Science Friday - Where Are We On The Science Of Menopause?

Episode Date: July 28, 2025

Menopause is having a moment. Celebrities like Halle Berry, Naomi Watts, and Michelle Obama have recently shared their personal menopause experiences. Menopause and perimenopause are showing up across social media and even in popular books. All this to say, menopause has finally gone mainstream. But, it wasn’t until about three decades ago that menopause research really kicked into gear. Since then, scientists have made a lot of progress in understanding the basic biological process as well as treatments like hormone therapy and the importance of separating symptoms of menopause from those of aging. Host Flora Lichtman talks with two menopause researchers, ob-gyn Monica Christmas and epidemiologist Carrie Karvonen-Gutierrez, about what we’ve learned so far—and what misconceptions bug them most.Guests: Dr. Monica Christmas is an associate professor of obstetrics and gynecology at the University of Chicago and director of the menopause program at UChicago Medicine.Dr. Carrie Karvonen-Gutierrez is an associate professor of epidemiology and the director of the Center for Midlife Science at the University of Michigan.Transcripts for each episode are available within 1-3 days at sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Hey, this is Flora Lickman, and you're listening to Science Friday. Today in the show, what do we know about the science of menopause? It always makes the hair stand up on the back of my neck when I hear, we don't know anything about menopause. There's no research. That's absolutely not true. Menopause is kind of having a moment. Everybody, we are here with the one and only Hallie Berry, and we have one big thing in common. we are both in peri menopause. Actress Naomi Watts was among the first to speak openly about menopause.

I had never heard that heart palpitations was a symptom of menopause. I wanted to do this because when I was going through it, there was nothing. There was nobody. I felt literally like I was going to die. Besides the celebrity testimonials in Oprah special, there have been a bunch of books that make menopause or perimenopause a plotline. All this to say, menopause at last has gone mainstream. But it wasn't until about three decades ago that menopause research really kicked into gear. And since then, we've made big progress in understanding this basic biological process

that affects half of the population. But there are still many more questions to be answered. Here to help sort through the science of menopause are my guests, Dr. Monica Christmas, Associate Professor of Obstetrics and Gynaecology at the University of Chicago, and Director of the Menopause Program at UChicago Medicine, and Dr. Kerry Carvinan Gutierrez, Associate Professor of Epidemiology, and the Director of the Center for Midlife Science at the University of Michigan based in Ann Arbor. Welcome to you both to Science Friday.

I'm excited to be here. Thanks for having us. Carrie, let's start with some basics. What is physiologically causing menopause? Yeah, that's a really good question. So menopause itself happens because the hormones that control our menstrual cycle in our body, which are mainly estrogen and progesterone, are produced in much smaller amounts in the ovaries as women age. What happens is that these hormones don't stop all at once, which is why we see the menopause as a transition rather than as an immediate event. And,

what we see with menopause and many of the symptoms is due to estrogen dropping because it affects many parts of the body, not just the reproductive system. And so when its levels go down, it can lead to a variety of different symptoms that are our hallmark, like hot flashes, night sweats, and so forth. And we define menopause clinically and for research purposes as the point 12 months after a woman has her final menstrual period. And that marks the end of her reproductive. of years. So is the menopausal transition the same as perimenopause? The perimenopause transition is when you start having those menstrual cycle changes up to the last menstrual period. And perimenopause also includes the menopause transition plus that one year before, you know, the menopause actually

is defined. So you don't know that you've completed menopause until like 12, months after you've completed it. Does that sound right? It's true. It is retrospective, but it's important to say that there's not one menopause syndrome that every single person gets. There are people that get very few symptoms, if any at all, that are short-lived. And then there's people at the other end of the spectrum, too. And I think that's where things get confusing. Well, how do you figure out whether what you're experiencing is normal or not? From a clinical's perspective, you know, I don't get to choose what's really bothersome to people. The hard part about this discussion is that, and what's most confusing to clinicians as well as

