Metabolic disorders in postmenopausal women: challenges and coping strategies
DOI: 10.32364/2618-8430-2025-8-4-8
M.I. Yarmolinskaya1,2, S.A. Cherkashina 1, E.A. Konopako1
1D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproduction, St. Petersburg, Russian Federation
2North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russian Federation
A steady trend towards widespread obesity among female population (especially, in postmenopausal women) combined with increased life expectancy requires a comprehensive approach to maintain health and high quality of life. Careful attention should be paid to prevention and treatment of comorbidities, but also to development of personalized weight management strategies taking into account hormonal changes and individual body characteristics. The paper highlights pathogenesis of the symptoms associated with hypoestrogenism including neurovegetative, psychoemotional, and metabolic disorders in postmenopausal women. Data on effectiveness of available approaches to obesity treatment including lifestyle and nutrition modifications, increased physical activity, and medication therapies, are presented.
Efficiency of menopausal hormone therapy (MHT) with regard to metabolic disorders in postmenopausal women considering the current Russian MHT eligibility criteria, is discussed. A significant role of glucagon-like peptide agonists and glucose-dependent insulinotropic polypeptide agonists in obesity management in postmenopausal women is noted. The importance of similar approaches to management of patients with premature ovarian insufficiency is emphasized.
Keywords: obesity, postmenopause, hot flashes, menopausal hormone therapy, glucagon-like peptide agonists, tirzepatide.
For citation: Yarmolinskaya M.I., Cherkashina S.A., Konopako E.A. Metabolic disorders in postmenopausal women: challenges and coping strategies. Russian Journal of Woman and Child Health. 2025;8(4):331–337 (in Russ.). DOI: 10.32364/2618-8430-2025-8-4-8
ABOUT THE AUTHORS:
Maria I. Yarmolinskaya — Dr. Sc. (Med.), Professor, Professor of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Head of the Department of Gynecology and Endocrinology, Head of the Center for Diagnosis and Treatment of Endometriosis, D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproduction; 3, Mendeleevskaya line, St. Petersburg, 199034, Russian Federation; Professor of the Department of Obstetrics and Gynecology, North Western State Medical University named after I.I. Mechnikov; 41, Kirochnaya str., St. Petersburg, 191015, Russian Federation; ORCID iD 0000-0002-6551-4147
Sofiya A. Cherkashina — Doctor, Consultative and Diagnostic Department No. 2, D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproduction; 3, Mendeleevskaya line, St. Petersburg, 199034, Russian Federation; ORCID iD 0009-0005-7208-3575
Ekaterina A. Konopako — Resident Physician, D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproduction; 3, Mendeleevskaya line, St. Petersburg, 199034, Russian Federation; ORCID iD 0009-0009-0788-5853
Contact information: Maria I. Yarmolinskaya, e-mail: m.yarmolinskaya@gmail.com
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 02.10.2025.
Revised 27.10.2025.
Accepted 21.11.2025.
2. Voedisch A.J., Dunsmoor-Su R., Kasirsky J. Menopause: A Global Perspective and Clinical Guide for Practice. Clin Obstet Gynecol. 2021;64:528–554. DOI: 10.1097/GRF.0000000000000639
3. Алферова В.И., Мустафина С.В. Распространенность ожирения во взрослой популяции Российской Федерации (обзор литературы). Ожирение и метаболизм. 2022;19:96–105.Alferova V.I., Mustafina S.V. The prevalence of obesity in the adult population of the Russian Federation (literature review). Obesity and metabolism. 2022;19:96–105 (in Russ.). DOI: 10.14341/omet12809
4. Knight M.G., Anekwe C., Washington K. et al. Weight regulation in menopause. Menopause. 2021;28:960–965. DOI: 10.1097/GME.0000000000001792
5. Pogodziński D., Ostrowska L., Smarkusz-Zarzecka J. et al. Secretome of Adipose Tissue as the Key to Understanding the Endocrine Function of Adipose Tissue. Int J Mol Sci. 2022;23(4):2309. DOI: 10.3390/ijms23042309
6. Kahn D., Macias E., Zarini S. et al. Exploring Visceral and Subcutaneous Adipose Tissue Secretomes in Human Obesity: Implications for Metabolic Disease. Endocrinology. 2022;163:bqac140. DOI: 10.1210/endocr/bqac140
7. Karvonen-Gutierrez C., Kim C. Association of mid-life changes in body size, body composition and obesity status with the menopausal transition. Healthcare (Basel). 2016;4(3):42. DOI: 10.3390/healthcare4030042
