Obesity and menopausal transition

Obesity is a chronic multifactorial disease influenced by biological, psychological, and environmental determinants, with a higher prevalence in women. It is associated with chronic inflammation, metabolicdisturbances, and an increased risk ofcardiovascular diseases and cancer. In postmenopause, the hormonal changes characteristic of this stage affect body composition and energy metabolism, promoting an increase in visceral adiposity. Oestrogen declinefavoursfat redistribution towardstheabdomen, which increases insulin resistance and the prevalence of metabolic syndrome. This process is accompanied bya reduction in resting energy expenditure and lean mass, without significant variations in body mass index (BMI). It is important to emphasise that body fat distribution is a more accurate predictor of cardiometabolic risk than BMI. Additionally, obesity influences the menopausal transition, exacerbating symptoms such as hot flushes, sleep disorders, and sexual dysfunction, as well as increasing the risk of urinary incontinence, sleep apnoea, and cognitive impairment, partly due to systemic inflammation induced by adipokines. Moreover, obesity also increases the risk of cancer, particularly endometrial and breast cancer, as it is associated with greater exposure to endogenous oestrogens. Given the increase in life expectancy, a growing number of women will spend a significant portion of their lives in postmenopause, a stage in which obesity is highly prevalent. This underscores the need to address obesity as a priority public health issue due to its impact on quality of life and the risk of chronic diseases.