INTRODUCTION Menopause represents a critical life transition marked by profound metabolic and hormonal changes that significantly influence women's health. The global prevalence of obesity particularly among women is alarming with the world health organization (WHO), reporting that approximately 13% of global adult population lives with obesity. AIM This narrative review aims to investigate how these hormonal fluctuations contribute to the development and progression of obesity in women aged 45–60. Additionally, it seeks to evaluate the associated metabolic risks and identify effective intervention strategies to reduce the health burden of obesity during this pivotal stage of life. METHODOLOGY The review analysed 24 peer-reviewed articles selected from Google scholar, Pubmed, Science direct, Research gate scientific databases. The included studies comprised longitudinal cohort studies, cross-sectional analyses, and clinical trials that examined hormonal fluctuations, alterations in body composition, and obesity-related health risks in midlife women undergoing menopause. RESULTS The findings indicate that obese women experience distinct hormonal changes during early menopause, characterized by reduced levels of oestradiol and inhibin B, and elevated levels of follicle-stimulating hormone (FSH). These hormonal shifts contribute to unfavourable changes in body composition, such as increased fat mass and decreased fat-free mass, leading to a higher risk of metabolic syndrome, osteoporosis, and other obesity-related conditions. Visceral obesity, worsened by oestrogen decline, is closely associated with chronic inflammation, insulin resistance, and heightened risks of cardiovascular disease, type 2 diabetes, and hormone-sensitive cancers. Certain hormone therapies were found to pose additional risks, including fractures and thromboembolic events, particularly in obese women. Genetic predisposition also plays a significant role in the development and persistence of obesity during menopause, complicating treatment and prevention strategies. CONCLUSION The review underscores the need for comprehensive lifestyle interventions—including balanced nutrition and regular physical activity—as primary strategies to counteract the health risks associated with obesity in menopausal women. It also highlights the importance of personalized treatment approaches and calls for further research to develop effective interventions that promote healthy aging and reduce the burden of obesity-related complications during the menopausal transition. The implication uses for need of personalize treatment approaches specially with health care provider, researchers, and physiotherapist.