WOMYN'S HEALTH
Review of over 70 years of menopause science highlights research gaps and calls for individualized treatment
IMAGE: CARDINAL SYMPTOMS AND CONSEQUENCES OF MENOPAUSE view more
CREDIT: CELL, DAVIS ET AL.
Although about half of people go through menopause, less than 15% of them receive effective treatment for their symptoms. Treatment options for people experiencing irritating or severe menopause symptoms are often under researched, and some have questionable efficacy, or cause harmful side effects. In a comprehensive review publishing in the journal Cell on September 6, a team of world-renowned menopause experts summarizes what we know about menopause, calls for more research into the timeline and treatment of menopause, and encourages individualized, holistic treatment that addresses both menopausal symptoms and other systemic changes happening in the body.
“The road to menopause is not difficult for all, but for some, symptoms may be severe or even disabling and disruptive to work and family,” write the authors, who are based in Australia, Italy, and the United States. “Recognition that menopause, for most women, is a natural biological event, does not exempt the use of interventions to alleviate symptoms.”
For this review, the researchers looked at over 200 sources across 71 years to synthesize what’s currently known about menopause. The authors note the importance of recognizing that menopause impacts more than just cis women; they elect to use the term “women” in this review to reflect the language and focus of much of the research that currently exists in the field.
Key takeaways from the review include the following:
- The authors propose a new definition for menopause as “final cessation of ovarian function,” an update to the traditional definition, which focused on menstruation. While the new definition doesn’t account for all variability, it seeks to encompass people of all genders, as well as people who have irregular periods, use certain types of contraception like IUDs, have had hysterectomies, and more.
- The timeline of when menopause phases occur isn’t well understood and varies from person to person, so the authors argue that current age restrictions on prescriptions and therapies are illogical and problematic. While symptoms often start during perimenopause, few menopause therapies are currently approved for perimenopausal patients.
- Menopause treatments range from hormone therapies to lasers to plant products, but the authors argue that few have been studied over long enough timespans. They highlight potential side effects and health concerns for each type of treatment and note that even the most effective and well-researched option available presently—hormone therapy targeting estrogen—is still far from a perfect solution for all.
- Symptoms vary widely between people and throughout the course of menopause. Some people get many severe symptoms while others get few to none; but even if someone has no noticeable symptoms, there can still be significant “silent health consequences,” including bone loss and a higher risk of diabetes, cardiovascular diseases, and certain types of cancers. Additionally, the authors highlight that some symptoms, like short-term memory loss, can be temporary, and note that other symptoms, like depression and anxiety, are sometimes pre-existing conditions that have been falsely attributed to menopause due to stigma surrounding it. They also recommend exercising regularly and maintaining a nutritious diet that includes plenty of protein as a way to reduce the likelihood of contracting symptomatic health complications.
- The authors highlight the fact that socio-economic factors such as lower quality of life and the potential negative impact of menopausal symptoms on a woman’s work performance aren't often acknowledged.
“Despite decades of research pertaining to menopause, more work is needed,” write the researchers. Going forward, they call researchers to look deeper into when the menopause process starts and to focus on making menopause treatments more effective and safer overall. They underline the importance of researching the symptoms and other health impacts of menopause outside of high-income countries. Additionally, they suggest studying the impacts of menopause on work both from home and in an office, as well as the impacts on people with less traditional career paths such as caregivers and volunteers.
The team also argues that menopause treatments need to be holistic and tailored to the person being treated—addressing both the physical and mental health impacts of menopause, as well as the underlying health risks associated with menopause and any other relevant health concerns. “Women with bothersome menopausal symptoms should be counseled on treatment options and offered evidence-based therapies,” they write. “Therapy should be individualized depending on age and health risks, recognizing that health risks may increase with age.”
“Optimizing health at menopause is the gateway to healthy aging for women,” write the authors.
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Cell, Davis et al. “Menopause – Biology, Consequences, Supportive Care and Therapeutic Options.” https://www.cell.com/cell/fulltext/S0092-8674(23)00905-4 DOI: 10.1016/j.cell.2023.08.016
Cell (@CellCellPress), the flagship journal of Cell Press, is a bimonthly journal that publishes findings of unusual significance in any area of experimental biology, including but not limited to cell biology, molecular biology, neuroscience, immunology, virology and microbiology, cancer, human genetics, systems biology, signaling, and disease mechanisms and therapeutics. Visit: http://www.cell.com/cell. To receive Cell Press media alerts, contact press@cell.com.
JOURNAL
Cell
METHOD OF RESEARCH
Literature review
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Menopause – Biology, Consequences, Supportive Care and Therapeutic Options
ARTICLE PUBLICATION DATE
6-Sep-2023
MU researcher awarded $2.17 million to study regeneration of endometrial lining of the uterus
Five-year NIH grant will fund study of uterine cell regeneration to increase understanding of endometrial disease and infertility in women
The endometrium of the adult uterus has remarkable regenerative ability. In most women, this complex tissue repairs itself after injury, including from childbirth, achieving full function to support pregnancy again in the future. Now researchers want to learn more about the cells responsible for those repairs.
