Women may dread menopause for the mood swings, hot flushes and its attendant discomforts, but did you know that menopause may also herald an increase in the risk for diabetes?

Menopausal women often gain weight, but fat also tends to get redistributed. Take a look in the mirror—are you pear-shaped or apple-shaped? Pear-shaped women have more fat in their hips and thighs. Apple-shaped women have more fat in the abdomen or what has been termed as central obesity.

Central obesity has been clearly linked with a higher risk of diabetes, cholesterol problems, hypertension and heart disease. Lean body mass or muscle mass also becomes reduced in menopause. This appears to be related to a more sedentary lifestyle with aging, which may contribute to central obesity.

Women approaching menopause should therefore be vigilant about weight gain and their waist lines! Losing the fight against the battle of the bulge? Try more aerobic exercise. Studies have shown that there is a preferential loss of abdominal fat with aerobic exercise. Fat cells inside the abdomen appear to be more sensitive to the weight loss-inducing effects of exercise than fat under the skin or subcutaneous fat. Regular endurance exercise may also have an impact on insulin resistance independent of the weight loss achieved. Thus, regular prolonged low-intensity exercise such as walking will go a long way in at least maintaining weight and reducing abdominal fat.

Menopause and heart disease Male sex and increasing age are important predictors of coronary artery disease. Clogging of the coronary arteries often leads to heart attacks. While women below the age of 50 years generally rarely have coronary artery disease, by age 70, women are just as likely as men to have this problem. This suggests that the lack of estrogen may lead to an acceleration in heart disease risk.

It seems that women lose the heart-protecting effects of estrogen in menopause, as the incidence of coronary artery disease in women after menopause is two to three times that in women at the same age before menopause. Furthermore, women with coronary artery disease are more likely to have not only cholesterol problems and hypertension, but diabetes as well. This is troubling because the relative risk of fatal coronary disease associated with diabetes is 50% higher in women!

If you are starting to have irregular menses and suspect the onset of menopause, it may be a good time to be screened for diabetes. Remember that the risk for diabetes is increased with a history of previous gestational diabetes or polycystic ovarian syndrome, a family history of diabetes, obesity and a sedentary lifestyle. The doctor will most likely request for a fasting blood sugar or if you are particularly high-risk, a 75-g oral glucose tolerance test.

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