Estrogen decline during menopause triggers gut microbiota dysbiosis that disrupts lipid homeostasis through altered bile acid metabolism, reduced short-chain fatty acid production, and increased systemic inflammation. These microbial shifts contribute directly to the dyslipidemia that elevates cardiovascular disease risk in postmenopausal women. This microbiome-lipid connection represents a paradigm shift in understanding menopause-related metabolic dysfunction. Rather than viewing hormonal changes as the sole driver, we now recognize the gut as a critical mediator of cardiovascular risk. The therapeutic implications are significant—microbiota-targeted interventions including Mediterranean diets, fiber supplementation, prebiotics, probiotics, and omega-3 fatty acids show promise for restoring metabolic balance. However, the heterogeneous findings across studies highlight a major limitation: establishing causality remains challenging due to confounding lifestyle factors. While this represents confirmatory evidence building on emerging microbiome-metabolism research, the clinical applications remain premature. The field needs robust longitudinal studies to identify specific microbial signatures that predict lipid dysfunction, enabling precision nutrition approaches for the 1.2 billion women who will experience menopause globally by 2030.