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.

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.

Explore findings from the SWAN study in this series of  fact sheets covering bone health, memory and cognition, hot flashes, and more.

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.

• My Menoplan is an online evidence-based tool created by researchers, with funding from NlA, to assist people in learning about menopausal symptoms and treatments and developing personalized plans.
• NIA’s Menopause webpage contains a wealth of information and practical advice for perimenopausal women, such as health information articles in English and Spanish:
  • What Is Menopause? / ¿Qué es la menopausia?
  • Sex and Menopause: Treatment for Symptoms / El sexo y la menopausia: Tratamiento para los síntomas
  • Sleep Problems and Menopause: What Can I Do? / La menopausia y los problemas para dormir: ¿Qué puedo hacer?
  • Hot Flashes: What Can I Do? / Calores súbitos (sofocos): ¿Qué puedo hacer?
• NIA also offers multimedia resources about menopause, including videos and infographics in English and Spanish:
  • Infographic: Staying Healthy During and After Menopause / Cómo mantenerse saludable durante y después de la menopausia
  • Video: Tips To Help Manage Menopause Symptoms / Consejos para ayudar con la menopausia
  • Video: What Is Menopause? / ¿Qué es la menopausia?
  • Video: What Are the Signs and Symptoms of Menopause? / ¿Cuáles son las señales y síntomas de la menopausia?
• NIA’s Research Highlights page explores research on menopause and other aspects of women’s health and aging.  
• Event recording: Women’s Health and Aging Q&A  (May 2023) 

Office of Research on Women’s Health (ORWH)

• Future Directions in Menopause Research: Optimizing Midlife Health of Women Roundtable
• Women’s Health in Focus at NIH quarterly publication: “Research on Menopause”
• 7th Annual Vivian W. Pinn Symposium (May 2023) — “Menopause and Optimizing Midlife Health of Women”
• NIH News in Health: "Managing Menopause"

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)

• Fact sheet: Menopausal Hormone Therapy and Cancer

National Center for Complimentary and Integrative Health (NCCIH)

• 4 Things To Know About Menopausal Symptoms and Complementary Health Practices

National Heart, Lung, and Blood Institute (NHLBI)

• Heart Health and Menopause 
• Listen to Your Heart: Women and Heart Disease

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)

• MedlinePlus - Menopause
• Hormone Replacement Therapy  
• What we know - and still don't know - about menopause | NIH MedlinePlus Magazine
• Menopause: What you need to know | NIH MedlinePlus Magazine

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.
• Sarcopenia and Menopause

Food and Drug Administration (FDA)

• FDA’s Menopause webpage lists general health information on menopause and describes current FDA-approved hormone therapies and nonhormonal medications, as well as nonprescription dietary supplements, herbs, and other natural products. Women considering medication for menopausal symptoms may also find FDA’s fact sheet Menopause & Hormones: Common Questions and downloadable booklet Menopause: Medicines to Help You informative.

U.S. Department of Labor (DOL) - Women's Bureau

• Women, Work, Aging and Financial Security

• Menopause.org is the website of the North American Menopause Society, providing information for professionals and women on menopause and menopause research. 
• The website of the American College of Obstetricians and Gynecologists includes medical information on menopause for physicians and researchers.
• The Endocrine Society’s Menopause webpage also has accurate general information on the menopausal transition. See also Hormones and Aging: An Endocrine Society Scientific Statement.
   

Society for Women's Health Research (SWHR)

• The Menopause Preparedness Toolkit: A Woman’s Empowerment Guide supports women through menopause and prepares them for conversations with friends, family, and physicians.  
• The event “Shedding Light on the Menopause Experience and Demystifying Treatment” showcased a panel of gynecological health experts who discussed the diverse effects of vasomotor symptoms related to menopause.  
• The course “Menopause Mastery: Tailoring Treatment for Every Patient” assists health care providers in better understanding the diverse symptoms, diagnostic approaches, treatment options, and long-term health implications of menopause. 

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. Click here to search "menopause" in the NIH Guide.  

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

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.