MENOPAUSAL TRANSITION AS A CRITICAL STAGE OF REPRODUCTIVE AGING: NEUROENDOCRINE AND CARDIOMETABOLIC IMPLICATIONS

Abstract

The menopausal transition is a critical stage of reproductive aging characterized by declining ovarian function, hormonal fluctuations, and systemic neuroendocrine remodeling. Alterations in central neurotransmitter systems, including serotonergic, noradrenergic, dopaminergic, and KNDy pathways, contribute to vasomotor symptoms, which reflect underlying autonomic and vascular dysregulation. Estrogen deficiency is associated with increased sympathetic activity, activation of the hypothalamic–pituitary– adrenal axis, insulin resistance, dyslipidemia, abdominal obesity, and lowgrade inflammation, leading to elevated cardiometabolic risk. Psychoemotional disturbances and sleep disorders further exacerbate these processes through stress-related mechanisms. The menopausal transition should therefore be considered a systemic condition with potential long-term health implications, while vasomotor symptoms may serve as clinical markers of adverse cardiometabolic changes.