Evidence check: COMT in the context of Wechseljahre

COMT (catechol-O-methyltransferase) is an enzyme involved in the degradation of estrogens, particularly catechol estrogens. During menopause, estrogen production declines, and the remaining estrogens are increasingly metabolized via the COMT pathway. The common variant rs4680 (Val158Met) reduces enzyme activity (Met carriers). Observational studies suggest that Met carriers may have a higher risk of hot flashes, mood changes, and altered estrogen exposure. However, the evidence is mostly observational and not strong enough for clinical recommendations. GWAS associations are weak and not consistently replicated. A consumer DNA test for COMT cannot reliably predict menopausal symptom severity. Individual symptoms are influenced by hormone levels, lifestyle, stress, and diet. Interpreting such results without medical guidance is misleading. In summary: COMT has a plausible biological role, but the evidence for direct clinical utility in menopause is moderate and insufficient for personalized advice.