Weight gain and cardiovascular risk factors in the post-menopausal woman

Cardiovascular disease is the leading cause of mortality and morbidity in the post-menopausal woman. The natural menopause does not appear to be an independent risk factor (or a minor one) for coronary heart disease. Obesity, more precisely excessive intra-abdominal fat, is a cardiovascular risk factor especially with regard to the metabolic risk factors associated with this type of obesity. There is a progressive increase in weight gain at the age of menopause but this weight gain is related to ageing independent of whether women are post-menopausal or not, or treated with oestrogens or not. At the same time, there is a central redistribution of fat with a decrease in gluteo--femoral fat and an increase in intra-abdominal fat with an associated muscle mass loss. This trend to central obesity obviously favours an increased cardiovascular risk. With regard to weight gain, these changes in body composition are related to ageing. Different factors (e.g., diet, physical activity, GH secretion, etc.) may be involved. Are these changes related to menopause? Can hormonal replacement therapy prevent them? The results of the studies in this field are not consistent and these questions remain under debate.