Mechanisms of frailty in postmenopausal women and the role of menopausal hormone therapy

Frailty is an age-related geriatric syndrome characterized by multisystem functional decline, which increases vulnerability to external stressors and raises the risk of adverse health outcomes. Epidemiological studies indicate a higher prevalence of frailty in women than in men, significantly influenced by the abrupt decline in estrogen levels after menopause, leading to deterioration in skeletal, muscular, metabolic, and immune functions. As an approach to postmenopausal management, menopausal hormone therapy (MHT) remains to have a debated impact on frailty risk. Studies show that MHT has demonstrated clear benefits on frailty-related physiological indicators; however, its overall efficacy in frailty prevention requires further validation through high-quality studies. This review summarizes current evidence linking menopause and frailty, with a focus on the role and limitations of MHT. Future research should focus on personalized treatment strategies, effects of combined intervention, and the role of psychosocial factors in frailty management.