Clinical, Biochemical, and Psychological Predictors of Metabolic Syndrome in Climacteric Women

Background/Objectives: To identify clinical, biochemical, and psychological factors associated with metabolic syndrome (MS) in climacteric women and to determine independent predictors of MS across menopausal stages. Methods: A cross-sectional study was conducted in 225 women (perimenopausal, n = 75; early postmenopausal, n = 75; late postmenopausal, n = 75). Anthropometry, clinical history, and fasting laboratory tests were obtained. Psychological measures included perceived stress (Perceived Stress Scale, PSS), anxiety symptoms (Short Health Anxiety Inventory, SHAI-18), and depressive symptoms (Hamilton-Bech-Rafaelsen Scale). Results: Perimenopausal women had higher BMI than both postmenopausal groups (33 ± 5 vs. 30 ± 5 and 29 ± 4 kg/m²; F = 13.39, p < 0.001). Waist/hip ratio showed a modest group effect (F = 6.34, p = 0.002), being higher in perimenopause versus late postmenopause (p = 0.001). Significant group differences were observed in lipid and glucose profiles across menopausal stages. Total cholesterol (F = 4.86, p = 0.009), HDL cholesterol (F = 7.12, p = 0.001), and non-HDL cholesterol (F = 8.13, p < 0.001) differed significantly, as confirmed by post hoc Tukey HSD tests, with higher total and non-HDL cholesterol levels in early and late postmenopausal women compared with the perimenopausal group, and higher HDL cholesterol levels in early postmenopausal women compared with the perimenopausal group. Fasting glucose showed a significant difference (H = 9.89, p = 0.007, Kruskal-Wallis test), with higher median levels in perimenopausal (127 mg/dL) than in early postmenopausal women (97 mg/dL, p = 0.003, Mann-Whitney U). Perceived stress was highest in early postmenopause (61.3%) compared with late postmenopause (48.0%) and perimenopause (34.7%), χ² = 10.68, p = 0.0048, while anxiety and depression did not differ. Logistic regression analyses identified perceived stress and depressive symptoms as significant predictors of metabolic syndrome under different diagnostic definitions. Higher perceived stress was inversely associated in the psychological model (aOR = 0.62; 95% CI 0.43-0.88; p = 0.008) but positively related in the clinical model including fasting glucose and blood pressure (aOR = 1.54; 95% CI 1.07-2.22; p = 0.021). In the combined model, both fasting glucose and perceived stress remained independent predictors (p < 0.05), under-scoring the contribution of psychological factors to metabolic risk. Conclusions: Among climacteric women, perceived stress and cardiometabolic factors (systemic arterial hypertension, Type 2 DM, and elevated fasting glucose) are independent predictors of metabolic syndrome. Early identification and integrated management of stress and metabolic risks may help reduce the burden of metabolic syndrome across menopausal stages.