Body composition and cardiometabolic health across the menopause transition

Abstract

Every year, 2 million women reach menopause in the United States, and they may spend 40% or more of their life in a postmenopausal state. In the years immediately preceding menopause-known as the menopause transition (or perimenopause)-changes in hormones and body composition increase a woman's overall cardiometabolic risk. In this narrative review, we summarize the changes in weight, body composition, and body fat distribution, as well as the changes in energy intake, energy expenditure, and other cardiometabolic risk factors (lipid profile, glucose metabolism, sleep health, and vascular function), that occur during the menopause transition. We also discuss the benefits of lifestyle interventions in women in the earlier stages of menopause before these detrimental changes occur. Finally, we discuss how to include perimenopausal women in research studies so that women across the life-span are adequately represented.

Figure 1

Associated changes in cardiometabolic risk during the menopause transition. Changes in cardiometabolic risk factors occur during the menopause transition, which is separated into two subcategories (early perimenopause and late perimenopause) and into the postmenopausal years. Horizontal arrows (↔) indicate stability, and smaller or larger/thicker directional arrows (↑ or ↓) indicate smaller or larger changes that occur. *Although E₂ concentrations are lower at menopause onset compared with premenopausal concentrations, the patterns of E₂ decline and FSH rise during perimenopause are heterogenous across women. AMH, anti-Müllerian hormone; C-IMT, carotid intima-media thickness; E₂, estradiol; EE, energy expenditure; FSH, follicle-stimulating hormone; FMP, final menstrual period; PWV, pulse wave velocity