Metabolic syndrome in perimenopausal and postmenopausal women attending gynaecology outpatient department at a tertiary institution in South Africa

Researchers: Lawrence Marapo, Lineo Matsela, ME Chabalala, Olakunle Adewunmi Towobola. .

August 2025

What Is The Study About?

The study was designed to describe the prevalence of metabolic syndrome in perimenopausal and postmenopausal and the lipid changes that occur during the menopause transition.

Why Is This Important?

The main reason for the study was to magnify the burden of metabolic syndrome in menopause in South Africa. Metabolic syndrome refers to the co-occurrence of several known cardiovascular risk factors, including insulin resistance, central obesity, atherogenic dyslipidaemia, and hypertension. Other causative factors include physical inactivity, aging, and hormonal imbalance, such as polycystic ovarian syndrome and menopause.

What We Know…

There is a noticeable gap in the knowledge of metabolic syndrome in menopause in South Africa. As patients transition from perimenopause to menopause, there is an accumulation of adipose tissue with the consequence of abdominal obesity. Metabolic syndrome increases the risk of both diabetes and cardiovascular diseases, resulting in poor quality of life in the affected women. The development of metabolic syndrome affects the women financially, physically, and emotionally as they will incur more costs to ensure that they are medically viable. The life expectancy of women in South Africa is 63 years old, while in America, 82 years old, according to the United Nations Population Division. Life expectancy differences imply an improved understanding of metabolic syndrome in menopause.

The prevalence of metabolic syndrome in menopause is higher in developed countries than in developing countries because metabolic syndrome is linked to diet and lifestyle. The prevalence of obesity, including in women, is increasing globally, and it is a poorly studied and neglected concept. Cardiovascular disease, which is a complication of metabolic disease, kills more women than men.

This study aimed to raise awareness and provide a comprehensive understanding of how metabolic syndrome impacts African women, thereby improving their quality of life. The menopausal transition is associated with increased adiposity and an accelerated risk of cardiovascular events due to hormonal fluctuations and lipid alterations. In South Africa, a developing country undergoing rapid urbanisation, the adoption of sedentary Western lifestyles and the increased consumption of processed and fast foods have contributed to rising rates of obesity. It is therefore plausible to anticipate that metabolic syndrome during menopause will become a significant global health burden, with developing countries being disproportionately affected.

What Was Discovered…

The current study demonstrated a strong positive correlation between metabolic syndrome and age, as prevalence was higher in the postmenopausal group than in the perimenopausal group. The prevalence of metabolic syndrome in perimenopausal and postmenopausal women was noted to be 47% and 61.4%, respectively, with a significant statistical difference between the 2 groups. Hot flushes and waist circumference were significantly associated with metabolic syndrome amongst post-menopausal women.

The study also highlights that BMI lowers in the postmenopausal period, as opposed to the high BMI noted in the postmenopausal period by other studies. These findings are a warning sign of the imminent future burden of metabolic syndrome. As this perimenopausal woman will be transitioning to the postmenopausal period, the prevalence of MetS will increase.

Postmenopausal women with MetS have been associated with increased risk of endometrial, ovarian, and breast cancer, as well as non-gynaecological neoplasms. Metabolic syndrome is also linked to a higher risk of uterine fibroids, which may be related to shared predisposing factors. Perimenopausal and postmenopausal women with MetS have been associated with a higher prevalence of stress urinary incontinence (SUI) when compared to those without the syndrome.

There was no significant statistical difference in terms of lipid profile between perimenopausal and postmenopausal women. There was a significant statistical difference in HDL, triglycerides, and blood pressure between perimenopausal women with metabolic syndrome as compared with those without metabolic syndrome. There was a significant statistical difference in HDL and triglycerides in postmenopausal women with metabolic syndrome as compared to those without.

The findings in this study highlight the need for additional research, including longitudinal studies to explore causal relationships and intervention studies to assess the effectiveness of different management approaches. Sensitivity and specificity of waist circumference in defining central obesity in black African women should be assessed.

The Future/ Possible Solutions…

Study finding reflects the current high burden of metabolic syndrome amongst perimenopausal and postmenopausal women in South Africa. The prevalence of metabolic syndrome was noted to be higher in postmenopausal women as compared to perimenopausal women. There was a correlation between metabolic syndrome and age, obesity, vasomotor symptoms and dyslipidaemias.