8. Tao Z., Zheng L.D., Smith C. et al. Estradiol signaling mediates gender difference in visceral adiposity via autophagy article. Cell Death Dis. 2018;9(3):309. DOI: 10.1038/s41419-018-0372-9
9. El Khoudary S.R., Greendale G., Crawford S.L. et al. The menopause transition and women's health at midlife: A progress report fr om the Study of Women's Health across the Nation (SWAN). Menopause. 2019;26:1213–1227. DOI: 10.1097/GME.0000000000001424
10. Дудинская Е.Н., Мачехина Л.В., Онучина Ю.С. Метаболический синдром у пожилых лиц. Российский кардиологический журнал. 2025;30(1S):6542. DOI: 10.15829/1560-4071-2025-6542Dudinskaya E.N., Matchekhina L.V., Onuchina Yu.S. Metabolic syndrome in the elderly. Russian Journal of Cardiology. 2025;30:6542 (in Russ.). DOI: 10.15829/1560-4071-2025-6542
11. Thurston R.C., Chang Y., Mancuso P. et al. Adipokines, adiposity, and vasomotor symptoms during the menopause transition: Findings from the Study of Women's Health Across the Nation. Fertil Steril. 2013;100(3):793–800. DOI: 10.1016/j.fertnstert.2013.05.005
12. Baker F.C., De Zambotti M., Colrain I.M. et al. Sleep problems during the menopausal transition: Prevalence, impact, and management challenges. Nat Sci Sleep. 2018;10:73–95. DOI: 10.2147/NSS.S125807
13. Alzueta E., Menghini L., Volpe L. et al. Navigating menopause at work: a preliminary study about challenges and support systems. Menopause. 2024;31(4):258–265. DOI: 10.1097/GME.0000000000002333
14. Mervosh N., Devi G. Estrogen, menopause, and Alzheimer's disease: understanding the link to cognitive decline in women. Front Mol Biosci. 2025;12:1634302. DOI: 10.3389/fmolb.2025.1634302
15. David P.S., Kling J.M., Vegunta S. et al. Vasomotor symptoms in women over 60: Results from the Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS). Menopause. 2018;25(10):1105–1109. DOI: 10.1097/GME.0000000000001126
16. Gombert-Labedens M., Vesterdorf K., Fuller A. et al. Effects of menopause on temperature regulation. Temperature. 2025;12:92–132. DOI: 10.1080/23328940.2025.2484499
17. Geraci A., Calvani R., Ferri E. et al. Sarcopenia and Menopause: The Role of Estradiol. Front Endocrinol (Lausanne). 2021;12:682012. DOI: 10.3389/fendo.2021.682012
18. Эседова А.Э., Уруджева Н.Г., Ильина И.Ю. Менопаузальный метаболический синдром и риски назначения менопаузальной гормональной терапии. Пути решения. РМЖ. Мать и дитя. 2020;3(4):260–266. DOI: 10.32364/2618-8430-2020-3-4-260-266Esedova A.E., Urudzheva N.G., Il'ina I.Yu. Menopausal metabolic syndrome and the risks of menopausal hormone therapy: the solutions. Russian Journal of Woman and Child Health. 2020;3:260–266 (in Russ.). DOI: 10.32364/2618-8430-2020-3-4-260-266
19. Апетов С.С., Апетова В.В. Роль менопаузальной гормональной терапии в профилактике сахарного диабета 2-го типа у женщин в постменопаузе. Фарматека. 2022;4:26–32. DOI: 10.18565/pharmateca.2022.4.26-32Apetov S.S., Apetova V.V. The role of menopausal hormone therapy in the prevention of type 2 diabetes melltus in postmenopausal women. Pharmateca. 2022;4:26–32 (in Russ.). DOI: 10.18565/pharmateca.2022.4.26-32
20. Panay N., Anderson R.A., Bennie A. et al. Evidence-based guideline: premature ovarian insufficiency. Climacteric. 2024;27:510–520. DOI: 10.1080/13697137.2024.2423213
21. Kulaksizoglu M., Ipekci S.H., Kebapcilar L. et al. Risk factors for diabetes mellitus in women with primary ovarian insufficiency. Biol Trace Elem Res. 2013;154:313–320. DOI: 10.1007/s12011-013-9738-0
22. Avgerinos K.I., Spyrou N., Mantzoros C.S., Dalamaga M. Obesity and cancer risk: Emerging biological mechanisms and perspectives. Metabolism. 2019;92:121–135. DOI: 10.1016/j.metabol.2018.11.001
23. Tong Y., Zhou T., Kong Y. et al. Causal impact of obesity class stratification and endometrial cancer subtypes: an integrated Mendelian randomization and Global Burden of Disease Study 2021 analysis. Int J Surg. 2025;111:6783–6801. DOI: 10.1097/JS9.0000000000002883
24. Raglan O., Kalliala I., Markozannes G. et al. Risk factors for endometrial cancer: An umbrella review of the literature. Int J Cancer. 2019;145(7):1719–1730. DOI: 10.1002/ijc.31961
25. Оразов М.Р., Михалева Л.М., Муллина И.А. и др. Патогенез рецидивирующей гиперплазии без атипии. Трудный пациент. 2021;19:36–9.Orazov M.R., Mikhaleva L.M., Mullina I.A. et al. Pathogenesis of recurrent hyperplasia without atypia. Difficult patient. 2021;19:36–39 (in Russ.).
