Obesity is a common problem and its health consequences depend on the phenotype of obesity. Clinical aspects of three phenotypes of obesity: upper body (visceral), lower body (healthy) and metabolic obesity with normal weight are discussed. The PolSenior study and other data show that the incidence of obesity increases during hormonal climacteric transformation with special emphasis on visceral (72%) and metabolic obesity with normal weight (16%). The etiology of menopausal obesity and fat redistribution with an increase incidence of menopausal metabolic syndrome is presented. The role of sex hormones and SHBG of fat mass and fat distribution in postmenopausal women is discussed on the basis of PolSenior study. The diagnostic-therapeutic algorithm for climacteric women is recommended according to cardiovascular diseases risk (CVD), elevated waist circumference, serum triglicerides, decreased HDL cholesterol, elevated fasting glucose, HOMA over 1.69 and BP over 130/80 mmHg. In women with CVD risk factors the metformin therapy is a golden standard.