Cardiometabolic Health During the Climacteric Transition: A Narrative Review of Lifestyle, Physiological, and...

Background/Objectives: The climacteric transition is a critical stage in women's health characterized by significant endocrine, metabolic, cardiovascular, and autonomic changes that increase cardiometabolic vulnerability during midlife. This narrative review aimed to synthesize current evidence on body composition, heart rate variability and autonomic function, phytoestrogens & estrobolome interactions, and exercise-based lifestyle approaches during the climacteric transition. Methods: A structured literature search was conducted across four domains (body composition, heart rate variability, phytoestrogens, and exercise) using PubMed/MEDLINE, Web of Science, Scopus, Google Scholar, and the Cochrane Library. Studies were selected based on relevance, study design, and methodological rigor, and synthesized using a narrative approach. Additional thematic components, including dietary patterns and gut microbiota estrobolome interactions, were incorporated through targeted searches. Results: The climacteric transition is associated with increased visceral adiposity, reduced lean mass, insulin resistance, dyslipidemia, and a higher prevalence of metabolic syndrome, while body mass index may underestimate metabolically relevant adiposity. Altered autonomic regulation, reflected by reduced heart rate variability and sympathetic predominance, is linked to increased cardiovascular risk, although its independent contribution is influenced by aging and comorbidities. Mediterranean and plant-based dietary patterns may improve metabolic and inflammatory profiles and modulate estrogen metabolism through gut microbiota mechanisms. Phytoestrogens show potential benefits for vasomotor symptoms and selected metabolic markers, although evidence remains heterogeneous. Exercise interventions consistently improve body composition, cardiometabolic parameters, and autonomic function. Conclusions: A multidimensional lifestyle-based approach integrating exercise, dietary strategies, and modulation of estrogen-related pathways may help mitigate cardiometabolic risk and support healthier aging during the climacteric transition.