26. Nahmias-Blank D., Maimon O., Meirovitz A. et al. Excess body weight and postmenopausal breast cancer: Emerging molecular mechanisms and perspectives. Semin Cancer Biol. 2023;96:26–35. DOI: 10.1016/j.semcancer.2023.09.003
27. Lee K., Kruper L., Dieli-Conwright C.M., Mortimer J.E. The Impact of Obesity on Breast Cancer Diagnosis and Treatment. Curr Oncol Rep. 2019;21(5):41. DOI: 10.1007/s11912-019-0787-1
28. Трошина Е.А., Румянцев П.О., Алташина М.В. и др. Влияние избыточной массы тела и ожирения на факторы риска развития рака молочной железы у женщин в постменопаузе. Ожирение и метаболизм. 2012;9(3):3–10. DOI: 10.14341/2071-8713-4965Troshina E.A., Rumyantsev P.O., Altashina M.V. et al. An impact of overweight and obesity on the risk factors for breast cancer in postmenopausal women. Obesity and Metabolism. 2012;9:3–10 (in Russ.). DOI: 10.14341/2071-8713-4965
29. Thompson W.G., Cook D.A., Clark M.M. et al. Treatment of Obesity. Mayo Clin Proc. 2007;82:93–102. DOI: 10.4065/82.1.93
30. Lowe D.A., Wu N., Rohdin-Bibby L. et al. Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men with Overweight and Obesity: The TREAT Randomized Clinical Trial. JAMA Intern Med. 2020;180(11):1491–1499. DOI: 10.1001/jamainternmed.2020.4153
31. Koliaki C., Spinos T., Spinou M. et al. Defining the optimal dietary approach for safe, effective and sustainable weight loss in overweight and obese adults. Healthcare (Basel). 2018;6(3):73. DOI: 10.3390/healthcare6030073
32. Liu Y., Mao S., Xie W. et al. Relationship between physical activity and abdominal obesity and metabolic markers in postmenopausal women. Sci Rep. 2024;14:26496. DOI: 10.1038/s41598-024-77900-x
33. Khalafi M., Habibi Maleki A., Sakhaei M.H. et al. The effects of exercise training on body composition in postmenopausal women: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2023;14:1183765. DOI: 10.3389/fendo.2023.1183765
34. Lobo R.A., Gompel A. Management of menopause: a view towards prevention. Lancet Diabetes Endocrinol. 2022;10(6):457–470. DOI: 10.1016/S2213-8587(21)00269-2
35. Anagnostis P., Paschou S.A., Katsiki N. et al. Menopausal Hormone Therapy and Cardiovascular Risk: Wh ere are we Now? Curr Vasc Pharmacol. 2018;17(6):564–572. DOI: 10.2174/1570161116666180709095348
36. Hurtado M.D., Tama E., Fansa S. et al. Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use. Menopause. 2024;31(4):266–274. DOI: 10.1097/GME.0000000000002310
37. Шляхто Е.В., Дедов И.И., Серов В.Н. и др. Российские критерии приемлемости назначения менопаузальной гормональной терапии пациенткам с сердечно-сосудистыми и метаболическими заболеваниями. Согласительный документ Российского кардиологического общества, Российского общества акушеров-гинекологов, Российской ассоциации эндокринологов, Евразийской ассоциации терапевтов, Ассоциации флебологов России, Российского научного медицинского общества терапевтов, Российской ассоциации геронтологов и гериатров, Российского общества специалистов по гинекологической эндокринологии и менопаузе. Акушерство и гинекология. 2025;10:193–221. DOI: 10.18565/aig.2025.308Shlyakhto E.V., Dedov I.I., Serov V.N. et al. Russian eligibility criteria for menopausal hormone therapy in patients with cardiovascular and metabolic diseases. Consensus document of the Russian Society of Cardiology, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Russian Phlebological Association, Russian Scientific Medical Society of Therapists, Russian Association of Gerontologists and Geriatricians, Russian Society of Gynecological Endocrinology and Menopause Specialists. Obstetrics and Gynecology. 2025;(10):193–221 (in Russ.). DOI: 10.18565/aig.2025.308
