Evidence check: Folsäure in the context of Wechseljahre

The evidence for folic acid in menopause is mixed. Folic acid (vitamin B9) is essential for DNA synthesis and homocysteine metabolism. During menopause, cardiovascular risk increases, and elevated homocysteine is an independent risk factor. Some studies show that folic acid supplementation (often with B12 and B6) can lower homocysteine. However, evidence for reducing actual cardiovascular events or menopausal symptoms (e.g., hot flashes) is weak to inconclusive. High-dose folic acid can mask vitamin B12 deficiency, which becomes more common with age. Genetic variants in MTHFR (e.g., rs1801131 A1298C) affect folate metabolism, but their clinical relevance for supplementation in menopause is unclear. Current guidelines do not recommend routine folic acid for all menopausal women; instead, they suggest individualized assessment based on deficiency or elevated homocysteine. Direct-to-consumer DNA tests often overstate the actionability of such variants. Bottom line: folic acid may be beneficial in specific cases, but broad evidence for menopause is limited. Be cautious about overinterpreting genetic test results.