Menopause

Menopause is the permanent cessation of menses, reflecting oocyte depletion and loss of gonadal steroids. ^[1] It is an inevitable component of ageing that encompasses the loss of ovarian reproductive function, occurring either spontaneously or secondary to other conditions. ^[2] It is preceded by a transition state, the perimenopause, characterized by the gradual loss of oocytes, altered responsiveness to gonadal steroid feedback, wide hormonal fluctuations, and irregular menstrual patterns. ^[1]

Menopause is the final step in the process of ovarian ageing, in which the age-related decrease in follicle numbers dictates the onset of cycle irregularity and the final cessation of menses. ^[3] The decline in ovarian oestrogen production at menopause can cause debilitating physical symptoms including hot flushes and night sweats, urogenital atrophy, sexual dysfunction, mood changes, bone loss, and metabolic changes that predispose to cardiovascular disease and diabetes. ^[2] The change in the hormonal milieu at menopause is associated with an increase in total body fat and abdominal fat, and is linked to an increase in insulin resistance and dyslipidaemia. ^{[4] [5]} Menopause is defined by the cessation of menstrual cycles and is driven by a marked decline in ovarian estrogen production, whose deficiency underlies most perimenopausal and postmenopausal symptoms ^[6]. Menopause arises from the cessation of ovarian reproductive function, which reduces production of the hormones oestrogen, progesterone and testosterone and produces its wide range of symptoms ^[7].

As ovarian oestrogen production diminishes in midlife and ultimately stops, it is estimated that more than 47 million women worldwide enter the menopause transition annually. ^[8] Vasomotor symptoms are the most commonly reported menopausal symptoms, with a reported prevalence of 50 to 82% among United States women who experience natural menopause, peaking approximately 1 year after the final menstrual period. ^[9] Depression is common among menopausal women, with a pooled global prevalence of 35.6% across perimenopausal and postmenopausal women. ^[10]

The menopausal transition is a turning point for women's health during which cardiometabolic changes can manifest, and the protection against cardiovascular disease provided by endogenous oestrogen during the reproductive years is lost around 10 years after the onset of menopause. ^[5] More than 70% of women will experience musculoskeletal symptoms and 25% will be disabled by them through the transition from perimenopause to postmenopause. ^[8] Many safe and effective management options are available, including hormone therapy, which can be effective for perimenopausal symptoms. ^[1] Menopause accelerates cardiovascular risk, as its metabolic changes such as dyslipidemia, insulin resistance, fat redistribution and hypertension contribute to atherosclerosis and cardiovascular aging ^[11]. Strength training benefits menopausal women by improving muscle strength, physical activity, bone density and hormonal and metabolic levels, helping reduce menopausal symptoms