Perimenopause is a transitional phase characterized by substantial hormonal fluctuations, particularly declining estradiol levels, accompanied by age-related metabolic changes. Increasing evidence suggests that this period constitutes a critical window of metabolic vulnerability, marked by adverse alterations in body composition, energy metabolism and cardiometabolic health. Notably, these changes may develop even without significant increases in body weight, potentially delaying their recognition in clinical settings. A narrative review was conducted using the PubMed/MEDLINE, Scopus, Web of Science and SciELO databases. Studies involving perimenopausal women, plus relevant animal models, were included. Search terms covered estrogen deficiency, body composition, metabolism, insulin resistance, inflammation, physical activity and nutrition. Fifty-six studies published between 2000 and 2026 were analyzed. Evidence shows that perimenopause is characterized by increased visceral fat, loss of lean mass, reduced fat oxidation and impaired metabolic flexibility, even without major weight changes. Declining estrogen drives adipose redistribution, muscle dysfunction, hepatic insulin resistance and chronic low-grade inflammation. These changes heighten risk for metabolic syndrome, type 2 diabetes and cardiovascular events. Lifestyle interventions, particularly resistance training and Mediterranean diet adherence, demonstrate strong potential to preserve muscle, improve insulin sensitivity and reduce inflammation. In conclusion, perimenopause should be recognized as a pivotal stage for early detection and prevention of metabolic dysfunction. Lifestyle-based interventions during this phase may reduce long-term cardiometabolic risk and improve women's health.

Genitourinary syndrome of menopause (GSM) is common among postmenopausal women and breast cancer survivors, particularly those receiving antiestrogen therapy. However, the role of the urinary and vaginal microbiomes in GSM remains underexplored. This study aimed to evaluate urinary and vaginal microbiome differences and their association with GSM in postmenopausal women and breast cancer survivors. A scoping review (PubMed, Embase; May 2025) identified 877 studies addressing the vaginal or urinary microbiome in postmenopausal women and 242 studies in breast cancer survivors. After screening and eligibility assessment, 18 studies involving postmenopausal women and three studies involving breast cancer survivors were included. Across 21 included studies (n = 30-1320 participants), Lactobacillus depletion and anaerobic overgrowth (e.g. Gardnerella, Prevotella, Sneathia) were associated with GSM. Postmenopausal women with low-Lactobacillus community state types (CSTs) had up to 25.9-fold higher odds of GSM. In breast cancer survivors, Lactobacillus was nearly absent (5% of samples), with increased Gardnerella and Sneathia in symptomatic women. Associations between Lactobacillus relative abundance and symptom severity were inconsistent. In conclusion, GSM appears to be associated with microbial dysbiosis characterized by anaerobic overgrowth, rather than Lactobacillus depletion alone. Estrogen suppression in breast cancer survivors may exacerbate dysbiosis and symptoms, highlighting the need for microbiome-targeted treatments.

Menopausal hormone therapy (MHT) with 17β-estradiol/dydrogesterone (E/D) or Femoston® at a range of doses has been shown to provide effective relief from climacteric symptoms and prevention of osteoporosis in postmenopausal women. However, less is known about personalizing MHT for women who require lower doses, or those with obesity or overweight. A literature search was conducted using PubMed to evaluate the safety and efficacy of E/D in perimenopausal and postmenopausal women, with a focus on women with high body mass index (BMI). The results confirmed that ultra-low and standard doses of E/D provide effective relief from symptoms of estrogen depletion, high rates of amenorrhea and fracture risk reduction, without any new safety concerns. In women with high BMI, E/D was shown to provide effective symptom relief, with no significant differences in adverse event frequency according to BMI subgroups. Safety data suggested that dydrogesterone may confer advantages in terms of venous thromboembolism and breast cancer risk as compared with other progestogens. The findings of this literature review shed light on options for optimizing MHT treatment and doses for perimenopausal and postmenopausal women. Further research is warranted to confirm findings in women with high BMI.

Premature ovarian insufficiency (POI) and early menopause (EM) affect millions of women worldwide. Compared with normal menopause, they confer a longer duration of estrogen deficiency and are associated not only with a shorter lifespan, but with a reduced healthspan, owing to an increased risk of cardiovascular, skeletal, cognitive and psychological morbidity, and sexual health concerns. Therefore, interventions in POI/EM represent some of the most actionable opportunities to reduce long-term disability and promote healthy longevity. However, current approaches to hormone therapy (HT) in POI/EM remain fragmented, delayed, and overly influenced by paradigms derived from older postmenopausal populations. We propose a shift toward a life-course model of care. POI and EM should no longer be managed as variants of menopause at normal age but recognized as chronic endocrine conditions and sentinel events for accelerated aging in women. HT should be reframed as a hormonal replacement aimed at preventing long-term disability. Timely initiation, adequate dosing, and long-term continuation of HT should be considered foundational to POI/EM care, alongside integrated preventive strategies. FIGO and IMS, therefore, call for a globally coordinated effort to strengthen awareness, professional education, and research on POI/EM, and to ensure equitable access to multidisciplinary care, with the goal of improving women's health and supporting the long-term sustainability of healthcare systems.

Osteoarthritis (OA) is the most common form of arthritis. OA becomes more prevalent in women around the age of menopause, and it has been suggested that the decrease in estrogen at menopause may be important in the pathophysiology of OA development. The association between estrogen exposure and OA is complex; a recent meta-analysis suggested that menopause hormone therapy use may be associated with an increased risk of joint replacement, bringing this research area back into focus. This narrative review used a systematic process, adopting a life-course approach to consider relationships between reproductive factors and OA, identifying 15 papers published over a 26-year period. Increased parity, use of the oral contraceptive pill, abortion, breastfeeding and inter-menstrual years were all considered but findings varied widely between studies. We note that progesterone is rarely considered, despite animal work suggesting its importance. These data highlight the need for further research with careful measurements of confounding variables, and consideration of the role for progesterone in OA etiology.