BACKGROUND: Lifestyle changes around the time of menopause have the potential to impact on morbidity and eventual mortality. Here we review this topic to identify how such changes may improve health at perimenopause and beyond. METHODS: Searches were performed in Medline and other databases. Each subject summary was presented to the ESHRE Workshop Group, where omissions or disagreements were resolved by discussion. RESULTS: Body weight increases because the decline in physical activity during the perimenopause is greater than the concomitant decline in energy intake. It is imperative to stop smoking before menopause because the risk of acute myocardial infarction rises sharply thereafter. Cardiovascular events can be reduced by managing risk factors, such as hypertension and increased lipids and body weight. Breast cancer risk is increased to a similar extent by hormone use, decreased physical activity, increased calorie intake and alcohol use, all reflecting lifestyle decisions. Smoking, alcohol and exercise may increase or decrease risk of aging brain disorders, especially dementia and Parkinson's disease, while stress is consistently associated with increased risk and a prudent diet is consistently associated with reduced risk. Osteoarthritis frequency increases after 50 years of age and risk is elevated 3-fold by obesity, while risk of osteoporosis can be minimized by smoking cessation, adequate vitamin D intake and regular weight-bearing exercise. CONCLUSIONS: Lifestyle changes around the time of the perimenopause can reduce the likelihood and severity of heart disease and chronic illness in later years and the cost of care of elderly women.