Physiology of Menopause

Smith-Ryan, Abbie E.; Hirsch, Katie R.; Cabre, Hannah E.

doi:10.1007/978-3-031-21881-1_15

Abbie E. Smith-Ryan²,
Katie R. Hirsch³ &
Hannah E. Cabre²

895 Accesses

Abstract

Menopause is the natural transition in the female lifespan when the menstrual cycle ceases and reproductive capabilities are eliminated. This transition begins when menstrual cycles become irregular, referred to as perimenopause, and can last 2–8 years. There is robust evidence that ovarian hormones play a vital role in the metabolic, cardiovascular, and musculoskeletal health of women. Because life expectancy has continually risen through the previous decades, women can spend up to 40% of their lives in the postmenopausal stage. Several physiological changes occur across the menopause transition. Starting in early perimenopause, changes in energy expenditure, substrate utilization, appetite, and energy intake contribute to increases in fat mass, particularly in the abdominal region, and loss of lean mass. Together, these changes in body composition and metabolism contribute to the development of chronic inflammation, insulin resistance, dyslipidemia, and cardiovascular dysfunction. These changes, and the transition to menopause, vary by race and ethnicity, with an increased disease risk reported among minorities. Beginning at around the time of menopause, women also report greater physical limitations and disabilities than men. The transition to menopause is a key time point for exercise to support metabolic, cardiovascular, musculoskeletal, and functional changes that occur.

