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Semin Reprod Med 2025; 43(02): 71-72
DOI: 10.1055/s-0045-1812085
Preface

Menopause/Aging

Authors

  • Hanna Savolainen-Peltonen

    1   Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
    2   Folkhälsan Research Center, University of Helsinki, Helsinki, Finland
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Hanna Savolainen-Peltonen, MD, PhD

Menopausal transition is a natural part of aging, yet many women experience symptoms that can significantly affect their wellbeing, productivity, and quality of life. Over the past centuries, women's life expectancy has increased markedly, reaching over 77.8 years in Europe and the United States in 2023.[1] As a result, women now spend approximately one-third of their lives in the postmenopausal stage.

Despite this, the health implications of the menopausal transition have historically received limited attention, and related health concerns have often been underestimated. Recent reports indicate that women spend more years in poor health compared with men, highlighting a substantial gender gap in healthcare.[2] [3]

This issue of Seminars in Reproductive Medicine addresses the gender gap in healthcare by presenting recent research on the menopausal transition and the treatment of menopausal symptoms. Dr. Cucinella and colleagues begin by examining cardiometabolic changes in postmenopausal women. Although cardiovascular diseases (CVD) are the leading cause of death in both sexes, women often experience longer diagnostic delays, and traditional CVD risk factors remain understudied and undertreated in female populations.[4] Their review highlights the influence of reproductive milestones, gynecological conditions, and pregnancy-related factors on cardiometabolic health during midlife. Improved recognition of adverse pregnancy outcomes and other gynecological conditions offers a valuable opportunity to identify women at increased risk for CVD after menopause.

Many women experience notable changes in body composition during the menopausal transition, which may influence their long-term cardiometabolic health. Although these changes have been widely studied, longitudinal data remain limited, and it is still unclear whether they are primarily driven by hormonal shifts, aging, or lifestyle factors. Dr. Juppi and colleagues provide a comprehensive overview of menopause-related changes in skeletal muscle and adipose tissue, emphasizing the decline in muscle mass and strength, as well as the increase and redistribution of adipose tissue—particularly the rise in visceral fat.

Dr. Hetemäki and colleagues delve deeper into sex steroid hormone biosynthesis within adipose tissue. The decline in circulating estrogen levels during menopause coincides with an increase in visceral adiposity and a heightened risk of metabolic disorders. As estrogen production shifts mainly to adipose tissue, local sex steroid production may play a key role in regulating fat distribution between subcutaneous and visceral depots. But does menopausal hormone therapy (HT) influence steroid hormone biosynthesis in adipose tissue?

The timing of menopause also has a profound impact on a woman's long-term health. Approximately 10% of women experience menopause between the ages of 40 and 44, and 2% before the age of 40.[5] Dr. Savukoski and Dr. Niinimäki review the consequences of early-onset menopause on morbidity, mortality, and quality of life, as well as the role of HT in mitigating these risks.

Hormone therapy is further explored in two in-depth reviews. Dr. Fidecicchi and colleagues focus on the perimenopausal period. In this specific stage of life, fertility has declined, and pregnancies are associated with a higher risk of obstetric and fetal complications. Women often experience symptoms related to fluctuating hormone levels and anovulatory cycles, such as abnormal uterine bleeding, mood disturbances, migraines, and vasomotor symptoms. Their review discusses the specific features of counseling during perimenopause and how contraception can be tailored to individual needs.

Mounting evidence highlights important differences in the risk profiles of estrogen-only and estrogen-progestogen HT. Although progestogens are essential for protecting the endometrium against cancer, they also exert effects on several extrauterine organs, including the breast, cardiovascular system, and brain. In their review, Dr. Ylikorkala and colleagues explore the mechanisms of action and varying risk profiles of different progestogens and propose strategies for tailoring estrogen-progestogen therapies in the management of menopausal symptoms.

Menopausal HT use may be contraindicated, for instance, in women with a history of estrogen-sensitive cancers or thromboembolic complications. Nevertheless, individualized care for menopausal symptoms remains essential. Alternative approaches include lifestyle modifications, cognitive-behavioral therapy, and a range of nonhormonal pharmacological treatments. Recently, novel neurokinin receptor antagonists have emerged, offering new options for personalized therapy. Genitourinary symptoms should not be overlooked, as they can significantly affect quality of life. Nonhormonal treatment options are reviewed by Dr. Niskanen and colleagues.

Although menopause is a natural life stage experienced by all women, many healthcare professionals report lack of knowledge and feeling unprepared for the symptoms and physiological changes it brings. There is also a growing need among healthcare professionals for more guidance on how to individualize menopausal care and balance between different treatment options. I hope this collection of reviews contributes meaningfully to the existing literature on healthy menopausal transition and supports the delivery of high-quality, personalized care for menopausal women.



Publikationsverlauf

Artikel online veröffentlicht:
27. Oktober 2025

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