The science of menopause could change women’s health
The Menopausal Hormone Therapy Story Revisited: How Do Women and Health Care Providers Perceive Menopause?
It happens between 45 and 55 years old. It can happen earlier because of natural causes or as a result of treatment. The experience of menopause can be improved through hormone therapy, which works by replenishing some hormones that are depleted during menopause, particularly oestrogen and progesterone. However, early results in 2002 from an influential study by the Women’s Health Initiative changed how many women and health-care providers perceive hormone therapy (Writing Group for the Women’s Health Initiative Investigators JAMA 288, 321–333; 2002). The results of the study showed that people who had been through menopause had a slightly higher risk of breast cancer, heart attack and stroke. Globally, prescriptions for menopause-related hormone therapy dropped sharply. Numbers struggled to recover even after later studies emphasized the limitations of the original findings. Researchers and clinicians are still playing catch-up in trying to get across the message that, as well as managing menopause symptoms, the long-term benefits of menopausal hormone therapy could outweigh the risks for those for whom hormone therapy is a suitable treatment.
Finally, in May 2024, a review2 gained traction in medical circles and the popular media. The authors of the 2002 paper re-explained that the hormone dosages and route of delivery in the WHI trials were different from what is used today. For example, the therapy was taken only orally in the trials. Today, the use of transdermal patches can reduce concerns about the blood clots that can be associated with oral delivery. The authors note that the shift to hormones that are identical to ones the body makes might further reduce risks. Most of the people in the WHI trials were older than 10 years old, something that researchers say is an important issue. There is research suggesting that the reappearance of oestrogen might cause health problems. In other words, the timing of hormone-therapy initiation might matter.
And beyond managing menopause symptoms, there are long-term benefits that could outweigh any risks. Data since the late 1980s solidly back the use of menopausal hormone therapy to prevent osteoporosis in all age groups. The benefit of oestrogen for break bones was not included in the WHI story. After menopause, she is looking into whether supplemental testosterone could also protect bones.
The equation gets more complicated for heart disease. If the therapy is started early, evidence suggests that it might prevent vascular disease. But, in people with vascular disease, researchers say, the therapy might worsen the condition. There are also emerging hints that well-timed therapy can benefit brain health.
At present, the exact benefits and risks of the therapy remain unclear, says Davis. If you slice and dice and cherry pick the data, I could give you any story you want to hear. She worries that researchers don’t understand the limitations of the big data sets.
When the ovaries fail, Renee Wegrzyn, director of the Advanced Research Projects Agency for Health, says there are a lot of chronic health conditions associated with that. Some scientists believe that the ovaries can be kept working indefinitely.
Replacing hormones might be not enough according to some specialists. The ovaries are responsible for more than making oestrogen, progesterone and eggs. Zev Williams, a reproductive endocrinologist at the Columbia University in New York, said that small organs send chemical signals throughout the body, and that is what drives health benefits.
Wearable sensors, as well as implantable bioelectronic devices, could help to identify the optimal window for starting hormone therapy by tracking hormone levels in real time. Some doctors don’t recommend therapy during perimenopause because of the potential for high combined hormones during natural fluctuations. One day, these devices might even dispense hormones on an as-needed basis.
The Nature of Menopause Research: How Funders Have Been and What They’ve Done To Improve Their Well-Behaved Health
Nature asked the world’s largest health-research funders what they are doing to study a life stage experienced by half of humanity. Here is what some of them told us.
An increasing number of health-care professionals are interested in becoming certified to treat menopause. In the United States between 2022 and 2024, for example, there was a fivefold increase in people applying to take the certification exam of the Menopause Society, a non-profit organization in Pepper Pike, Ohio.
It is important that these initiatives are better known. On the funding side, perhaps one of the more surprising things is that, so far, few funders seem to be following in the NIH’s footsteps.
It’s not easy to set up a separate category of research in order to show that menopause is a priority for funders. It allows researchers to know how much money is available and how to apply for it; and lets them track what has been spent in the past and who received it.
Ovarian implants to prevent diseases associated with menopause are two of the menopause projects being developed by the US Advanced Research Projects Agency for Health.
Researchers have said a study by the Women’s Health Initiative (WHI) in 2002 changed how many women and health care providers perceive hormone therapy. The study had shown a drop in prescriptions for menopause-related hormone therapy globally. Globally, prescriptions formenopausal hormone therapy dropped sharply. Researchers said the timing of hormone-therapy initiation is an important issue.