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References

Abildgaard J, Pedersen AT, Green CJ, Harder-Lauridsen NM, Solomon TP, Thomsen C, Juul A, Pedersen M, Pedersen JT, Mortensen OH, Pilegaard H, Pedersen BK, Lindegaard B. Menopause is associated with decreased whole body fat oxidation during exercise. Am J Physiol-Endocrinol Metab. 2013;304(11):E1227–36. https://doi.org/10.1152/ajpendo.00492.2012.
Article CAS PubMed Google Scholar
Aloia JF, Vaswani A, Ma R, Flaster E. Aging in women—the four-compartment model of body composition. Metabolism. 1996;45(1):43–8. https://doi.org/10.1016/S0026-0495(96)90198-5.
Article CAS PubMed Google Scholar
Ambikairajah A, Walsh E, Tabatabaei-Jafari H, Cherbuin N. Fat mass changes during menopause: a metaanalysis. Am J Obstet Gynecol. 2019;221(5):393-409.e50. https://doi.org/10.1016/j.ajog.2019.04.023.
Article PubMed Google Scholar
Avis NE, Stellato R, Crawford S, Bromberger J, Ganz P, Cain V, Kagawa-Singer M. Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups. Soc Sci Med. 2001;52(3):345–56. https://doi.org/10.1016/S0277-9536(00)00147-7.
Article CAS PubMed Google Scholar
Bamman MM, Ferrando AA, Evans RP, Stec MJ, Kelly NA, Gruenwald JM, Corrick KL, Trump JR, Singh JA. Muscle inflammation susceptibility: a prognostic index of recovery potential after hip arthroplasty? Am J Physiol Endocrinol Metab. 2015;308(8):E670-679. https://doi.org/10.1152/ajpendo.00576.2014.
Article CAS PubMed PubMed Central Google Scholar
Bondarev D, Laakkonen EK, Finni T, Kokko K, Kujala UM, Aukee P, Kovanen V, Sipilä S. Physical performance in relation to menopause status and physical activity. Menopause. 2018;25(12):1432–41. https://doi.org/10.1097/GME.0000000000001137.
Article PubMed Google Scholar
Brown JP, Albert C, Nassar BA, Adachi JD, Cole D, Davison KS, Dooley KC, Don-Wauchope A, Douville P, Hanley DA, Jamal SA, Josse R, Kaiser S, Krahn J, Krause R, Kremer R, Lepage R, Letendre E, Morin S, Ste-Marie L-G. Bone turnover markers in the management of postmenopausal osteoporosis. Clin Biochem. 2009;42(10–11):929–42. https://doi.org/10.1016/j.clinbiochem.2009.04.001.
Carr MC. The Emergence of the Metabolic Syndrome with Menopause. J Clin Endocrinol Metab. 2003;88(6):2404–11. https://doi.org/10.1210/jc.2003-030242.
Article CAS PubMed Google Scholar
Chen S, Jiang H, Wu X, Fang J. Therapeutic effects of quercetin on inflammation, obesity, and type 2 diabetes. Mediators Inflamm. 2016;2016:1–5. https://doi.org/10.1155/2016/9340637.
Article CAS Google Scholar
Cunningham TJ, Seeman TE, Kawachi I, Gortmaker SL, Jacobs DR, Kiefe CI, Berkman LF. Racial/ethnic and gender differences in the association between self-reported experiences of racial/ethnic discrimination and inflammation in the CARDIA cohort of 4 US communities. Soc Sci Med. 2012;75(5):922–31. https://doi.org/10.1016/j.socscimed.2012.04.027.
Article PubMed PubMed Central Google Scholar
Dama A, Baggio C, Boscaro C, Albiero M, Cignarella A. Estrogen receptor functions and pathways at the vascular immune interface. Int J Mol Sci. 2021;22(8):4254. https://doi.org/10.3390/ijms22084254.
Article CAS PubMed PubMed Central Google Scholar
Devries MC. Sex-based differences in endurance exercise muscle metabolism: impact on exercise and nutritional strategies to optimize health and performance in women: sex-based differences in muscle metabolism. Exp Physiol. 2016;101(2):243–9. https://doi.org/10.1113/EP085369.
Article PubMed Google Scholar
Draper CF, Duisters K, Weger B, Chakrabarti A, Harms AC, Brennan L, Hankemeier T, Goulet L, Konz T, Martin FP, Moco S, van der Greef J. Menstrual cycle rhythmicity: metabolic patterns in healthy women. Sci Rep. 2018;8(1):14568. https://doi.org/10.1038/s41598-018-32647-0.
Article CAS PubMed PubMed Central Google Scholar
Duval K, Prud’homme D, Rabasa-Lhoret R, Strychar I, Brochu M, Lavoie J-M, Doucet É. Effects of the menopausal transition on dietary intake and appetite: a MONET Group Study. Eur J Clin Nutr. 2014;68(2):271–76. https://doi.org/10.1038/ejcn.2013.171.
El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, Limacher MC, Manson JE, Stefanick ML, Allison MA. On behalf of the American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association. Circulation 2020;142(25). https://doi.org/10.1161/CIR.0000000000000912.
