Evidence check: Folsäure in the context of menopause

Folic acid (vitamin B9) is crucial for DNA synthesis and homocysteine metabolism. During menopause, homocysteine levels often rise, which is linked to increased cardiovascular risk. Randomized trials show that folic acid supplementation lowers homocysteine, but evidence for reducing hard endpoints like heart attack or stroke is inconsistent. The VITATOPS and HOPE-2 trials found modest benefits for stroke prevention but no significant reduction in overall mortality. For cognitive function or menopausal symptoms (hot flashes, mood), robust evidence is lacking. High folic acid intake can mask vitamin B12 deficiency and has been associated with increased cancer risk (e.g., colorectal cancer). The German Nutrition Society recommends 300 µg folate equivalent per day for adults, with no special increase for menopause. Supplementation should only be considered if deficiency is confirmed or under medical advice. Genetic testing for MTHFR variants may influence individual needs, but clinical utility remains debated. Conclusion: Folic acid in menopause is not an evidence-based standard; potential benefit is limited to homocysteine lowering in at-risk individuals. Caution against excessive intake is warranted.