Check out this series of videos featuring ORWH Director, Janine Austin Clayton, M.D., FAVRO answering frequently asked questions about menopause.

ORWH is committed to improving the health of women across the life course. As part of this mission, ORWH seeks to identify gaps, create discussions, and stimulate and support research on the health of midlife and older women prior to, throughout, and after the menopausal transition. 

The experience of menopause is, in most cases, a normal and healthy phase of the female life course. Symptoms of menopause vary in severity; some individuals experience mild symptoms, whereas others have debilitating symptoms. Fortunately, treatment options are expanding, many of which have been supported by or informed by NIH-funded research. Still, many important knowledge gaps and research questions remain. 

Over the past several decades, NIH has supported several major research initiatives on menopause, notably the Women’s Health Initiative (WHI) and the Study of Women’s Health Across the Nation (SWAN), which have enriched our understanding of this pivotal life stage. (See NIH Research on Menopause, below.)

Menopause research is central to the mission of ORWH. In 1993, as part of the NIH Revitalization Act, which established ORWH in statute, ORWH was directed to identify projects and multidisciplinary research on women’s health that should be conducted or supported by NIH—and to do so “with respect to the aging process in women, with priority given to menopause.” In alignment with this mandate, ORWH continues to coordinate with other institutes, centers, and offices (ICOs) across NIH to stimulate and track research in this area. Most recently, ORWH dedicated the 2023 Vivian W. Pinn Symposium to the topic of menopause and optimizing the midlife health of women, the materials for which are linked to below.   

"Many women need options to manage the menopausal transition successfully. Doing so will allow them to enhance their health and many aspects of their lives. Everyone gains from the full participation and benefits of the brilliance, energy, and experience of midlife women."—ORWH Director Janine Clayton, M.D., FARVO

Note: This page is not a comprehensive collection of NIH resources, research, and other efforts related to menopause but a selection of important resources compiled to serve as an overview. We encourage you to explore the websites of other ICOs, as well as the websites of other Federal agencies, to learn more. 

Menopause is a natural and irreversible life course stage marked by the cessation of menstrual cycling for 12 consecutive months. As the frequency of menses can become irregular in the months and years preceding menopause, clinical guidelines recommend confirming the start of menopause retroactively after 12 months with no periods.1 Perimenopause, the transitional period leading up to this time, usually begins between ages 45 and 55 and lasts several years. Worldwide, over 27 million women—and other individuals born with a uterus and ovaries—experience menopause each year.2  Common symptoms associated with menopause include hot flashes, sleep disturbances, mood changes, headaches, abnormal uterine bleeding, and heart palpitations. With or without these symptoms, the menopausal transition involves many changes in a woman’s physiology and often her health status. Women should communicate with their health care providers about any symptoms or concerns they may have related to menopause. 

Multiple biological and social factors—including genetics, race, ethnicity, smoking history, stress, diet, exercise, and environment—contribute to the age of onset of menopause (median age = 51). Early menopause sometimes occurs, and some women begin their natural menopausal transition in their 30s. Certain medical interventions—such as surgical removal of the ovaries, pelvic radiation, and exposure to some medications (including many cytotoxic chemotherapy agents)—may also result in early menopause. Chronological age and the menopausal hormonal environment interact in many ways to affect health.

Midlife, which usually coincides with the menopausal transition, often marks the onset of many chronic diseases. During the menopausal transition, a woman’s changing endogenous hormone environment can affect her lipid profiles, weight, body mass index (BMI), and bone density—all of which influence her health status. Women’s risks for heart disease and osteoporosis increase at menopause, and the timing of the onset of the menopausal transition may predict risk for later-life health problems, such as cardiovascular disease and Alzheimer’s disease. As such, menopause constitutes a pivotal moment for delaying, preventing, or ameliorating chronic disease. Increasingly, clinicians and researchers are recognizing that the onset of the transition and progression of menopause—and menstruation in general—represent vital signs akin to blood pressure and body temperature. These vital signs can inform biomedical research and health care for individual women.

