Menopause-related hormonal changes are associated with an increased prevalence of various cardiometabolic risk factors, components of the metabolic syndrome, and an excess risk of all-cause and cardiovascular mortality. Estrogen withdrawal and the subsequent androgenicity interact in a synergistic manner to predispose post menopausal women to an increase in total body weight but also to a pronounced change of body composition. Central fat accumulation and ectopic fat storage constitute potent determinants of the increased cardiometabolic risk in post menopausal women. In contrast, peripheral subcutaneous fat has an independent cardioprotective and anti-atherogenic impact. Data are less conclusive regarding the contribution of lean body mass to metabolic syndrome and cardiometabolic health in post menopausal women.