Objective Menopause is associated with profound hormonal changes, including declines in estradiol and progesterone and increases in follicle stimulating hormone (FSH) and luteinizing hormone (LH), which contribute to elevated cardiovascular disease (CVD) risk. Digital twin frameworks offer a novel approach to simulate these complex dynamics. Method This study developed a semi-mechanistic digital twin model of menopause using 1000 simulated women (50% age ≥55 years, 50% age <55 years) followed over 90 days. Hormonal dynamics were modeled as cyclical in non-menopausal women and stable in postmenopausal women. Cardiovascular risk was assessed with linear mixed-effects models and generalized estimating equations, adjusting for age, body mass index and smoking. Results The model reproduced expected patterns, with estradiol and progesterone peaks at ovulation and luteal phases in non-menopausal women, and stable, low levels in postmenopausal women, alongside elevated gonadotropins. After adjustment, menopause remained significantly associated with hormonal changes and CVD risk (p < 0.001). CVD-related differences were more pronounced in non-menopausal women, where estradiol peaks and luteal progesterone amplitudes were attenuated. Conclusion This proof of concept highlights the potential of digital twin models to capture menopause-related hormonal dynamics and their cardiovascular implications. Future work should integrate real-world data, perimenopausal variability and ethical governance to enhance clinical translation.

Women in early midlife often experience specific health issues due to aging and the menopausal transition. Hormonal changes, systemic chronic inflammation and micronutrient deficiencies contribute to symptoms such as vasomotor disturbances, metabolic syndrome, neurocognitive decline and reduced mobility, which can adversely affect overall health and quality of life. However, the menopausal transition also offers opportunities for improving health and preventing diseases. Many women use dietary supplements as a form of complementary and alternative medicine (CAM) to manage these complex challenges during this life stage. Given the multifaceted nature of these health concerns, an integrated approach that combines dietary supplements with conventional medicine and harnesses nutrient synergy for enhanced benefits should be considered. This article examines current evidence on the use of multivitamins, minerals and dietary supplements (including those containing phytonutrients and other CAMs) for health issues during early midlife and the menopausal transition. Although current evidence suggests that multi-nutrient dietary supplementation combinations are promising, further research is needed to verify their effectiveness and evaluate potential interactions with standard treatments across diverse populations. The successful integration of dietary supplements alongside conventional medicine during the menopausal transition will also require personalized care, support from healthcare professionals and public education.

Objective This study aimed to examine the 20-year incidence of cardiovascular disease (CVD) in menopausal women, exploring the interplay of traditional and menopause-specific risk factors. Method The ATTICA study is a prospective cohort survey established in 2001–2002, with three consecutive follow-ups performed in 2006, 2012 and 2022. A total of 1001 women with complete data for CVD evaluation comprised the sample of the current study. For the purposes of this analysis, women were classified according to their menopausal status (at menopause, 276 out of 1001 women [27.6%]). Results The 20-year cumulative CVD incidence was 321 cases among 1001 women (32%); 274 out of the 337 (81.3%) who were at menopause developed CVD, whereas 47 out of 664 at premenopause developed CVD (7.1%). Age-adjusted analysis revealed that postmenopausal women had 2.25 times (95% confidence interval: 1.20, 4.24) higher risk of CVD, compared to women not at menopause. The fully adjusted model revealed that history of diabetes and hypercholesterolemia were significant predictors for the 20-year-CVD events. Moreover, high-sensitivity C-reactive protein was a significant predictor for CVD events only in women aged above 52 years at menopause. Conclusion Postmenopausal women had an age-adjusted 2.25 times higher 20-year risk of CVD, as compared to women who were not at menopause. Prevailed hypercholesterolemia and diabetes were the most important determinants for long-term CVD events, whereas chronic systemic inflammation had significant predictive value only in women aged above 52 years at menopause.

