Expanding Menopause Research to Advance the Health of All Women

Posted on May 15th, 2023 by Janine Austin Clayton, M.D., FARVO, NIH Office of Research on Women’s Health

Since 2017, NIH’s Office of Research on Women’s Health (ORWH) has hosted the Vivian W. Pinn Symposium during National Women’s Health Week (NWHW) in May. This event honors the first full-time director of the office, Dr. Vivian W. Pinn, and serves as a critical forum for experts across sectors to communicate and collaborate for the advancement of women’s health.

This week marks the beginning of the 2023 NWHW, and on May 16, ORWH will host the 7th Annual Vivian W. Pinn Symposium. It’s titled: Menopause and Optimizing Midlife Health of Women.

Topics to be discussed include: the menopausal transition (also known as perimenopause), the accumulation of morbidity after menopause, menopause in special populations, the influence of social determinants of health on the experience of menopause, the use of menopausal hormone therapy (MHT), and interventions to promote healthy aging.

This year, JoAnn Manson, Harvard Medical School, Cambridge, MA, will deliver the keynote speech, titled “Menopausal Hormone Therapy: 30 Years of Lessons from the Women’s Health Initiative.” I encourage everyone with an interest in women’s health to register for the event.

In 1992, NIH’s National Heart, Lung, and Blood Institute launched the Women’s Health Initiative (WHI), seeking to improve the health of women through research on prevention of serious health conditions in postmenopausal women. Over three decades later, WHI remains an extraordinary example of centering research around the health needs of women, and WHI research results “definitively established that menopausal hormone therapy should not be used to prevent heart disease, stroke, and other chronic diseases.” These results were practice-changing and led to a dramatic decline in the use of MHT.

Menopause is a natural and irreversible life course stage marked by the cessation of menstrual cycling for 12 consecutive months. Common symptoms associated with menopause include hot flashes, sleep disturbances, mood changes, headaches, and heart palpitations. An article, co-authored by Dr. Manson, summarizes effective hormonal and non-hormonal treatments to manage menopausal symptoms [1].

The WHI’s longer-term follow-up of the treatment of these women, however, has demonstrated many nuanced findings [2]. For example, MHT’s risks and benefits are complex and vary based upon patient-level characteristics, including the age at which the therapy is initiated and the formulation of the MHT prescribed. Importantly, WHI was designed to assess the efficacy of MHT in preventing chronic disease, not to assess the efficacy or safety of MHT when used to treat menopausal symptoms. The average study participant was older, with over a decade since the start of their menopausal transition.

When considering any treatment, people should consult a health care professional, and MHT may be an option for some women, especially those who are experiencing menopausal symptoms and are at low risk for adverse events. The Food and Drug Administration (FDA) offers a fact sheet to answer questions and provide guidance about menopause and hormones, and has evaluated the risks and benefits of MHT for specific age groups of women [3].

In addition to WHI, there are two other valuable NIH-funded studies helping to make progress in our understanding of the health of midlife and older women:

• Study of Women’s Health Across the Nation (SWAN)

• Menopause Strategies: Finding Lasting Answers for Symptoms and Health (MsFLASH)

A major health concern for women during perimenopause, menopause, and post menopause is cardiovascular health. More research is needed to understand how different stages of menopause affect women’s cardiovascular health and how different doses and formulations of MHT may affect risk.

Among the many speakers at the Vivian W. Pinn Symposium will be Wendy Kohrt, a co-author on a recent comprehensive review of cardiovascular health and menopause [4]. She is director of the University of Colorado Specialized Centers of Research Excellence on Sex Differences (SCORE), Aurora. Also, a recent issue of ORWH’s Women’s Health in Focus at NIH discussed current NIH-funded research on menopause, resources, future menopause-related research, and more.

In response to a Congressional request to address NIH efforts related to women’s health research, ORWH hosted, along with the NIH Advisory Committee on Research on Women’s Health, “Advancing NIH Research on the Health of Women: A 2021 Conference.” The importance of menopause research as it relates to chronic debilitating conditions, which pose a significant burden on the health of women, was addressed during the conference, and the full report is available on the ORWH website.

Further, ORWH and partnering institutes released two notices of funding opportunities titled Understanding Chronic Conditions Understudied Among Women (R01 and R21), and ORWH sponsored the forthcoming Framework for the Consideration of Chronic Debilitating Conditions in Women from the National Academies of Sciences, Engineering, and Medicine.

I wish everyone a happy and healthy NWHW and look forward to gathering virtually for the 7th Annual Vivian W. Pinn Symposium. For more information and resources on menopause, visit the FDA’s Office of Women’s Health and NIH’s National Institute on Aging (NIA) websites. Also, My Menoplan, developed by NIA-funded researchers, offers information and personalized tools to help plan for perimenopause and menopause. Please stay connected to ORWH by visiting our website for updates; signing up for our monthly newsletter, The Pulse; liking us on Facebook; and following ORWH on Twitter.

References:

[1] Management of menopausal symptoms: A review. Crandall CJ, et al. JAMA. 2023 February 7: 329(5):405-420.

[2] Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. Manson JE, et al. JAMA. 2013 October 2: 310(13)1353-1368.

[3] Randomized trial evaluation of the benefits and risks of menopausal hormone therapy among women 50-59 years of age. Prentice RL, et al. Am J Epidemiol. 2021 February 1: 190(3):365-375.

[4] Body composition and cardiometabolic health across the menopause transition. Marlatt KL, et al. Obesity. 2022 January; 30(1)14-27.

Links:

Office of Research on Women’s Health (NIH)

7th Annual Vivian W. Pinn Symposium (ORWH)

ORWH Quarterly Publication

Specialized Centers of Research Excellence on Sex Differences (SCORE) (ORWH)

National Women’s Health Week (Office on Women’s Health, U.S. Department of Health and Human Services, Rockville, MD)

Women’s Health Initiative (WHI)

Study of Women’s Health Across the Nation (SWAN)

Menopause Strategies: Finding Lasting Answers for Symptoms and Health (MsFLASH) (Fred Hutchinson Cancer Center, Seattle)

Office of Women’s Health (U.S. Food and Drug Administration, Silver Spring, MD)

Note: Dr. Lawrence Tabak, who performs the duties of the NIH Director, has asked the heads of NIH’s Institutes, Centers, and Offices to contribute occasional guest posts to the blog to highlight some of the interesting science that they support and conduct. This is the 30th in the series of NIH guest posts that will run until a new permanent NIH director is in place.