El Khoudary SR, Greendale G, Crawford SL, Avis NE, Brooks MM, Thurston RC, Karvonen-Gutierrez C, Waetjen LE, Matthews K. The menopause transition and women’s health at midlife: a progress report from the Study of Women’s Health Across the Nation (SWAN). Menopause, Publish Ahead of Print; 2019. https://doi.org/10.1097/GME.0000000000001424.
El Khoudary SR, Thurston RC. Cardiovascular implications of the menopause transition. Obstet Gynecol Clin North Am. 2018;45(4):641–61. https://doi.org/10.1016/j.ogc.2018.07.006.
Article PubMed Google Scholar
Ferrando AA, Wolfe RR. Restoration of hormonal action and muscle protein. Crit Care Med. 2007;35(Suppl):S630–4. https://doi.org/10.1097/01.CCM.0000278529.44899.57.
Article CAS PubMed Google Scholar
Fuglsang-Nielsen R, Rakvaag E, Langdahl B, Knudsen KEB, Hartmann B, Holst JJ, Hermansen K, Gregersen S. Effects of whey protein and dietary fiber intake on insulin sensitivity, body composition, energy expenditure, blood pressure, and appetite in subjects with abdominal obesity. Eur J Clin Nutr. 2021;75(4):611–9. https://doi.org/10.1038/s41430-020-00759-4.
Article CAS PubMed Google Scholar
Gemmati D, Varani K, Bramanti B, Piva R, Bonaccorsi G, Trentini A, Manfrinato MC, Tisato V, Carè A, Bellini T. “Bridging the gap” everything that could have been avoided if we had applied gender medicine, pharmacogenetics and personalized medicine in the gender-omics and sex-omics era. Int J Mol Sci. 2019;21(1):E296. https://doi.org/10.3390/ijms21010296.
Article Google Scholar
Glaser DL, Kaplan FS. Osteoporosis: definition and clinical presentation. Spine. 1997;22(Supplement):12S–16S. https://doi.org/10.1097/00007632-199712151-00003.
Article CAS PubMed Google Scholar
Gold EB. The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am. 2011;38(3):425–40. https://doi.org/10.1016/j.ogc.2011.05.002.
Article PubMed PubMed Central Google Scholar
Goodpaster BH, Sparks LM. Metabolic flexibility in health and disease. Cell Metab. 2017;25(5):1027–36. https://doi.org/10.1016/j.cmet.2017.04.015.
Article CAS PubMed PubMed Central Google Scholar
Gould LM, Gordon AN, Cabre HE, Hoyle AT, Ryan ED, Hackney AC, Smith-Ryan AE. Metabolic effects of menopause: a cross-sectional characterization of body composition and exercise metabolism. Menopause, Publish Ahead of Print; 2022. https://doi.org/10.1097/GME.0000000000001932.
Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, Cauley JA, Finkelstein JS, Jiang S-F, Karlamangla AS. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5): 124865. https://doi.org/10.1172/jci.insight.124865.
Article PubMed Google Scholar
Hackney AC, Koltun KJ, Williett HN. Menstrual cycle hormonal changes: estradiol-β-17 and progesterone interactions on exercise fat oxidation. Endocrine. 2022. https://doi.org/10.1007/s12020-022-02998-w.
Article PubMed PubMed Central Google Scholar
Hall MH, Matthews KA, Kravitz HM, Gold EB, Buysse DJ, Bromberger JT, Owens JF, Sowers M. Race and financial strain are independent correlates of sleep in midlife women: the SWAN sleep study. Sleep. 2009;32(1):73–82.
PubMed PubMed Central Google Scholar
Hansen M. Female hormones: do they influence muscle and tendon protein metabolism? Proc Nutr Soc. 2018;77(1):32–41. https://doi.org/10.1017/S0029665117001951.
Article CAS PubMed Google Scholar
Hodson L, Harnden K, Banerjee R, Real B, Marinou K, Karpe F, Fielding BA. Lower resting and total energy expenditure in postmenopausal compared with premenopausal women matched for abdominal obesity. J Nutr Sci. 2014;3: e3. https://doi.org/10.1017/jns.2013.38.
Article PubMed PubMed Central Google Scholar
Im E-O, Kim G, Choi M, Chee W. Gastrointestinal symptoms in four major racial/ethnic groups of midlife women: race/ethnicity and menopausal status. Menopause. 2022;29(2):156–63. https://doi.org/10.1097/GME.0000000000001898.
Article Google Scholar
Im E-O, Lee B, Chee W, Brown A, Dormire S. Menopausal symptoms among four major ethnic groups in the United States. West J Nurs Res. 2010;32(4):540–65. https://doi.org/10.1177/0193945909354343.
Article PubMed PubMed Central Google Scholar
Janssen I. Menopause and the metabolic syndrome: the study of women’s health across the nation. Arch Intern Med. 2008;168(14):1568. https://doi.org/10.1001/archinte.168.14.1568.