Sarcopenic obesity, defined as the coexistence of excess adiposity and sarcopenia, represents a high-risk clinical condition that amplifies the adverse effects of each disorder. When accompanied by bone loss, the entity progresses to osteo-sarcopenic obesity (OSO), which further compromises physical function, metabolic health and overall prognosis. Affected individuals face an increased risk of falls, fractures, functional disability, hospitalization, cardiometabolic complications and premature mortality. In women transitioning through menopause, declining estrogen levels accelerate fat accumulation and muscle loss, while also heightening susceptibility to osteoporosis, insulin resistance, hypertension, dyslipidemia, type 2 diabetes and certain cancers. These interrelated changes underscore the need for heightened awareness, early identification and multidisciplinary management of the OSO syndrome. Establishing clear and universally accepted diagnostic criteria, integrating patient education and implementing preventive strategies – including lifestyle, nutritional and medical interventions – are essential to address this complex and emerging clinical entity, ultimately improving health outcomes and quality of life for midlife and older women.

Objective Menopausal hormone therapy (MHT) is the most effective treatment for relieving menopausal symptoms. However, many women avoid this therapy due to fear, and in Brazil numerous cities lack access to this treatment in the public health system. This study aimed to investigate prescribing habits regarding MHT among gynecologist-obstetricians in the Brazilian public versus private health systems, and to identify the main barriers to its use. Method This descriptive cross-sectional study utilized a quantitative approach. Gynecologist-obstetricians from across Brazil were invited to complete a structured electronic questionnaire assessing their prescribing practices in both the public and private health sectors. Result A total of 433 valid responses were analyzed. Among them, 51.5% of participants reported providing care to climacteric patients in the public health system, with 46.2% working in both sectors. Among physicians practicing in both settings, 76.5% reported prescribing MHT more frequently in the private sector. The main barriers to MHT prescription in the public system were treatment cost (68.2%) and lack of availability of free medication (61.4%), while in the private system the predominant barriers were fear of therapy-related risks (93.6%), especially cancer. Only 27.8% reported free access to MHT in their cities. Conclusion The findings indicate that MHT prescribing practices in Brazil are still significantly influenced by structural barriers in the public sector and by negative perceptions in the private sector. Interventions aimed at expanding access and educating both physicians and patients are essential to ensure safe and equitable use of MHT.

Objective Menopause, typically occurring between ages 45 and 55 years, is a natural life stage marked by hormonal changes that can affect the symptom burden, quality of life and chronic disease risk. While not a disease, the transition often requires individualized, holistic care. Lifestyle medicine – encompassing healthy eating, physical activity, mental well-being, avoidance of risky substances, restorative sleep and healthy relationships – offers a promising non-pharmacological strategy to optimize health during this period. Method A systematic literature search was conducted in PubMed, Embase, Scopus and Web of Science (January 2000–December 2024) using the following keywords and combinations: ‘menopause’, ‘lifestyle medicine’, ‘healthy eating’, ‘physical activity’, ‘mental wellbeing’, ‘avoidance of risky substances’, ‘restorative sleep’, ‘healthy relationships’, ‘weight management’, ‘chronic disease prevention’, ‘health equity and access’ and ‘general health frameworks’. Peer-reviewed human studies in perimenopausal, menopausal or postmenopausal women evaluating one or more lifestyle medicine pillars were included. Data were extracted on study design, population, interventions, outcomes and main findings. Results Lifestyle medicine interventions were associated with reductions in vasomotor symptoms, improved sleep quality, enhanced mental well-being, healthier weight regulation, and reduced cardiometabolic and osteoporosis risk. Multidisciplinary, person-centered approaches improved adherence and patient-reported outcomes. Strategies were cost-effective, adaptable and beneficial for long-term disease prevention across diverse populations. Conclusion Lifestyle medicine offers a foundational, evidence-based framework for equitable menopause care. Integrating these strategies into clinical guidelines and public health policy can improve quality of care, empower women to manage their health and reduce disparities in access. Collaborative action among healthcare providers, policymakers and communities is essential to maximize impact.