Andrew Kelleher, PhD, assistant professor in the Department of Obstetrics, Gynecology and Women’s Health at the University of Missouri School of Medicine has been awarded a five-year, $2.17 million grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, an institute of the National Institutes of Health, to study the ability of cells in a women’s uterine endometrial lining to regenerate in a manner similar to stem cells.
“The uterine endometrial lining appears to contain cells that coordinate successful regeneration following injury,” said Kelleher. “An increased understanding of the cellular and molecular mechanisms that govern this regenerative capacity is important not only for gaining fundamental knowledge of tissue and stem cell biology but also for the development of therapeutics for the treatment of endometrial diseases.”
In addition to endometrial diseases, such as endometriosis, endometrial fibroids, Asherman’s syndrome and endometrial cancer, aberrations in regeneration can make pregnancy more difficult or lead to infertility. This research aims to increase our understanding of the mechanisms governing uterine epithelial cell differentiation and regeneration with a long-term goal of improving the ability to diagnose, treat, and prevent endometrial disease and infertility in women.
Kelleher’s research lab is in the Roy Blunt NextGen Precision Health building at the University of Missouri. His team’s grant runs through May 2028.
New Myriad Genetics survey reveals widespread confusion and misconceptions about ovarian cancer screening among a majority of women
Nearly three out of four women falsely believe a pap smear will reveal ovarian cancer presence
Reports and ProceedingsSALT LAKE CITY, Sept. 6, 2023 – Myriad Genetics, Inc. (NASDAQ:MYGN), a leader in genetic testing and precision medicine, today revealed new nationwide survey results indicating widespread confusion and misconceptions about ovarian cancer screening among a majority of women.
The Myriad Genetics Cancer Risk survey shows that nearly three out of four women (71%) falsely believe annual pap smears include testing for ovarian cancer. According to the Centers for Disease Control and Prevention (CDC), the “only gynecologic cancer the Pap test screens for is cervical cancer.”
“Ovarian cancer is one of the deadliest forms of cancer for women due to the lack of screening techniques available and clinically specific symptoms. Many women believe they only need to visit every 3-5 years if they have a normal pap smear result,” said Ifeyinwa Stitt, MD, OB/GYN and medical director, Luminis Health in Annapolis, MD. “If women incorrectly believe having a normal pap equates to a low chance of ovarian cancer and don’t need an annual visit, this eliminates the opportunity for providers to annually screen for early symptoms and identify through abnormal pelvic exams. Knowledge of predisposing factors and surveillance is imperative to early detection which is key to ovarian cancer survival."
While almost half (47%) of the women surveyed believe they are being proactive when it comes to ovarian health, only 38% say they visited an OB-GYN in the past year and 13% say they have taken a genetic test to assess risk for cancer. For those who have not taken a genetic test, many women said they’d be motivated to get a genetic test if they had a high-risk of ovarian cancer based on family medical history (49%) or an immediate family member with ovarian cancer (38%).
Regardless of risk factors, 71% of the women surveyed believe all women should have genetic testing to determine ovarian cancer risk. Two out of three (66%) agree that knowing their risk will allow them to take more appropriate preventative measures and 58% agree knowing their risk will help their doctor more appropriately plan treatment should they get cancer.
“Our latest survey results underscore the dire need to break down any confusion about ovarian cancer, including symptoms and screening, to help women better understand their cancer risk and how to take appropriate preventative measures,” said Melissa Gonzales, president of women’s health, Myriad Genetics. “Listening to your body, having open conversations with your doctor and knowing your family history are essential in this quest. For women with elevated risk factors, genetic testing can be a helpful tool that provides a cancer risk assessment personalized to them.”
For more information about Myriad’s hereditary cancer test and risk assessment, MyRisk® Hereditary Cancer Test with RiskScore®, please visit: https://myriad.com/genetic-tests/myrisk-hereditary-cancer-risk-test/.
About Myriad Genetics Cancer Risk nationwide survey
Myriad Genetics Cancer Risk Survey is a nationwide poll conducted online by ACUPOLL Precision Research, Inc. in from June 20-29, 2023 among a statistically representative sample (n=1632) of U.S. females age 18+. The survey included a representative sample of women at high-risk for breast or ovarian cancer. The margin of error in survey results for the total base population at a 95% confidence interval is +/- 3%.
About MyRisk® Hereditary Cancer Test with RiskScore®
MyRisk with RiskScore evaluates 48 genes associated with hereditary cancer risk to identify genetic changes associated with an increased cancer risk. When combined with family history and other clinical factors, MyRisk with RiskScore provides each patient with a cancer risk assessment individualized to them.
About Myriad Genetics
Myriad Genetics is a leading genetic testing and precision medicine company dedicated to advancing health and well-being for all. Myriad develops and offers genetic tests that help assess the risk of developing disease or disease progression and guide treatment decisions across medical specialties where genetic insights can significantly improve patient care and lower healthcare costs. For more information, visit www.myriad.com.
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