Estrogen decline during menopause alters fat, muscle, and lipid metabolism; multimodal lifestyle strategies help reduce cardiovascular risk.
At the 2025 Menopause Society Annual Meeting, Brooke Aggarwal, EdD, MS, FAHA, associate professor of Medical Sciences in the Division of Cardiology at Columbia University Irving Medical Center, discussed the physiologic mechanisms that drive shifts in body composition during the menopausal transition and strategies to mitigate related cardiovascular risks.1
According to Aggarwal, “the main mechanisms that drive the changes in body composition are the decline in estrogen, which has several different ways that it affects changes in body composition.” She explained that estrogen regulates how and where fat is stored in the body, and its decline contributes to “accelerated storage of visceral fat or central adiposity” in midlife women.
Estrogen also supports the maintenance of lean muscle and influences lipid metabolism. “That’s why sometimes a woman’s lipid profile can change and her total cholesterol or her LDL cholesterol can increase during the menopausal transition, even though she hasn’t made any changes in her diet or exercise patterns,” she said.
Aggarwal emphasized that the menopausal transition represents “a critical window for prevention of cardiovascular disease.” The accumulation of visceral fat is biologically active and “releases inflammatory cytokines and it surrounds our organs, including potentially surrounding our heart.” These changes, she noted, can contribute to elevated cardiometabolic risk.
Maintaining muscle and bone mass through lifestyle interventions is key. “We want to do our best to preserve muscle and preserve bone to keep us strong and healthy during postmenopause years,” she said. “When we’re going through the menopausal transition, we want to think about nutrition, sleep, and maintaining our muscles.”
Aggarwal recommended a multimodal approach incorporating exercise, nutrition, and sleep. Strength or resistance training “at least 2 to 3 times per week” helps preserve lean muscle tissue, and “participating in weight-bearing exercises” such as walking, light jogging, or using a rebounder or trampoline supports bone health. She also cited current aerobic activity guidelines—“150 minutes per week of moderate-intensity activity, or 75 minutes of vigorous-intensity activity per week, or a combination of both.”
Dietary fiber intake is another focus. “It’s really important to focus on getting enough fiber—at least 25 grams of fiber per day,” she said, noting that fruits and vegetables are the best sources.
Sleep quality also plays a major role. Aggarwal advised patients to practice good sleep hygiene—maintaining a cool, dark room; avoiding caffeine before bed; and staying active during the day. For women who continue to struggle with insomnia despite these strategies, “it is helpful to have a conversation with their physician, because there are actual treatments for insomnia symptoms,” she said. Cognitive behavioral therapy for insomnia (CBT-I) is “the gold standard for treating insomnia,” and digital CBT-I programs can expand access where certified providers are limited.2
Aggarwal reports no relevant disclosures.
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