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Hormonal shifts during perimenopause and menopauseparticularly the drop in estrogen, progesterone, and DHEAcreate a cascade of changes in the body: Slower metabolism (especially after age 40) Increased insulin resistance Visceral fat accumulation (around the belly and midsection) Disrupted sleep and cortisol imbalance Loss of lean muscle mass This isnt just about appearance

However, the use of thiazolidinediones in people is now limited by PPAR-driven adverse effects, including weight gain, oedema and the risk of bone fracture72

doi: 10.26502/aimr.0189

For interruptions of 2 weeks or less at the same dose level, many providers consider it safe to resume at the same dose without re-escalation