Article CAS PubMed PubMed Central Google Scholar
Johnson ML, Zarins Z, Fattor JA, Horning MA, Messonnier L, Lehman SL, Brooks GA. Twelve weeks of endurance training increases FFA mobilization and reesterification in postmenopausal women. J Appl Physiol. 2010;109(6):1573–81. https://doi.org/10.1152/japplphysiol.00116.2010.
Article CAS PubMed PubMed Central Google Scholar
Juppi H-K, Sipilä S, Cronin NJ, Karvinen S, Karppinen JE, Tammelin TH, Aukee P, Kovanen V, Kujala UM, Laakkonen EK. Role of menopausal transition and physical activity in loss of lean and muscle mass: a follow-up study in middle-aged Finnish women. J Clin Med. 2020;9(5):1588. https://doi.org/10.3390/jcm9051588.
Article PubMed PubMed Central Google Scholar
Karim R, Stanczyk FZ, Brinton RD, Rettberg J, Hodis HN, Mack WJ. Association of endogenous sex hormones with adipokines and ghrelin in postmenopausal women. J Clin Endocrinol Metab. 2015;100(2):508–15. https://doi.org/10.1210/jc.2014-2834.
Article CAS PubMed Google Scholar
Karlamangla AS, Burnett-Bowie S-AM, Crandall CJ. Bone health during the menopause transition and beyond. Obstet Gynecol Clin North Am. 2018;45(4):695–708. https://doi.org/10.1016/j.ogc.2018.07.012.
Article PubMed PubMed Central Google Scholar
Kaunitz AM, Pinkerton JV, Manson JE. Hormone therapy and sarcopenia: implications for the prevention of frailty as women age. Menopause. 2020;27(5):496–7. https://doi.org/10.1097/GME.0000000000001541.
Article PubMed Google Scholar
Kelley DE, Mandarino LJ. Fuel selection in human skeletal muscle in insulin resistance: a reexamination. Diabetes. 2000;49(5):677–83. https://doi.org/10.2337/diabetes.49.5.677.
Article CAS PubMed Google Scholar
Kennedy RE, Sawyer P, Williams CP, Lo AX, Ritchie CS, Roth DL, Allman RM, Brown CJ. Life-space mobility change predicts 6-month mortality. J Am Geriatr Soc. 2017;65(4):833–8. https://doi.org/10.1111/jgs.14738.
Article PubMed PubMed Central Google Scholar
Khera A, McGuire DK, Murphy SA, Stanek HG, Das SR, Vongpatanasin W, Wians FH, Grundy SM, de Lemos JA. Race and gender differences in c-reactive protein levels. J Am Coll Cardiol. 2005;46(3):464–9. https://doi.org/10.1016/j.jacc.2005.04.051.
Article CAS PubMed Google Scholar
Kramer PR, Kramer SF, Guan G. 17β-estradiol regulates cytokine release through modulation of CD16 expression in monocytes and monocyte-derived macrophages. Arthritis Rheum. 2004;50(6):1967–75. https://doi.org/10.1002/art.20309.
Article CAS PubMed Google Scholar
Kravitz HM, Kazlauskaite R, Joffe H. Sleep, health, and metabolism in midlife women and menopause. Obstet Gynecol Clin North Am. 2018;45(4):679–94. https://doi.org/10.1016/j.ogc.2018.07.008.
Article PubMed PubMed Central Google Scholar
Lavin KM, Perkins RK, Jemiolo B, Raue U, Trappe SW, Trappe TA. Effects of aging and lifelong aerobic exercise on basal and exercise-induced inflammation. J Appl Physiol. 2020;128(1):87–99. https://doi.org/10.1152/japplphysiol.00495.2019.
Article CAS PubMed Google Scholar
Lavin KM, Roberts BM, Fry CS, Moro T, Rasmussen BB, Bamman MM. The importance of resistance exercise training to combat neuromuscular aging. Physiology. 2019;34(2):112–22. https://doi.org/10.1152/physiol.00044.2018.
Article CAS PubMed PubMed Central Google Scholar
Lawson SM, Chou B, Martin KL, Ryan I, Eke AC, Martin KD. The association between race/ethnicity and peripartum hysterectomy and the risk of perioperative complications. Int J Gynecol Obstet. 2020;151(1):57–66. https://doi.org/10.1002/ijgo.13304.
Article Google Scholar
Lovejoy JC, Champagne CM, de Jonge L, Xie H, Smith SR. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes. 2008;32(6):949–58. https://doi.org/10.1038/ijo.2008.25.
Article CAS Google Scholar
Luoto R, Kaprio J, Uutela A. Age at natural menopause and sociodemographic status in Finland. Am J Epidemiol. 1994;139(1):64–76. https://doi.org/10.1093/oxfordjournals.aje.a116936.
Article CAS PubMed Google Scholar
Lurati AR. Effects of menopause on appetite and the gastrointestinal system. Nurs Women’s Health. 2018;22(6):499–505. https://doi.org/10.1016/j.nwh.2018.09.004.
Article Google Scholar
Maltais ML, Desroches J, Dionne IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact. 2009;9(4):186–97.
