Bridging the gap: Multi-omic Insights into Exercise Responses in Post-Menopausal Women.

Post-menopausal women represent the fastest-growing demographic at risk of sarcopenia and cardiometabolic disease, yet exercise biology research remains disproportionately derived from male or hormone-replete phenotypes. Menopause constitutes a chronic endocrine perturbation characterized by sustained reductions in estrogen and progesterone and altered androgen balance, superimposed on the acute and chronic perturbations induced by exercise. This hormonal shift modifies substrate metabolism, inflammation, redox balance, and recovery capacity, factors that shape molecular responses to exercise across tissues and time. Here, we synthesize current evidence on exercise responses in post-menopausal females across genomics, epigenomics, transcriptomics, proteomics and metabolomics/lipidomics. Across omics layers, direct data in post-menopausal cohorts remain limited, with frequent under-reporting of menopausal status, hormone therapy exposure, circulating hormone concentrations, medication use, and bio sampling timing relative to exercise and hormone dosing. We outline a menopause-aware framework for exercise-omics that prioritizes endocrine stratification, repeated sampling across exercise and recovery, and integrative multi-omics approaches linking molecular responses to functional outcomes. We also outline minimum reporting standards to improve reproducibility, inclusivity, and translational relevance. Advancing menopause-aware exercise-omics will be essential for developing precision exercise strategies that improve healthspan and functional independence in later life.