Menopause: What Is Happening to My Body

Menopause is a natural biological process marking the end of a woman’s reproductive years,  beginning on average at 51. 4 years of age in the U.S.¹ Although menopause itself is not a disease, the hormonal fluctuations it brings can profoundly impact multiple body systems, increasing the risk of cardiovascular disease, osteoporosis, metabolic disorders, cognitive decline, and mood imbalances.²

To navigate this stage with grace and resilience, an integrative, evidence-based approach including medical interventions, nutritional strategies, lifestyle modifications for sleep, stress management, and exercise, as well as select holistic therapies, can help mitigate symptoms, support overall well-being, and promote a longer health span for women. ³

In this article, we provide an overview of changes associated with menopause. To learn more about menopausal hormone therapy and non-hormonal therapies, read this article. 

Menopause as a Window of Opportunity for Whole-Body Health

Menopause is diagnosed after 12 consecutive months without a menstrual period, reflecting a permanent decline in ovarian follicular function and stabilization of estrogen at a significantly lower level. This hormonal transition marks more than the end of reproductive capacity-it signals a shift in physiology that has profound, lifelong health implications. ⁴ 

Estrogen plays a protective role across multiple organ systems, and its decline during the menopausal transition affects cardiovascular, skeletal, metabolic, genitourinary, and cognitive health. For the last two decades, since the WHI study came out, women were expected to simply endure these changes with minimal hormonal support. Today, however, evidence-based practice recognizes menopausal transition as a critical window of opportunity–a time to both relieve current symptoms and implement strategies that can protect long-term health. Women will spend nearly 40% of their lives in menopause, underscoring the importance of proactive care .⁵

Overview of Common Symptoms

Many women experience one or more of the following during the menopausal transition:

• Vasomotor symptoms (VMS): hot flashes and night sweats.
• “Brain fog”/cognitive complaints such as memory lapses, trouble concentrating, and word-finding difficulty
• Significant reduction in bone density
• Reduction in muscle mass
• Mood changes: increased anxiety, depressed mood, and irritability
• Poor sleep
• Genitourinary symptoms (GSM): vaginal dryness, pain with sex (dyspareunia), urinary frequency/urgency
• Decreased libido 
• Headaches
• Joint and muscle aches/myalgias
• Weight distribution changes, central adiposity (increased abdominal fat) 
• Skin changes (thinning, reduced elasticity)
• Hair loss
• Worsening of biomarkers, such as increase in lipid markers LDL-C and ApoB, and increase in blood glucose

Clinically, menopause should be seen as both a time to alleviate symptoms and improve quality of life, and a window to engage in age-appropriate risk factor assessment (or, hopefully, continue engaging in it). It is then the role of your healthcare team to discuss how best to establish (or reassess) foundational health habits that reduce the risk of, or delay, cardiovascular disease, fracture, metabolic dysfunction, cancer and cognitive decline. ⁷In addition to lifestyle and nutritional interventions, medications, supplements and other integrative modalities, while outside the scope of this article, may be used when indicated. 

Systemic Health Impacts of Menopause

Cardiovascular Health

Menopause is one of the most significant risk factors for heart disease in women. Estrogen plays a protective role in vascular function, supporting healthy endothelial function, arterial flexibility, and cholesterol regulation. As estrogen levels decline, women experience increased risk of hypertension, dyslipidemia, central adiposity, and cardiovascular disease, with particularly heightened risk in those who undergo early menopause. Cardiovascular disease develops gradually over years, influenced by genetics, lifestyle, inflammation, and other comorbidities, yet the hormonal shifts of menopause accelerate this process.^{8  9}

During and after the menopausal transition, women typically experience adverse changes in lipid profiles, including higher total cholesterol and LDL (“bad” cholesterol), lower HDL (“good” cholesterol), and often increased triglycerides, all of which contribute to a more atherogenic pattern. In addition, changes in lipoprotein particle characteristics, such as a rise in small dense LDL particles and shifts in apolipoproteins like ApoB, can further elevate cardiovascular risk beyond what traditional cholesterol numbers show, making a comprehensive lipid panel and interpretation with your clinician particularly valuable. 

Importantly, menopause is often associated not only with changes in lipidprofile, but also with adverse changes in inflammatory markers and lower insulin sensitivity, which together provide a more complete picture of cardiovascular risk than total cholesterol alone. Understanding these patterns allows clinicians to move beyond a “one-number” approach and instead develop a personalized cardiovascular prevention plan–targeting diet quality, fiber intake, physical activity, metabolic health, stress, sleep, and when appropriate, medication–to meaningfully improve lipid profiles and long-term heart health^{.10 11} 

From an integrative perspective, prevention should be the focus, emphasizing the establishment of heart-healthy habits  such as balanced nutrition, regular physical activity, stress management, and sleep hygiene, well before any clinical signs of heart disease emerge.  ^{9 12 13 14} 

