Menopause: it’s a natural part of aging that affects millions of people each year, and yet there’s still plenty that we don’t know about it. 

It’s widely considered to be understudied and even ignored in the majority of studies investigating the biology of aging. That’s not to say there’s no research on the subject at all, however – so what does the latest science have to say?

What is menopause?

Menopause is often defined as the moment in time when a person’s menstrual periods stop, which happens because the ovaries have stopped releasing eggs and there’s a significant drop in the level of estrogen and progesterone that they produce. It can also occur if someone’s ovaries are removed, or if they are damaged by certain medical conditions or treatments.

It usually happens between the ages of 45 and 55, although it can also affect some people younger than that lower bound, which is early menopause. Once it’s happened, a person is considered postmenopausal – this is considered to be 12 months after the last menstrual period.

Symptoms of menopause – and the build-up to it, known as perimenopause – can include hot flashes, vaginal dryness, changes in mood, brain fog, and lower sex drive. Some of these symptoms might be eased by things like diet, exercise, and maintaining mental wellbeing, but sometimes, more help is required.

In such cases, medical approaches like hormone replacement therapy (HRT) can help alleviate symptoms. However, not everyone can have or wants to have HRT, so some symptoms can be tackled with other medications. The blood pressure medication clonidine, for example, can be prescribed to treat hot flashes.

Menopause research – what’s the latest?

Timing may be in the genes

A recent study published in the journal Nature identified five genes that, in certain variants, appear to have a particularly strong influence on the timing of menopause.

Using data from 106,973 post-menopausal participants in the UK Biobank, researchers found that those with only one working copy of the genes ETAA1, ZNF518A, PNPLA8, and PALB2, menopause occurred between 2 and 5.5 years earlier than average. For those with particular variants in the gene SAMHD1, menopause occurred just over a year later than average.

The team found that these variants were rare, but significant, with an influence on menopause timing five times greater than previously identified common genetic variants. They also discovered that the changes seen in SAMHD1 could be linked to cancer risk, too.

New non-hormonal hot flash drug shows promise

Hot flashes (aka vasomotor symptoms) can be one of the most uncomfortable menopause symptoms for some – and seeing as HRT isn’t always for everyone, researchers have been working on non-hormonal treatments to tackle them. One of these is elinzanetant, which has recently seen success in two phase 3 clinical trials.

In both trials, postmenopausal participants aged 40 to 65 who were experiencing moderate to severe hot flashes first received either 120 mg of elinzanetant or a placebo daily for 12 weeks, followed by 14 weeks of daily elinzanetant for both groups.

The studies found that those receiving elinzanetant had a statistically significant drop in the number and severity of their hot flashes as early as the first week of taking it in one of the trials, and by weeks 4 and 12 in both of them. By week 12, participants also reported having better sleep and overall quality of life.

Heart health could take a nosedive

Menopause also appears to catch females up with males in terms of cardiovascular risk.

In a study of 579 postmenopausal females taking statins to control cholesterol levels, researchers compared scans for coronary artery calcium taken a year apart. They found that this measure of plaque buildup appears to be accelerated in post-menopausal females, compared to males of a similar age and health profile.

The study authors suggest the effect has something to do with the drop in estrogen, which otherwise has a protective effect on heart health.

“After menopause, women have much less estrogen and shift to a more testosterone-heavy profile,” said lead author Dr Ella Ishaaya in a statement. “This affects the way your body stores fat, where it stores fat and the way it processes fat; it even affects the way your blood clots. And all of those [changes] increase your risk for developing heart disease.”

It doesn’t just happen to humans

While menopause is part of the human experience for many, it’s not an exclusively human trait. Adding to a club that includes us and five toothed whale species, a 2023 study revealed that wild chimpanzees can also go through menopause.

Female chimpanzees living in the Ngogo community in Uganda’s Kibale National Park were found to experience menopause around the age of 50. Wild chimpanzees usually don’t live to such an age, but in this particular population, they live for a surprisingly long time.

Exactly why they go through menopause isn’t clear; in whales, it’s been associated with caring for the young, but older chimpanzees aren’t known to be keen grandparents.

We don’t know enough

“Despite decades of research pertaining to menopause, more work is needed.” That’s the conclusion of a 2023 review of the field of menopause research.

Not only do the authors of the review argue for a new definition of menopause – it should be “final cessation of ovarian function” rather than when periods stop, they say – but they also call for a better understanding and recognition of multiple different aspects of menopause, its impacts, and its treatments.

That includes the timing of the three menopause stages, the prevalence of different symptoms, and the impact that they have on not only health but also socioeconomic factors (such as the ability to work or care for others) – particularly in lower-income countries.

In terms of treatment, they suggest that there’s not enough data on the long-term efficacy and safety of many and that, in more general terms, treatments need to be better tailored to the individual.

“Further research, including studies of perimenopausal women, is needed to close knowledge gaps and achieve better care,” the authors conclude.

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The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.