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Disability-adjusted life years (DALY) is a globally applied measurement based on expected health in an ideal situation. It combines the measurement of years of life lost (YLL) and years of lived disability (YDL) to give a picture of the burden of disease [1]. As a nation's economic resources improve, maternal-neonatal morbidity and infectious disease play a decreasing role and cardiovascular disease, stroke, and diabetes mellitus appear in the top 20 causes of DALY. In both high middle and high income nations, chronic lung disease, mood disorders, and cancers are added to the picture. Only in high income nations does cognitive impairment become a top cause of disability [2]. However, the disease burden is a dynamic situation. Low and low middle income nations are experiencing the most rapid increase in non-communicable disease burden [3].Global risk factors in the leading causes of chronic disease are identified by the World Health Organization. Modifiable risk factors are influenced by social determinants of health and include tobacco use, unhealthy diet, lack of physical activity, and the harmful use of alcohol, which in turn lead to overweight and obesity, elevated blood pressure, increased cholesterol, and, if unmanaged, ultimately target organ disease [3]. The presence of risk factors are not equitably distributed across or within nations, races, and ethnicities. Risk factor amelioration plays an important role in disease prevention both in the individual and the society. However, there is no place for incorporating blame for failed risk factor management in the diagnosing and treating of chronic disease in the individual. The impacts of aging and environmental/behavioral risk interact with the gradual loss of sex steroids in the menopause transition. Although multiple risk factors with variable influence may outweigh the influence of sex steroids, the

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Menopausal symptoms are experienced by 70-85% of women worldwide with geographic and cultural variations (see Chap. 1). Along with myalgia/arthralgia and sleep disruption, VMS are the most commonly experienced symptoms [1, 2] (see Chap. 1). Vasomotor symptoms include a mild feeling of heat, or a moderate to severe feeling of heat with flushing, cold sweats, and night sweats. The sensation may be limited to a consistent body region such as the chest and face or the legs. There is sometimes a detectible prodrome. A woman may first awaken during the night with a feeling of dread or increased heart rate, and a subsequent sensation of hot flush or sweating. Women describe VMS differently and the nature of VMS may vary over the course of the menopause transition [3,4].An interplay of social and genetic variables illustrate the complex influences that result in the lived experience of the individual woman. Among women in North America and Europe, VMS are the most common menopausal experience, while women in Japan report a "chilliness" but have no word for "hot flashes" in the Japanese language [5,6]. Within geographic regions, the experience of VMS is influenced by the interplay of race/ethnicity and socioeconomic factors. In the United States culture, the incidence and severity of clustered VMS, sleep disruption, and psychological distress were correlated with lower educational level and African American race [2]. The reporting of vasomotor and other symptoms within populations also varies over time. The incidence of VMS in a review of five studies from multiple countries within the African continent increased from 39% of women surveyed in 2009 to 77% of women in 2012 [1].