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Midlife women with the metabolic syndrome (MS) are at a higher risk of experiencing a broad array of symptoms. Recently, Min et al. [1] published a scoping review aimed at identifying the prevalence, types, and clustering of symptoms in climacteric women comparing those with or without the MS. The authors performed a three-step search method according to Joanna Briggs Institute methodology. Eligibility criteria of the participants, concept, context, and types of evidence were selected in accordance to review questions. Seven databases were searched using search terms with no language or date restrictions. Two independent investigators performed title and abstract screening, full-text reviewing, data charting, and data synthesis. Finally, a total of eight studies were reviewed and analysed which reported the prevalence and types of symptoms individually or grouped based on each body system. It was found that climacteric women with the MS experience a wide prevalence of individual and grouped urogenital, vasomotor, psychological, sleep, and somatic symptoms. Mental exhaustion had the highest prevalence (84.4%) among the individual symptoms, while urogenital symptoms had the highest prevalence (81.3%) among the grouped symptoms. There were mixed findings on symptoms between those women with or without the MS. None of the analysed studies focused on symptom clusters. The authors finally conclude that their findings may serve as a knowledge basis for the understanding of symptoms experienced by climacteric women with the MS, which can assist clinicians to effectively assess and manage their symptoms in clinical settings and inform future development of targeted symptom management interventions.


The climacteric has been defined as the menopausal transition when menstrual irregularities and ovarian hormonal fluctuations, especially estrogen, start occurring some time before the menopause, the final menstrual after 12 months of amenorrhea [2]. During this phase the risk of the MS and related factors increases and have been studied in detail [3]. But what has not been widely studied are the symptoms of climacteric women with the MS and how they perceive the menopause and other mid-life health related issues [4]. The MS increases mortality due to a higher risk of coronary artery disease and is a big public health expenditure problem along with quality of life (QoL) issues for the increasing word-wide population of mid-life women. In an extension of SWAN study [5] Reeves et al. concluded that having multiple concurrent moderate to high intensity physical and psychological symptoms in midlife were associated with early onset of diabetes and the MS. Monitoring and subsequent intervention during mid-life on a broad range of symptoms may significantly alleviate cardiometabolic risk during midlife in order to improve QoL and have a healthy aging.

The authors of the commented review [1] have brought about a hypothesis to answer if there are differences in the prevalence of symptoms and the types in climacteric women with or without the MS or is there are cluster of symptoms. Authors just found eight studies which could be included and conflicting results were found in these studies. Grouped urogenital and sexuality issues had a statistical significant. Sleep disturbances and psychological issues also had important occurrence but pain symptoms were not statistically significant. Others have also found conflicting results [6-8]. For instance, Lee et al. [7] found statistical differences in Menopause Rating Scale (MRS) scores, with higher sub-domain somatic symptoms like hot flashes and sweating in relation to high triglyceride levels and more MS components. Contrary to this, Sayan et al. [8] did not find any correlation between severe vasomotor symptoms and the MS. The question is why these differences in outcomes? This could be due to the fact that different studies have used different symptom evaluating tools, such as the Female Sexual Function Index, the MRS, the Cervantes Scale, the Female Sexual Distress Scale; although all validated ones some assess different questions. Also, these studies have been conducted in different populations, some communities might underreport their symptoms. For instance, while Hispanic women do not want to discuss mental health issues, Asian women do not want to report hot flushes as they think it is part of aging and do not need treatment. For this reason, there is a need for more studies in all populations in which the same validated tools is used in order to compare climacteric symptoms in women with and without the MS.

Time to menopause is also important, as in SWAN study some symptoms were of short duration and transitory while others were long lasting. There is a need to include in future studies peri- and postmenopausal women. Identification of these symptoms whether grouped as single or in clusters would help in early identification and preventive strategies to be implemented. Patient treatments would also differ whether they already have the MS and whether menopause hormone therapy can be instituted or not.

Different reviewing methods can be used to assess scare evidence of a primary research in a new topic. The commented scoping review [1] used the three-step search method according to Joanna Briggs Institute methodology. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature [9].

In conclusion, future robust studies are needed to answer these queries and further review and analysis of these is required to institute proper preventive, awareness and treatment strategies for the healthy aging of the growing mid-life female population.

Prof. (Hony) Maninder Ahuja
Director Ahuja Health Services, Faridabad (Haryana) India
Editor in Chief of the Journal of Mid-Life Health


  1. Min SH, Yang Q, Min SW, et al. Are there differences in symptoms experienced by midlife climacteric women with and without metabolic syndrome? A scoping review. Womens Health (Lond). 2022;18:17455057221083817. doi: 10.1177/17455057221083817.
  2. Hill K. The demography of menopause. Maturitas. 1996 Mar;23(2):113-27.
  3. Mehndiratta N, Sharma S, Sharma RK, Grover S. A Prospective Study on the Incidence of Metabolic Syndrome in Premenopausal and Postmenopausal Women. J Midlife Health. 2020;11(1):17-21.
  4. Hoga L, Rodolpho J, Gonçalves B, Quirino B. Women’s experience of menopause: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep. 2015;13(8):250-337.
  5. Reeves AN, Elliott MR, Brooks MM, et al. Symptom clusters predict risk of metabolic-syndrome and diabetes in midlife: the Study of Women’s Health Across the Nation. Ann Epidemiol. 2021;58:48-55.
  6. Min SH, Docherty SL, Im EO, Yang Q. Identification of Symptom Clusters Among Midlife Menopausal Women with Metabolic Syndrome. West J Nurs Res. 2021;1939459211018824.
  7. Lee SW, Jo HH, Kim MR, Kwon DJ, You YO, Kim JH. Association between menopausal symptoms and metabolic syndrome in postmenopausal women. Arch Gynecol Obstet. 2012;285(2):541-8.
  8. Sayan S, Pekin T, Yıldızhan B. Relationship between vasomotor symptoms and metabolic syndrome in postmenopausal women. J Int Med Res. 2018;46(10):4157-4166.
  9. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141-6.


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