Objective This study aimed to investigate the association between the day-to-day impact of vaginal aging and female sexual function among postmenopausal Turkish women. Method The McCoy Female Sexuality Questionnaire (MFSQ) and the Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire were distributed to 195 postmenopausal women. The most bothersome vulvovaginal symptoms were recorded. The scores for each of the MFSQ and DIVA domains were compared between women with moderate to severe symptoms and those with no or mild symptoms. Results The mean scores for the MFSQ sexual interest and MFSQ partner satisfaction domains, the total MFSQ, and the total DIVA decreased as women got older. Women with moderate to severe pain with penetration had a lower score for the MFSQ sexual interest domain, and a higher score for the DIVA self-concept and body image domain. Women with moderate to severe dryness had a higher score for the MFSQ sexual interest domain, and a lower score for the DIVA self-concept and body image domain. Conclusion The mean scores of each of the MFSQ and DIVA domains were not influenced by vulvovaginal symptoms such as itching, pain, and irritation. The mean scores of the MFSQ sexual interest and DIVA self-concept and body image domains differed with the severity of dryness and pain with penetration.

For women with mild-to-moderate menopausal symptoms, lifestyle changes and over-the-counter products and services can be beneficial for symptom management, especially for those who are contraindicated or averse to using menopausal hormone therapy (MHT). Lifestyle changes, such as increased exercise and improvements in diet, enhance overall health and are suggested by some low-level evidence – largely from observational studies – to alleviate menopausal symptoms. Over-the-counter dietary and herbal supplements are a popular alternative to MHT. While evidence is mainly low-level, some of these products have shown efficacy and tolerability in menopausal symptom management through meta-analyses, systematic reviews and randomized controlled trials (RCTs). However, mixed evidence and inconsistencies in product dosage, components and quality remain an issue. In addition, caution is advised for women on other medications or with conditions such as breast cancer that could interact with or be impacted by these products. There is high-level evidence from RCTs supporting the efficacy of behavioral therapies, in particular cognitive behavioral therapy, in menopausal symptom management, and clinicians should consider their implementation. Education on menopause and its management is essential. The authors recommend a three-step approach for treating women with self-reported mild-to-moderate menopausal symptoms who prefer to avoid prescription medications even after being informed about their benefit–risk profiles: 1) lifestyle changes; 2) non-prescription options and over-the-counter products; and 3) prescription therapies, if still necessary and with patient agreement. This approach broadens access to menopausal symptom management, providing relief to a wide range of women.

Objective Social media is an increasingly relevant tool for health education, enabling information exchange, promoting autonomy and supporting informed decision-making. This study introduces Menopausando, a predominantly Portuguese-language digital platform designed to support women during menopausal transition and postmenopause. Method This cross-sectional study has been carried out in the Gynecology Discipline, São Paulo University, Brazil, since 2019. In the pre-implementation phase of the digital platform, interviews were conducted with 287 Internet users about their experiences and preferences to be disclosed on the digital platform. The chi-square test or Fisher’s exact test and analysis of variance with Stata 16 SE were utilized. Results Interviewees were 83.3% white with mean age 54.3 (1.82) years, and 78.8% were interested in a menopause digital platform. The platform reached 21,617 website users, 3048 Instagram users, 133 Facebook users and 1126 Spotify users. Facebook users were older, men age 51.3 (9.3) years, than Spotify users, mean age 45.6 (12.2) years (p < 0.001). Female gender was present in all social networks (p < 0.001). The largest number of Brazilian users was on the website, with 21,000 (97.1%) (p < 0.001) (all groups), and other countries’ websites and Instagram (p < 0.001). Conclusion Menopausando effectively supports women during menopausal transition and postmenopause via multiple digital channels. The results expose digital access tendencies and inequalities.