Perimenopause and metabolic vulnerability: hormones, body composition and lifestyle changes.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing human observational studies and animal models
PubMed 42634879 · doi:10.1080/13697137.2026.2713394
What was done
A narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and SciELO databases covering literature published between 2000 and 2026. The authors analyzed 56 studies involving perimenopausal women as well as relevant animal models. Search terms focused on estrogen deficiency, body composition, energy metabolism, insulin resistance, chronic low-grade inflammation, physical activity, and dietary interventions.
What was found
The abstract provides qualitative directional findings across the 56 included studies but reports no specific numerical data or effect sizes. Perimenopausal estrogen decline was associated with increased visceral adiposity, skeletal muscle loss, reduced fat oxidation, hepatic insulin resistance, chronic low-grade inflammation, and impaired metabolic flexibility—changes that occur even in the absence of significant total body weight gain. Lifestyle interventions, specifically resistance training, higher protein intake, dietary fiber, and Mediterranean diet adherence, were identified as strategies that preserve lean mass, enhance insulin sensitivity, and decrease systemic inflammation.
Why it matters
This review emphasizes that metabolic and cardiovascular risk factors accelerate during the perimenopausal transition independent of overt weight gain. Recognizing perimenopause as an early window of vulnerability allows clinicians to prioritize targeted lifestyle interventions, like resistance training and dietary modification, before postmenopausal disease manifests.
Limits
The work is a narrative review rather than a systematic review or meta-analysis, lacking formal risk-of-bias assessments and quantitative effect sizes. Findings conflate human clinical data with basic animal models, and the abstract provides no specific metrics on sample sizes, study populations, intervention adherence, or long-term clinical endpoints.
Cited by
- supports Estrogen has significant anti-inflammatory benefits, leading to a baseline increase in systemic inflammation upon entering menopause.
- supports Women develop increased insulin resistance as they approach menopause, regardless of whether they have PCOS.