The metabolic syndrome, an increasingly prevalent disorder, is known to significantly enhance the risk of developing cardiovascular disease and diabetes. The syndrome is defined by a constellation of cardiac risk factors that include obesity, atherogenic dyslipidemia, hypertension, and insulin resistance. There are several unique features of the metabolic syndrome in women. An insulin-resistant state associated with both polycystic ovarian syndrome and increased abdominal fat may contribute to the development of the metabolic syndrome and increase cardiovascular risk when present. Menopause heralds a decline in circulating estrogen levels, which may increase cardiovascular risk through effects on adiposity, lipid metabolism, and prothrombotic state. The key elements involved in managing the metabolic syndrome are dietary and lifestyle modification. Appropriate treatment may also include managing individual cardiac risk factors with the use of antihypertensive and lipid-modifying agents among others.