The BioSynIRS trial: biologic versus synthetic mesh for multicompartment pelvic floor reconstruction.

Female reproductive aging is characterized by a progressive decline in ovarian follicle reserves and circulating estrogen levels, leading to physiological changes that typically begin around age 40 and define the menopausal transition. Menopause—defined as the permanent cessation of menstruation and confirmed after 12 consecutive months of amenorrhea—marks the culmination of this transition. In Western populations, menopause usually occurs around age 51, although its timing can vary due to genetic, socioeconomic, and regional factors. While climacteric symptoms such as vasomotor disorders, sleep disturbances, and mood changes are well recognized, the most concerning long-term consequences of menopause involve metabolic alterations. These include changes in lipid metabolism, increased insulin resistance, central adiposity, and heightened risks of type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease. Estrogen receptors are present in both subcutaneous and visceral adipocytes, and the decline in estrogen levels during the menopausal transition contributes to disrupted lipid regulation and impaired insulin sensitivity. As a result, climacteric women—especially those in postmenopause—experience a higher prevalence of metabolic disturbances, including abdominal obesity, glucose intolerance, and dyslipidemia. The prevalence of type 2 diabetes in this population ranges from 15% to 20%, and cardiovascular disease remains the leading cause of death. Hypertension affects approximately 41% of women after menopause and rises to over 75% in those older than 60 years. Similarly, the incidence of new-onset dyslipidemia during the postmenopausal period can reach up to 78.4%, highlighting the elevated risk of lipid abnormalities in this population. Given that many women now spend up to one-third of their lives in the postmenopausal state, identifying effective and sustainable strategies to mitigate these clinical and metabolic consequences is a significant public health priority.