Metabolic syndrome is a lifestyle disorder constellation of interrelated risk factors—including central obesity, insulin resistance, Type 2 DM, dyslipidemia, hypertension, and predilection to cancer especially endometrial cancer. Its prevalence rises during the menopausal transition owing to hormonal changes, altered body fat distribution, and aging. Estrogen deficiency contributes to increased visceral adiposity, adverse lipid profile, and reduced insulin sensitivity, thereby amplifying cardiometabolic risk in postmenopausal women. Early recognition of metabolic syndrome at menopause is crucial, as it offers a window for timely lifestyle modification and pharmacological intervention to reduce long-term morbidity and mortality. This chapter reviews the risk factors, diagnostic criteria, and management strategies of metabolic syndrome in menopausal women, emphasizing the importance of multidisciplinary care and preventive approaches tailored to this vulnerable population.