INTRODUCTION
Menopause is a physiological stage in a woman's life characterized by the permanent cessation of ovarian follicular activity and a consequent decline in circulating estrogen levels. This transition reflects a complex neuroendocrine remodeling of the hypothalamic-pituitary-ovarian (HPO) axis and results in systemic changes that extend far beyond reproductive function. Estrogen deficiency affects multiple organ systems, including the cardiovascular, metabolic, skeletal, genitourinary, immune, and integumentary systems, contributing to a broad range of clinical manifestations that may significantly influence both overall health and quality of life.1–3
Neuroendocrine and Hormonal Changes
The menopausal transition is characterized by a progressive decline in ovarian reserve, reflected by decreasing anti-Müllerian hormone (AMH) and inhibin B concentrations. The resulting reduction in negative feedback to the hypothalamus and pituitary gland leads to increased secretion of gonadotropins, particularly follicle-stimulating hormone (FSH), often exceeding 25–30 IU/L, and increased luteinizing hormone (LH) levels.4
Estradiol (E2), the predominant biologically active estrogen during the reproductive years, declines substantially throughout the menopausal transition and frequently reaches serum concentrations below 20 pg/mL after menopause. Estrone (E1), produced primarily through peripheral aromatization of
Neuroendocrine and Hormonal Changes
The menopausal transition is characterized by a progressive decline in ovarian reserve, reflected by decreasing anti-Müllerian hormone (AMH) and inhibin B concentrations. The resulting reduction in negative feedback to the hypothalamus and pituitary gland leads to increased secretion of gonadotropins, particularly follicle-stimulating hormone (FSH), often exceeding 25–30 IU/L, and increased luteinizing hormone (LH) levels.4
Estradiol (E2), the predominant biologically active estrogen during the reproductive years, declines substantially throughout the menopausal transition and frequently reaches serum concentrations below 20 pg/mL after menopause. Estrone (E1), produced primarily through peripheral aromatization of