38. Moiz A., Filion K.B., Tsoukas M.A. et al. The expanding role of GLP-1 receptor agonists: a narrative review of current evidence and future directions. EClinicalMedicine. 2025;86:103363. DOI: 10.1016/j.eclinm.2025.103363
39. Moiz A., Filion K.B., Toutounchi H. et al. Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss Among Adults Without Diabetes. Ann Intern Med. 2025;178:199–217. DOI: 10.7326/ANNALS-24-01590
40. Zhao X., Wang M., Wen Z. et al. GLP-1 Receptor Agonists: Beyond Their Pancreatic Effects. Front Endocrinol (Lausanne). 2021;12:721135. DOI: 10.3389/fendo.2021.721135
41. Lincoff A.M., Brown-Frandsen K., Colhoun H.M. et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221–2232. DOI: 10.1056/nejmoa2307563
42. Perkovic V., Tuttle K.R., Rossing P. et al. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med. 2024;391:109–121. DOI: 10.1056/NEJMoa2403347
43. Bandyopadhyay S., Das S., Samajdar S.S. et al. Role of semaglutide in the treatment of nonalcoholic fatty liver disease or non-alcoholic steatohepatitis: A systematic review and meta-analysis. Diabetes Metab Syndr. 2023;17(10):102849. DOI: 10.1016/j.dsx.2023.102849
44. Goldberg A., Graca S., Liu J. et al. Anti-obesity pharmacological agents for polycystic ovary syndrome: A systematic review and meta-analysis to inform the 2023 international evidence-based guideline. Obes Rev. 2024;25(5):e13704. DOI: 10.1111/obr.13704
45. Sodhi M., Rezaeianzadeh R., Kezouh A. et al. Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss. JAMA. 2023;330(18):1795–1797. DOI: 10.1001/jama.2023.19574
46. Jastreboff A.M., Aronne L.J., Ahmad N.N. et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022;387(3):205–216. DOI: 10.1056/nejmoa2206038
47. Regmi A., Aihara E., Christe M.E. et al. Tirzepatide modulates the regulation of adipocyte nutrient metabolism through long-acting activation of the GIP receptor. Cell Metab. 2024;36:1534–1549.e7. DOI: 10.1016/j.cmet.2024.05.010
48. Anderson S.L., Marrs J.C. Tirzepatide for type 2 diabetes. Drugs Context. 2023;12:2023-6-1. DOI: 10.7573/dic.2023-6-1
49. Coskun T., Sloop K.W., Loghin C. et al. LY3298176, a novel dual GIP and GLP-1 receptor agonist for the treatment of type 2 diabetes mellitus: From discovery to clinical proof of concept. Mol Metab. 2018;18:3–14. DOI: 10.1016/j.molmet.2018.09.009
50. Willard F.S., Douros J.D., Gabe M.B.N. et al. Tirzepatide is an imbalanced and biased dual GIP and GLP-1 receptor agonist. JCI Insight. 2020;5(17):e140532. DOI: 10.1172/jci.insight.140532
51. Луговик И.А., Бабина А.В., Арутюнян С.С. и др. Первый дженерик тирзепатида GP30931: физико-химическое и биологическое сходство с референтным лекарственным средством. Разработка и регистрация лекарственных средств. 2025;14(2):54–74. DOI: 10.33380/2305-2066-2025-14-2-2084Lugovik I.A., Babina A.V., Arutyunyan S.S. et al. The first generic tirzepatide GP30931: physicochemical and biological similarity to the reference drug. Drug Development & Registration. 2025;14(2):54–74 (in Russ.). DOI: 10.33380/2305-2066-2025-14-2-2084
52. Mukherjee A., Ghaem-Maghami S., Syed A.A. Use of incretin-based therapies in women using hormone replacement therapy (HRT). Post Reprod Health. 2025;31:127–131. DOI: 10.1177/20533691251343069
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