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.

Menopause is the biological process that occurs with the end of the menstrual cycle, not only involving hormonal changes but also leading to significant epigenetic transformations at the genomic level. Alterations in estrogen, progesterone and androgen levels positively or negatively influence epigenetic mechanisms such as DNA methylation, histone modifications, genome methylation and microRNA expression. These changes can alter the aging process by altering cell gene expression, and immunosenescence can increase susceptibility to osteoporosis, cardiovascular disease and some cancers. Furthermore, altering epigenetic mechanisms through environmental factors (such as nutrition, exercise and stress management) and lifestyle offers promising strategies for maintaining health during menopause and reducing the risk of chronic disease. Menopause-associated epigenetic alterations are not only linked to accelerated biological aging but also play a critical role in the pathogenesis of major chronic diseases, including cardiovascular disease, osteoporosis and hormone-related cancers. These epigenetic changes, particularly DNA methylation patterns and microRNA profiles, have emerged as promising biomarkers for early detection and risk stratification, as well as potential targets for personalized therapeutic interventions. This review aims to review the literature on epigenetic changes associated with menopause.

Menopause is a natural life stage characterized by biological, psychological and social changes that collectively influence women's health and quality of life. Despite the prevalence of vasomotor disturbances, sleep disruption, mood changes and genitourinary complaints, access to evidence-based menopause care remains limited by inadequate models of care, polarized social narratives and limited awareness among healthcare providers. The biopsychosocial model offers a holistic framework for understanding menopause, emphasizing that symptom burden is shaped not only by hormonal changes but also by individual health beliefs, coping strategies, lifestyle and sociocultural context. Evidence-based interventions, including menopausal hormone therapy and cognitive behavioral therapy (CBT), are complementary tools that can be offered separately or in combination. Digital health solutions, in particular prescription and non-prescription digital therapeutics (DTx), provide an opportunity to expand access to CBT and other evidence-based interventions at scale, addressing existing barriers such as limited availability and long waiting times. Countries such as Germany, France, the UK and the USA are beginning to develop reimbursement and regulatory pathways to support prescription DTx, highlighting opportunities for global implementation. Reframing menopause through a biopsychosocial lens, integrating scalable behavioral and pharmacological interventions, and leveraging digital technologies represent a critical pathway toward equitable, personalized and effective care for women.