Research Square · Oct 22, 2026
Menopause and accelerated decline in the physical component of intrinsic capacity in Chinese women: a longitudinal cohort study
By Yang L, Deng S
Background Women, who live longer, face unique health challenges across the menopausal transition. Intrinsic capacity (IC), the composite of all physical and mental capacities that an individual can draw on, is central to the World Health Organization framework for healthy ageing. Whether the menopausal transition accelerates the decline of the physical component of IC in women has not been examined longitudinally. We estimated the association of menopausal status and years since menopause (YSM) with the rate of change in the physical component of IC, measured with objective performance tests, in a national cohort of Chinese women. Methods Participants were women from the 2011, 2013, and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). The physical component of IC was measured with three performance domains (handgrip strength, gait speed, and balance), standardised within wave and combined into a continuous score by single-factor analysis. Menopausal status and age at menopause were obtained from self-reports, with midpoint imputation for women transitioning between waves. Linear mixed-effects models with random intercepts estimated the interaction of time with menopausal status (Model 1) and with time-varying YSM (Model 2), adjusting for baseline age, education, marital status, smoking, alcohol use, comorbidity, and body mass index (BMI). Results The analytic sample comprised 4,944 women (mean age 58.5 years at baseline), of whom 3,542 were postmenopausal in 2011. Relative to premenopausal women, postmenopausal women experienced an additional decline in the physical IC score of 0.026 standard deviation (SD) per year (time × menopausal status: β = −0.0255; 95% CI − 0.0471 to − 0.0040; P = 0.020). Each additional year since menopause was associated with an extra annual decline of 0.002 SD (time × YSM: β = −0.0020; 95% CI − 0.0028 to − 0.0013; P < 0.001). The estimated annual change in the score ranged from + 0.017 SD at YSM = 0 to − 0.013 SD at YSM = 15. Findings were consistent in random-slope models and were most pronounced among women aged ≥ 60 years. Conclusions In Chinese middle-aged and older women, menopause was associated with a faster decline in the physical component of intrinsic capacity, and the rate of decline increased with time since menopause. Monitoring physical capacity around the menopausal transition may help identify midlife women during the perimenopausal period who would benefit from early targeted interventions to preserve physical capacity, thereby promoting healthy ageing specifically in women.