommend speaking with your healthcare provider about:
1. Hemoglobin A1c test
This test measures the average blood sugar over the preceding three months, and is reported as a percentage. Generally, continuous levels of high blood sugar will result in a higher percentage result; less than 5.7% is considered a healthy range.
2. Lipoprotein profile
Also called a “lipid profile,” this test can be “fasting” or “nonfasting” and measures for levels of HDL (bad) cholesterol and LDL (good) cholesterol. Providers use these measures to get a total-cholesterol-to HDL ratio, which is used to assess cardiovascular and metabolic risk. Cholesterol is also measured in milligrams per dL, and ideally, the HDL measurement stays above 60 mg/dL, and LDL stays below 100 mg/dL.
This profile also measures the amount of triglycerides, or fat, in our blood, which poses metabolic risk at too high levels. Usually, less than 150 mg/dL is considered healthy.
3. Blood pressure measurement
Most of us are probably familiar with this test, which is performed with an inflatable cuff around the arm and measures the pressure in our blood vessels. Blood pressure is measured in millimeters of mercury (mm Hg), and has two readings: systolic, which represents the pressure of blood flow when the heart contracts, and diastolic, which is the pressure measured between heartbeats. We typically want to see a measure below 120 for systolic and below 80 for diastolic, so an ideal rate is 120/80.
Phew, that was a lotttt of mechanics, so let’s talk about what this has to do with menopause. (Spoiler alert, a lot).
Why should women in menopause care about this?
Several studies have found that the menopausal transition itself increases the risk of MetS and that prevalence of the syndrome is higher in postmenopausal women (aka women whose last menstrual period was over one year ago). In fact, one longitudinal study by an organization called the Study of Women’s Health Across the Nation assessed premenopausal women over nine years and found that by the final menstrual period, 13.7% of the participants had a new MetS diagnosis.
The connection? Well for one, menopause leads to significant changes in women’s metabolism and is linked with weight gain (especially around the belly) as well as greater sugar consumption, and worse sleep – all of which we now know play a role in risk of MetS. But beyond these changes, fluctuations in hormones like estrogen, progesterone, and estradiol can increase risk of becoming insulin resistant. This means it’s harder for our body’s cells to take in glucose and create energy with the insulin levels we have, a process that results in extra fat storage. This also causes feelings of tiredness and hunger. It’s a cascade of physiological events that can get stuck in repeat, leading to more weight gain.
Let’s just pause to acknowledge that it’s not all doom and gloom here – focusing on and controlling these risk factors through exercise, diet, stress, and sleep hygiene are all powerful preventative measures we can take to improve our health post-menopause. We’ll dive into all this in greater depth in 5 Ways to Boost Your Metabolic Health.
The bottom line
Everyone experiences metabolic changes throughout life — hey, we can’t eat like we used to either. But, our menopausal status is a large determinant of our metabolic health, in part due to the effects of hormonal changes, which can cause changes in body weight and fat distribution, as well as insulin resistance.
Interested in taking charge of your metabolic health during menopause? Learn more and book a visit with a board-certified, menopause-trained Elektra clinician.
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