Learn More: Women’s Health in Focus at NIH quarterly publication: “Research on Menopause”

References
1 Harlow, S. D., et al. (2012) J. Clin. Endocrinol. Metab. PMID: 22344196
2 Zephyrin, L. C., et al. The Commonwealth Fund. (2020). Transforming Primary Health Care for Women — Part 1: A Framework for Addressing Gaps and Barriers. https://www.commonwealthfund.org/publications/fund-reports/2020/jul/transforming-primary-health-care-women-part-1-framework. Accessed 12-Apr-2022.

Menopause is a normal phase of life. However, the experience is different for everyone. More research is needed to help women and their healthcare providers navigate the menopausal transition and promote well-being through midlife and beyond. The NIH Office of Disease Prevention (ODP) is planning a Pathways to Prevention (P2P) workshop to identify research gaps in this area. ORWH and ODP have partnered with the National Cancer Institute; National Heart, Lung, and Blood Institute; National Institute on Aging; Eunice Kennedy Shriver National Institute of Child Health and Human Development; and National Institute of Mental Health. The workshop is tentatively scheduled to take place in late 2025.

Visit the How the P2P Program Works page to learn more about the workshop planning process and sign up to receive email updates about what's happening at ODP.

Visit our Annual Vivian W. Pinn Symposium webpage for the videocast and materials from the 7th Annual Vivian W. Pinn Symposium, “Menopause and Optimizing Midlife Health of Women.”

Over the past few decades, NIH has developed and supported several major research initiatives—as well as many smaller projects—to improve our understanding of menopause and its impact on the health of midlife and older women, a few examples of which are highlighted below. NIH’s menopause-related studies have illuminated our understanding of this important life stage and improved women’s health care. To learn more about specific recent NIH-funded research in this area, refer to the biennial Report of the Advisory Committee on Research on Women’s Health: Office of Research on Women’s Health and NIH Support for Research on Women’s Health.

As menopause intersects with many aspects of human health, many ICOs contribute to this research area, including the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Aging (NIA), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), among others. It is also important to note that not all NIH research that informs our understanding of menopause is specifically labeled as such; NIH funds a tremendous amount of basic research that also generates insights in this area. For example, although studies on bone health and musculoskeletal disorders may not be specifically categorized as menopause research, this research can inform our understanding of changes that occur in bone density throughout the menopausal transition.

The Women’s Health Initiative

In 1991, NHLBI launched the Women’s Health Initiative (WHI), one of the largest women’s health projects in history. This long-term national health study aimed to improve the health of postmenopausal women of all races and socioeconomic backgrounds and enrolled over 161,000 participants at 40 clinical centers across the country. The WHI’s primary goals included preventing heart disease, breast and colorectal cancers, osteoporosis, and other diseases common among postmenopausal women.

Overall, the WHI improved our knowledge base on the health of older women and dramatically reduced the incidence of breast cancer and cardiovascular disease among postmenopausal women. The scientific information gained from the hormone trials alone has helped save the United States an estimated $35.2 billion in direct medical costs.1 Although data collection for the original WHI study concluded in 2005, multiple extension and secondary studies followed and continue to this day, including the Objective Physical Activity and Cardiovascular Health in Older Women (OPACH) study, the WHI Strong and Healthy (WHISH) study, and the WHI Sleep Hypoxia Effects on Resilience (WHISPER) study.

The Study of Women’s Health Across the Nation

The NIH-sponsored Study of Women’s Health Across the Nation (SWAN) began in 1994 as a longitudinal epidemiological study of women’s health through their middle years. This ongoing study involves multiple U.S. research centers and a cohort of over 3,300 premenopausal women who were ages 42–52 when first enrolled and who participate in annual follow-ups with SWAN researchers. SWAN examines the physical, biological, psychological, and social changes occurring throughout midlife, with particular emphasis on the menopausal transition. The study takes a multidomain approach to track participants’ mental, cardiometabolic, and musculoskeletal health; physical and cognitive function; sleep quality; and overall well-being.

SWAN researchers have discovered (and continue to discover) important insights for women’s health. For example, researchers found that cardiovascular health is more strongly associated with menopause and reproductive aging than with chronological aging.2  Chronological aging, however, has a greater effect on changes in blood pressure and BMI.3 Ongoing SWAN research continues to explore unanswered and new research questions, such as understanding the midlife onset of chronic diseases and investigating the effects of the COVID-19 pandemic on the health and functioning of study participants.

