Timing Matters: What the New Science of Menopause Reveals
By Dawn Patton Mangine
As women live longer, a greater percentage of their lives will be spent in their menopausal years—nearly 40 percent. Menopause and the transition leading up to it, called perimenopause, can cause significant health changes. As estrogen production declines, people experience irregular menses, night sweats and hot flushes, insomnia, brain fog, and weight gain, among other detrimental effects. Once past menopause, which is diagnosed when a woman ceases to have menses for 12 months, more serious health conditions, such as dementia, heart disease, and osteoporosis, can arise.
While menopause is usually the natural result of aging, it can also be the result of certain surgeries, cancer treatments, or drug treatments. The good news is that researchers are discovering new ways to better protect the overall health of people experiencing perimenopause and menopause.
Research, Past and Present
Doctors began treating menopause symptoms in the 1940s with a combination of estrogen and synthetic progesterone (progestin). This changed in 2002, when a report from the Women’s Health Initiative (WHI), a long-term national health study in the United States, showed troubling results. This report indicated that hormone replacement therapy (HRT) had adverse health outcomes, including increased risks for heart attack, breast cancer, dementia, and stroke.
However, further examination of the results provided new insights into HRT, as explained in “The Women’s Health Initiative Randomized Trials and Clinical Practice,” a review published in JAMA. Women from the study who started HRT ten years or later after menopause and those taking combined hormones had the worst outcomes. In contrast, women taking only estrogen showed lowered risk for heart disease and decreased rates of breast cancer.
They also discovered that the timing of what is now called menopausal hormone therapy (MHT) impacted long-term health, with the most effective treatment starting in early menopause or before age 60. They concluded that MHT delivered at the right time protects heart, bone, and brain health.
In addition, the follow-up study indicates more effective treatment depends on the types of hormones and how they are administered. For example, bioidentical hormones in lower doses may further reduce risks, as well as using estradiol transdermal patches or creams instead of oral medications. The effects of post-menopausal treatment with progesterone and testosterone are also being studied.
More research is needed to identify the full extent of the benefits and risks of long-term MHT.
Extending Fertility to Extend Life
Another exciting frontier in women’s healthcare includes attempts to extend the life of ovaries, which are primarily responsible for producing estrogen. Research titled “Short-term rapamycin treatment increases ovarian lifespan in young and middle-aged female mice,” published in Aging Cell, revealed that rapamycin, an oral immunosuppressant drug approved to prevent organ-transplant rejection, slows the aging of ovaries in mice.
Two researchers at Columbia University intend to study the effects of rapamycin on human ovaries, too. Their work is published in the article “The Validating Benefits of Rapamycin for Reproductive Aging Treatment.” As of 2024, Yousin Suh, a professor of reproductive sciences and genetics and development at Columbia, and Zev Williams, an associate professor of women’s health and the chief of reproductive endocrinology and infertility at Columbia University Irving Medical Center, were recruiting for a study they hope will include over one thousand women ages 35 to 45.
Suh says early indications from a small human study suggest the drug can decrease ovary aging by nearly 20 percent, which would extend fertility, delay menopause, and increase lifespan by 9 to 14 percent. She reports that early participants have described improved health, memory, and energy levels.
Scientists are also studying the effects of slicing and freezing pieces of ovaries to preserve ovarian function, as explained in the American Journal of Obstetrics & Gynecology article “Modeling delay of age at natural menopause with planned tissue cryopreservation and autologous transplantation.” Although this method is more invasive, reimplanting frozen ovarian tissue has restored fertility in some patients who have undergone chemotherapy. In theory, freezing ovarian tissue when a woman is younger and reintroducing it years later could extend fertility and stave off menopause.
Embracing the Change
Although menopause is inevitable, by extending fertility or replacing decreasing hormones, one’s latter years can be improved through timely therapeutic interventions. By reassessing past research and undertaking new studies, the hope is that perimenopause and menopause symptoms will be better understood, treated, and prevented and help all women enjoy longer and healthier lives.
Dawn Patton Mangine is a Thermo Fisher Scientific staff writer.