CAS PubMed Google Scholar
Marlatt KL, Pitynski-Miller DR, Gavin KM, Moreau KL, Melanson EL, Santoro N, Kohrt WM. Body composition and cardiometabolic health across the menopause transition. Obesity. 2022;30(1):14–27. https://doi.org/10.1002/oby.23289.
Article PubMed Google Scholar
Marlatt KL, Redman LM, Beyl RA, Smith SR, Champagne CM, Yi F, Lovejoy JC. Racial differences in body composition and cardiometabolic risk during the menopause transition: a prospective, observational cohort study. Am J Obstet Gynecol. 2020;222(4):365.e1–365.e18. https://doi.org/10.1016/j.ajog.2019.09.051.
Article CAS PubMed Google Scholar
McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas. 1992;14(2):103–15. https://doi.org/10.1016/0378-5122(92)90003-M.
Article CAS PubMed Google Scholar
McKnight KK, Wellons MF, Sites CK, Roth DL, Szychowski JM, Halanych JH, Cushman M, Safford MM. Racial and regional differences in age at menopause in the United States: findings from the reasons for geographic and racial differences in stroke (REGARDS) study. Am J Obstet Gynecol. 2011;205(4):353.e1–353.e8. https://doi.org/10.1016/j.ajog.2011.05.014.
Article PubMed Google Scholar
Merritt EK, Stec MJ, Thalacker-Mercer A, Windham ST, Cross JM, Shelley DP, Craig Tuggle S, Kosek DJ, Kim J, Bamman MM. Heightened muscle inflammation susceptibility may impair regenerative capacity in aging humans. J Appl Physiol. 2013;115(6):937–48. https://doi.org/10.1152/japplphysiol.00019.2013.
Article CAS PubMed PubMed Central Google Scholar
Nedergaard A, Henriksen K, Karsdal MA, Christiansen C. Menopause, estrogens and frailty. Gynecol Endocrinol. 2013;29(5):418–23. https://doi.org/10.3109/09513590.2012.754879.
Article CAS PubMed Google Scholar
Nelson HD. Menopause. Lancet. 2008;371(9614):760–70. https://doi.org/10.1016/S0140-6736(08)60346-3.
Article PubMed Google Scholar
Ogden CL, Fryar CD, Martin CB, Freedman DS, Carroll MD, Gu Q, Hales CM. Trends in obesity prevalence by race and hispanic origin-1999–2000 to 2017–2018. JAMA. 2020;324(12):1208–10. https://doi.org/10.1001/jama.2020.14590.
Article PubMed PubMed Central Google Scholar
Oosthuyse T, Bosch AN. The effect of the menstrual cycle on exercise metabolism: implications for exercise performance in eumenorrhoeic women. Sports Med. 2010;40(3):207–27. https://doi.org/10.2165/11317090-000000000-00000.
Article PubMed Google Scholar
Park Y-M, Keller AC, Runchey SS, Miller BF, Kohrt WM, Van Pelt RE, Kang C, Jankowski CM, Moreau KL. Acute estradiol treatment reduces skeletal muscle protein breakdown markers in early- but not late-postmenopausal women. Steroids. 2019;146:43–9. https://doi.org/10.1016/j.steroids.2019.03.008.
Article CAS PubMed PubMed Central Google Scholar
Piers LS, Soares MJ, McCormack LM, O’Dea K. Is there evidence for an age-related reduction in metabolic rate? J Appl Physiol. 1998;85(6):2196–204. https://doi.org/10.1152/jappl.1998.85.6.2196.
Article CAS PubMed Google Scholar
Pontzer H, Yamada Y, Sagayama H, Ainslie PN, Andersen LF, Anderson LJ, Arab L, Baddou I, Bedu-Addo K, Blaak EE, Blanc S, Bonomi AG, Bouten CVC, Bovet P, Buchowski MS, Butte NF, Camps SG, Close GL, Cooper JA, IAEA DLW Database Consortium§. Daily energy expenditure through the human life course. Science 2021;373(6556):808–812. https://doi.org/10.1126/science.abe5017.
Pope SK, Sowers M, Welch GW, Albrecht G. Functional limitations in women at midlife: the role of health conditions, behavioral and environmental factors. Women’s Health Issues. 2001;11(6):494–502. https://doi.org/10.1016/S1049-3867(01)00089-5.
Article CAS PubMed Google Scholar
Randolph JF, Zheng H, Sowers MR, Crandall C, Crawford S, Gold EB, Vuga M. Change in follicle-stimulating hormone and estradiol across the menopausal transition: effect of age at the final menstrual period. J Clin Endocrinol Metab. 2011;96(3):746–54. https://doi.org/10.1210/jc.2010-1746.
Article CAS PubMed Google Scholar
Richard-Davis G, Wellons M. Racial and ethnic differences in the physiology and clinical symptoms of menopause. Semin Reprod Med. 2013;31(05):380–6. https://doi.org/10.1055/s-0033-1348897.
Article PubMed Google Scholar
Rosa-Caldwell ME, Greene NP. Muscle metabolism and atrophy: let’s talk about sex. Biol Sex Differ. 2019;10(1):43. https://doi.org/10.1186/s13293-019-0257-3.