MsFLASH and MsBRAIN

Two NIA-funded studies—the Menopause Strategies: Finding Lasting Answers for Symptoms and Health Trials (MsFLASH) and Menopausal Vasomotor Symptoms and Brain Aging in Women (MsBRAIN)— explore, respectively, treatment of the physical symptoms of menopause and the transition’s effects on brain health. In 2008, six MsFLASH academic research centers began examining current and new treatments for menopausal symptoms. MsFLASH researchers have conducted five clinical trials with women ages 40–70 and tested interventions such as antidepressants, yoga, exercise, omega-3 supplements, and telephone-based cognitive behavioral therapy, with some study participants experiencing beneficial effects.4 

NIA’s ongoing MsBRAIN study explores how menopausal symptoms affect short- and long-term brain health and how menopause and chronological aging have different effects on the brain. MsBRAIN researchers consider how some menopausal symptoms, such as hot flashes and sleep problems, are connected to the nervous system and how menopause can be considered a neurological, as well as a physiological, transition. 

Studies on Bilateral Oophorectomy at the Mayo Clinic SCORE

ORWH’s Specialized Centers of Research Excellence on Sex Differences (SCORE) program’s Mayo Clinic site—directed by Michelle M. Mielke, Ph.D., and Kejal Kantarci, M.D.—researches the effects of early menopause brought on by bilateral oophorectomy (i.e., the surgical removal of both ovaries), which is usually done to treat or prevent ovarian cancer or a benign condition. Studying younger women who undergo premenopausal bilateral oophorectomy affords researchers new insights into the distinction between chronological and reproductive aging. Research from the Mayo Clinic suggests that premenopausal bilateral oophorectomy is associated with increased risks of several diseases and conditions, as well as mortality and multimorbidity.5   

Learn More: Women’s Health in Focus at NIH quarterly publication: “Research on Menopause”

Want to be a part of these potential discoveries? Find an active NIH clinical trial by going to ClinicalTrials.gov. 

References
1 NHLBI. (n.d.). Women’s Health Initiative. https://www.nhlbi.nih.gov/science/womens-health-initiative-whi Accessed 12-Apr-2022.
2 El Khoudary, S. R., et al. (2021). Menopause. PMID: 34636354.
3 Matthews, K. A., et al. (2001). Int J. Obes. Relat. Metab. Disord. PMID: 11439301.
4 McCurry, S.M., et al. (2016). JAMA Intern. Med. PMID: 27213646.
Fred Hutchinson Cancer Center. (n.d.). Menopause Strategies: Finding Lasting Answers for Symptoms and Health Trials. https://www.fredhutch.org/en/research/divisions/public-health-sciences-division/research/cancer-prevention/msflash.html Accessed 19-Apr-2022.
5 Rocca, W. A., et al. (2021). Climacteric. PMID: 33719814.
Office of Research on Women’s Health (ORWH)
Study of Women’s Health Across the Nation (SWAN) fact sheets
  • These fact sheets list the major findings from SWAN on bone health; memory and cognition; hot flashes; sleep; depression; and urinary incontinence, sexual functioning, and vaginal health.
National Cancer Institute (NCI)
National Center for Complimentary and Integrative Health (NCCIH)
National Heart, Lung, and Blood Institute (NHLBI)
National Institute on Aging (NIA)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
  • NICHD’s Menopause webpage provides general information on the menopausal transition and describes several in-progress research efforts. 
National Library of Medicine (NLM)
U.S. Department of Health and Human Services (HHS) Office on Women’s Health (OWH)
  • For accurate general information on the menopausal transition, see OWH’s Menopause webpage.
Food and Drug Administration (FDA)
U.S. Department of Labor (DOL) - Women's Bureau

Refer to ORWH’s Funding Opportunities and Notices webpage to view ORWH-supported funding opportunities.

Refer to the NIH Guide for Grants and Contracts to search for recent funding opportunities related to menopause or associated topics. 

Please see Grants.gov to search for grants across Federal agencies.