Menopausal transition and metabolic syndrome risk: insights from the Chinese PALM longitudinal cohort

Objective This study aimed to investigate trends of metabolic syndrome (MetS) and its components across the menopausal transition and to identify key metabolic risk factors in Chinese midlife women.Method The longitudinal study included 841 women from the Peking Union Medical College Hospital Aging Longitudinal Cohort of Women in Midlife (PALM cohort, 2005–2024), classified by the Stages of Reproductive Aging Workshop +10 (STRAW +10) criteria. Repeated measures of metabolic indicators, sex hormones and sociodemographic factors were analyzed using generalized estimating equations.Results MetS prevalence rose from 15.0% in the reproductive stage to 43.9% in late postmenopause. All components except reduced high-density lipoprotein cholesterol (HDL-C) increased progressively. After adjustment, perimenopause and postmenopause stages showed higher MetS odds than the reproductive stage (p = 0.008), with the highest observed in the early postmenopause stage (odds ratio = 1.796, 95% confidence interval = 1.224–2.634), primarily driven by central obesity and elevated triglycerides. Age, follicle stimulating hormone (FSH) and estradiol (E2) were independently associated with MetS risk. Lower education and poor self-rated health correlated with higher MetS risk. Vasomotor symptoms were significantly associated with central obesity (p = 0.012) and elevated triglycerides (p < 0.001).Conclusion The menopausal transition is a critical period for metabolic deterioration. Central obesity and elevated triglycerides are key markers. Early identification and targeted intervention are essential during this transition.