Optimizing Healthspan in Women: A New Paradigm for Successful Aging through the Menopausal Transition

Area of Science:

• Integrative medicine focusing on women's midlife healthspan.
• Endocrinology and its impact on aging.
• Neurocognitive and psychosocial aspects of menopause.

Background:

• Menopause is a natural midlife transition with significant hormonal shifts.
• Associated with changes in cardiometabolic risk, musculoskeletal health, sleep, mood, and cognition.
• Current evidence primarily shows association, not causal acceleration of aging.

Purpose of the Study:

• Propose a menopause-centered healthspan framework integrating biological, neurocognitive, and psychosocial domains.
• Translate evidence into pragmatic clinical pathway tools for individualized care.
• Clarify the relationship between menopause and aging, cognitive function, and cardiovascular risk.

Main Methods:

• Narrative review synthesizing evidence from guidelines, randomized trials, meta-analyses, and large cohort studies.
• Structured evidence scan using PubMed and citation tracking.
• Review of 102 selected citations from an initial 256 identified.

Main Results:

• Menopausal hormone therapy is highly effective for vasomotor symptoms and fracture risk reduction in select candidates.
• Hormone therapy is not indicated for primary prevention of cardiovascular disease or dementia.
• Menopause is not an established independent risk factor for dementia; midlife cognitive complaints are often transient.

Conclusions:

• A menopause-centered healthspan framework supports comprehensive, individualized care.
• Clinical pathways should guide appropriate use of hormone therapy based on age, time since menopause, and formulation.
• Distinguishing menopausal cognitive changes from neurodegenerative disease is crucial for accurate diagnosis and management.