Article CAS PubMed PubMed Central Google Scholar
Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinol Metab Clin North Am. 2015;44(3):497–515. https://doi.org/10.1016/j.ecl.2015.05.001.
Article PubMed PubMed Central Google Scholar
Santos-Parker JR, Strahler TR, Vorwald VM, Pierce GL, Seals DR. Habitual aerobic exercise does not protect against micro- or macrovascular endothelial dysfunction in healthy estrogen-deficient postmenopausal women. J Appl Physiol. 2017;122(1):11–9. https://doi.org/10.1152/japplphysiol.00732.2016.
Article CAS PubMed Google Scholar
Shieh A, Epeldegui M, Karlamangla AS, Greendale GA. Gut permeability, inflammation, and bone density across the menopause transition. JCI Insight. 2020;5(2):e134092. https://doi.org/10.1172/jci.insight.134092.
Article PubMed PubMed Central Google Scholar
Siervogel RM, Wisemandle W, Maynard LM, Guo SS, Roche AF, Chumlea WC, Towne B. Serial changes in body composition throughout adulthood and their relationships to changes in lipid and lipoprotein levels: the Fels longitudinal study. Arterioscler Thromb Vasc Biol. 1998;18(11):1759–1764. https://doi.org/10.1161/01.atv.18.11.1759.
Siglinsky E, Krueger D, Ward RE, Caserotti P, Strotmeyer ES, Harris TB, Binkley N, Buehring B. Effect of age and sex on jumping mechanography and other measures of muscle mass and function. J Musculoskelet Neuronal Interact. 2015;15(4):301–8.
CAS PubMed PubMed Central Google Scholar
Sowers M, Pope S, Welch G, Sternfeld B, Albrecht G. The association of menopause and physical functioning in women at midlife. J Am Geriatr Soc. 2001;49(11):1485–92. https://doi.org/10.1046/j.1532-5415.2001.4911241.x.
Article CAS PubMed Google Scholar
Stanford JL, Hartge P, Brinton LA, Hoover RN, Brookmeyer R. Factors influencing the age at natural menopause. J Chronic Dis. 1987;40(11):995–1002. https://doi.org/10.1016/0021-9681(87)90113-5.
Article CAS PubMed Google Scholar
Svendsen OL, Hassager C, Christiansen C. Age- and menopause-associated variations in body composition and fat distribution in healthy women as measured by dual-energy X-ray absorptiometry. Metab Clin Exp. 1995; 44(3):369–373. https://doi.org/10.1016/0026-0495(95)90168-x.
Toth MJ, Sites CK, Matthews DE, Casson PR. Ovarian suppression with gonadotropin-releasing hormone agonist reduces whole body protein turnover in women. Am J Physiol-Endocrinol Metabol. 2006;291(3):E483–E490. https://doi.org/10.1152/ajpendo.00600.2005.
Article CAS Google Scholar
Tsalamandris S, Antonopoulos AS, Oikonomou E, Papamikroulis G-A, Vogiatzi G, Papaioannou S, Deftereos S, Tousoulis D. The role of inflammation in diabetes: current concepts and future perspectives. Eur Cardiol. 2019; 14(1):50–59. https://doi.org/10.15420/ecr.2018.33.1.
Van Pelt RE, Gavin KM, Kohrt WM. Regulation of body composition and bioenergetics by estrogens. Endocrinol Metab Clin North Am. 2015;44(3):663–76. https://doi.org/10.1016/j.ecl.2015.05.011.
Article PubMed PubMed Central Google Scholar
Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006;84(3):475–82. https://doi.org/10.1093/ajcn/84.3.475.
Article CAS PubMed Google Scholar
Woods NF, Mitchell ES. Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives. Am J Med. 2005;118(12):14–24. https://doi.org/10.1016/j.amjmed.2005.09.031.
Article PubMed Google Scholar
Zaidi M, Turner CH, Canalis E, Pacifici R, Sun L, Iqbal J, Guo XE, Silverman S, Epstein S, Rosen CJ. Bone loss or lost bone: rationale and recommendations for the diagnosis and treatment of early postmenopausal bone loss. Curr Osteoporos Rep. 2009;7(4):118–26. https://doi.org/10.1007/s11914-009-0021-4.
Article PubMed Google Scholar

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Applied Physiology Laboratory, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
Abbie E. Smith-Ryan & Hannah E. Cabre
Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
Katie R. Hirsch

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Anthony C. Hackney

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Smith-Ryan, A.E., Hirsch, K.R., Cabre, H.E. (2023). Physiology of Menopause. In: Hackney, A.C. (eds) Sex Hormones, Exercise and Women. Springer, Cham. https://doi.org/10.1007/978-3-031-21881-1_15

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