Metabolic Health

The decline in estrogen also promotes unfavorable metabolic changes, including increased visceral fat accumulation, (a shift toward an apple-shape appearance), reduction in muscle mass, insulin resistance, and a higher risk of type 2 diabetes. These changes contribute to the prevalence of overweight and obesity, metabolic syndrome, and inflammation-related diseases in postmenopausal women. Maintaining muscle mass through resistance training, ensuring adequate fiber and protein intake, and supporting metabolic health through nutrient-dense, anti-inflammatory foods are essential strategies to mitigate these risks.¹⁵

Bone and Musculoskeletal Health

Estrogen is critical for bone remodeling, suppressing bone resorption and maintaining bone density. Its loss during menopause accelerates bone loss, increasing the risk of osteopenia, osteoporosis, and fractures. Concurrently, age and hormone-related declines in muscle mass, known as sarcopenia, contribute to frailty, decreased metabolic rate, and impaired glucose control. These changes underscore the importance of interventions such as weight-bearing exercise, resistance training, and targeted nutrition, including sufficient protein, calcium, and vitamin D, to preserve musculoskeletal health and functional independence.  ^{16 17 18}

The reality of bone health statistics highlights why proactive assessment matters. Among U.S. women 65 years or older, data show that by the time women reach the age at which routine bone density screening is recommended, a significant proportion already have clinically meaningful bone loss. Approximately 27% of American women aged 65 and older have osteoporosis, and when both osteopenia (low bone mass) and osteoporosis are considered together, nearly 50% of women in this age group are affected by reduced bone density. This high prevalence is largely driven by postmenopausal estrogen loss and underscores why osteoporosis is often described as a “silent disease,” progressing for years before  fractures occur.

Despite the substantial burden of disease, osteoporosis remains underdiagnosed and undertreated. Studies indicate that only 12% to 27% of women over age 65 who experience hip fractures receive appropriate bone density screening, highlighting a major gap in preventive care. Osteoporotic fractures, particularly hip fractures, are associated with significant morbidity, loss of independence, and increased mortality. Concurrent age- and hormone-related declines in muscle mass, known as sarcopenia, further compound fracture risk by contributing to frailty, balance impairment, and reduced metabolic resilience. 

Current guidelines recommend routine bone density screening (DEXA) for women beginning at age 65, with earlier screening in younger postmenopausal women who have additional risk factors. In our practice, however, we encourage women to consider earlier evaluation of bone density, particularly in the early postmenopausal years, so that subtle declines in bone mass, whether osteopenia or early osteoporosis, can be detected well before a fracture occurs and appropriate preventive strategies can begin. Earlier DEXA assessment allows us to tailor nutrition, lifestyle, and medical interventions to optimize long-term skeletal health, rather than waiting until age 65 when a large proportion of women already have significant bone loss.^{19 20 21} 

Cognitive Function and Mood 

Estrogen also plays a key role in regulating neurotransmitters that support memory, mood, and executive function. As estrogen levels decline, many women report cognitive changes, often described as “brain fog”, along with shifts in mood, increased anxiety, or symptoms of depression during this stage of life. Sleep disruption is common and may be driven or worsened by vasomotor symptoms such as hot flashes and night sweats, which can fragment sleep and further impair cognitive and emotional regulation. When vasomotor symptoms are contributing to poor sleep quality, they should be specifically identified and addressed as part of a comprehensive treatment plan. Addressing sleep quality, vasomotor symptoms, stress management, physical activity, and nutrition during midlife is a key component of long-term brain health and emotional well-being. .^{22  23}

Genitourinary and Sexual Health

Genitourinary syndrome of menopause (GSM) is a common but often under-recognized consequence of estrogen loss. Thinning of vaginal and urinary tract tissues can lead to vaginal dryness, painful intercourse, recurrent urinary tract infections, and decreased sexual function, all of which can significantly affect quality of life. Early recognition and management of GSM symptoms can prevent progression and maintain sexual and urinary health. ^{24  25}

Given the broad systemic effects of menopause on nearly every organ system, from the cardiovascular and metabolic to the musculoskeletal, cognitive, and genitourinary, midlife becomes a pivotal time for proactive screening and prevention. Early identification of emerging risk factors allows for timely interventions that can significantly reduce long-term disease burden and support healthy aging.

For more articles on hormone health, menopause, perimenopause, testing and treatment, please go here.

We encourage all women experiencing menopausal symptoms to speak to their doctor, or qualified menopause specialist about symptom management and available treatment options.

Our team is here to guide and support our patients every step of the way. Dr. Bojana Jankovic Weatherly is a certified menopause practitioner. We are committed to providing the personalized care you deserve, helping you move forward with confidence and strength.

You have the power to take charge of your health during perimenopause and menopause. We are here to partner with you to achieve your goals. To learn more about our medical, nutrition and health coaching services, contact us at 646.627.8000, fill out this form for a complimentary discovery call, or email Bridget@drbojana.com.

References

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18. https://pmc.ncbi.nlm.nih.gov/articles/PMC9546973
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