Heart Health and Bone Density: Critical Considerations for Women with Diabetes in Menopause

Menopause is a significant life transition that can affect many aspects of health. For women living with diabetes, this stage may bring added considerations—particularly related to heart health and bone density. Understanding how hormonal changes during menopause interact with diabetes can help women take proactive steps to reduce risk and support long-term well-being.

How Menopause Affects Heart Health in Women

Heart disease is one of the biggest health threats to postmenopausal women. Menopause can have a significant impact on heart disease risk in women due to several factors, including changes in hormones, increases in blood pressure, and weight gain—changes that often happen organically as we age.

The decline in estrogen levels during menopause can lead to changes in lipid profiles. Low-density lipoprotein (LDL), often called “bad cholesterol,” is a fat that circulates in the blood and delivers cholesterol to cells throughout the body. LDL levels tend to increase with menopause. High-density lipoprotein (HDL), known as “good cholesterol,” helps remove excess cholesterol from the bloodstream and transport it to the liver. HDL levels often decrease during menopause.

This rise in LDL and decline in HDL is one of the reasons heart disease risk increases with age, particularly during and after menopause.

Blood Pressure, Weight Changes, and Cardiovascular Risk

Menopause is frequently associated with higher blood pressure, which is a major risk factor for heart disease. Elevated blood pressure causes the heart and blood vessels to work harder, placing additional strain on the cardiovascular system. As women age, the risk of heart disease, heart attack, and stroke continues to increase.

Many women also experience weight gain during menopause. Increased cortisol—often related to stress and disrupted sleep—can promote fat storage, especially in the abdominal area. This pattern of weight gain can make blood glucose management more challenging and further increase cardiovascular risk for women living with diabetes.

Monitoring Key Cardiovascular Risk Factors

Because of these changes, it is especially important to regularly monitor cardiovascular risk factors during menopause. This is particularly true for women with diabetes or a family history of heart disease.

Cholesterol Monitoring

• Total cholesterol:
  Ideal level: Less than 200 mg/dL (5.2 mmol/L)
• LDL cholesterol (“bad” cholesterol):
  • Lower risk: Less than 100 mg/dL (2.6 mmol/L)
  • Higher risk (including diabetes): Less than 70 mg/dL (1.8 mmol/L)
• HDL cholesterol (“good” cholesterol):
  • Women: 50 mg/dL (1.3 mmol/L) or higher

Monitoring typically occurs annually, or more frequently for those with diabetes or additional risk factors. Lifestyle changes and medications such as statins may be recommended if levels are above target.

Blood Pressure Monitoring

• Normal: Less than 120/80 mm Hg
• Elevated: 120–129 systolic and less than 80 diastolic
• High blood pressure: 130/80 mm Hg or higher

Blood pressure should be checked at least yearly, and more often if levels are elevated. Home monitoring can be helpful for tracking trends over time.

Triglycerides

• Normal: Less than 150 mg/dL (1.7 mmol/L)
• High: 200 mg/dL (2.3 mmol/L) or higher

Triglycerides are usually checked as part of a fasting lipid panel. Lifestyle strategies and, in some cases, medications may be recommended when levels are elevated.

Menopause and Osteoporosis Risk

In addition to cardiovascular changes, menopause significantly increases a woman’s risk of osteoporosis. This is largely due to declining estrogen levels. Estrogen plays a key role in maintaining bone density by slowing bone breakdown and supporting calcium balance.

After menopause, bone resorption can outpace bone formation. Over time, this imbalance leads to reduced bone mineral density, making bones more fragile and prone to fractures—most commonly in the spine, hips, and wrists.

The Combined Impact of Diabetes and Menopause

Women living with diabetes who are in menopause face overlapping risks:

• Heart health: Elevated blood glucose, inflammation, and insulin resistance increase the likelihood of cardiovascular disease.
• Bone health: Diabetes may affect bone quality and increase fracture risk, even when bone density appears normal.

Together, these factors underscore the importance of regular screening, individualized care, and preventive strategies during and after menopause.

Strategies to Support Bone Health After Menopause

Calcium and Vitamin D

• Calcium needs:
  • Women 50 and younger: 1,000 mg/day
  • Women over 50: 1,200 mg/day
• Vitamin D needs:
  • Adults up to age 70: 600 IU/day
  • Adults over 70: 800 IU/day

Food sources are preferred when possible, with supplementation considered if intake is inadequate.

Physical Activity

• Weight-bearing activities such as walking, dancing, or stair climbing
• Muscle-strengthening exercises two to three times per week

Lifestyle Considerations

• Avoid smoking
• Limit alcohol intake
• Moderate caffeine and sodium consumption

The Role of Support and Prevention

Managing menopause and diabetes is an ongoing process, and support can make a meaningful difference. Education, peer connection, and prevention-focused resources can help women feel informed and empowered.

Women interested in prevention-focused education and peer support can explore a DiabetesSisters Prevention Meetup here.

Final Thoughts

Menopause represents an important opportunity to focus on long-term cardiovascular and bone health. Through regular monitoring, healthy lifestyle choices, and ongoing support, women living with diabetes can reduce risk and support overall well-being during this stage of life.

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About the Author

Dr. Mala Freeman-Kwaku, lead physician at Arboretum Gynecology, has over 22 years of experience specializing in gynecologic care, including treating uterine fibroids, heavy menstrual bleeding, and menopausal symptoms. A graduate of the University of Virginia and Georgetown University Medical Center, she transitioned from a group practice to create a more intimate healthcare environment, successfully rebranding her practice while maintaining patient loyalty. Skilled in hysteroscopy and advanced procedures like the Sonata fibroid ablation, she shares her expertise as a speaker for Gynesonics and through her private consulting firm, MFK Advising Group, LLC. Dr. Freeman-Kwaku is married with four children, enjoys traveling, and remains active in her church and community.