A narrative review of energy expenditure and substrate oxidation during menopause

The menopausal transition is characterized by numerous physiological changes associated with the hormonal modifications that occur during this period, such as increased body weight and visceral body fat, reduced energy expenditure and fat oxidation rates, and increased risk of cardiometabolic disorders. While the influence of ovarian hormones on the regulation of energy balance has been widely investigated, the effects of the menopausal transition, also called perimenopause, on the different compartments of energy expenditure (i.e. resting, sleeping, thermic effect of food and physical activity energy expenditure) are less described. Furthermore, substrate metabolism adaptations to the menopausal transition are also poorly described despite their significant influence on health. To address this knowledge gap, this narrative review considers the energetic adaptations of the resting and non-resting components during the menopausal transition, as well as central and peripheral estrogen-associated cellular mechanisms that may play a role. Although research on energetic adaptations during the menopausal transition remains limited, current evidence indicates declines in resting and sleeping energy expenditure and fat oxidation, as well as physical activity energy expenditure and peak fat oxidation. These alterations appear to result from central and peripheral adaptations triggered by the menopausal decline in estrogen and the concomitant rise in follicle stimulating hormone (FSH).