What to watch with Homocystein and Wechseljahre?

During menopause, homocysteine levels often rise due to declining estrogen, which normally helps metabolize homocysteine. Elevated homocysteine is a moderate risk factor for cardiovascular disease and may also affect bone health. However, genetic testing for MTHFR variants (e.g., C677T) is not clinically useful for managing homocysteine – the ACMG and CDC advise against routine MTHFR screening because it does not change treatment. Instead, direct blood measurement of homocysteine, vitamin B12, B6, and folate is recommended. If homocysteine is high, supplementation with folic acid, B12, and B6 can lower it, but only under medical supervision. Folic acid is safe even for MTHFR TT carriers; methylfolate is not superior. Caveat: Do not supplement based on genetic test results alone. Evidence: human-moderate (homocysteine as risk factor) + practice (MTHFR testing not recommended).