is the people experiencing the menopause transition, is that this timeframe also coincides at a point where we are aging. And it's often difficult to truly disentangle what's truly due to menopause versus what is due to the chronological aging process. However, that menopause transition where our hormone levels are fluctuating, and it's not often the absence of estrogen, but it's that fluctuations, because sometimes before those ovaries kind of conch out, they start malfunctioning a little bit. Sometimes they're creating more estrogen than is really needed, and then sometimes they're concluding less. And it's often that fluctuation,

especially for things like mood swings or anxiety that are triggering those type of simple. And the good news is it doesn't last forever. Carrie? So one of the studies that has done a tremendous amount of work in understanding and disentangling these two ideas of reproductive aging versus chronological aging is the study of women's health across the nation or affectionately called Swan. That study has been going on for nearly 30 years now and has followed a cohort of over 3,000 women from their premenopausal life stage into their mid-70s now. And so we can analyze our data

in a way that will help us disentangle which changes or which types of symptoms a woman might be experiencing that are, in fact, due to that menopausal transition versus those that are due to aging as a process overall. And it's also a diverse group of individuals, which is really exciting too. It's racially and ethnically diverse. So that data is such a meaningful contribution to midlife women's health and understanding it. Well, do people of different demographics experience menopause differently? Are there correlations or trends there? We do have data from Swan, and we do see that there are notable differences in menopause experiences, particularly between black and white women. In particular, we find, we find

that black women on average tend to reach menopause at a slightly younger age compared to white women, and they have a more symptomatic experience. They report experiencing hot flashes and night sweats with greater prevalence. They have longer durations of those symptoms and often with greater severity. Why? That's a good question. Yeah, I don't know that we can answer that one, but they're definitely not just for black women, but things are multifactorial. And there are lots of things that play into it. Swann looked at just cohort from the United States. But if we look at data that's international too, depending on where you live, what your social cultural influences are, what your underlying mental and physical health is, all play a role in how you experience

the menopause transition. You know, one of the things that came with Swan. too. I actually used their data for some of this to publish a paper was that the uptake of treatment was different too, meaning in our swan cohort that more white women were open or receptive to taking hormone therapy, whereas the other racial ethnic groups preferred more complementary or integrative modalities for managing their symptoms as well. What is the treatment for menopause? It depends on what we're treating. And more recently in the media, almost hormone therapy has become synonymous with menopause. Now I feel like there's this demand for hormone therapy, like it's the antidote to aging or the cure-all for everything, which it is not, spoiler alert.

What does it help? Well, we know that hormone therapy helps minimize hot flashes and night sweats. It's one of the most effective treatment options for managing those symptoms. But, you know, again, how we manage things really depends on what the person's symptomatology is. And that perimenopause time frame, often the first symptom is changes to the menstrual cycle. And, you know, and they can be varied. Some people, they get shorter, they get lighter, they space out, and then they just politely go away. Other people may notice that their menstrual cycles are getting heavier.

Often the mood swings are the most common during that perimenopause transition. too. And so if we think the mood swings are truly just due to these hormonal fluctuations, hormonal birth control can actually help to stabilize hormone levels so that mood is better too. But that's not a first-line treatment for mood disorder. So they might need a mood stabilizer like an antidepressant. Carrie, are there long-term risks of hormone therapy? The early 2000s were hallmarked by the finding from the Women's Health Initiative or the WHO that I think scared a lot of individuals, a lot of women, a lot of clinicians, given that the finding was that the usage of hormone therapy was associated with an increased risk of breast cancer and an increased risk of

cardiovascular disease in some women, including blood clot stroke and heart attack. Understandably, those findings led to a lot of concern. We saw in our data from Swan that there were dramatic changes in usage patterns. And there's been an ongoing debate continuing in the field about when, for who and how long hormone therapy should be used? So it gets really complicated. But there is a finite, there's a window of opportunity, I'll say, or this timing hypothesis that we call it in medicine, when the benefit of hormone therapy seems to outweigh the risk.

Now, we can never say that there's zero risk, but in younger individuals, meaning under the age of 60, or within 10 years of the onset of menopause, however, in individuals over the age of 60 or more than 10 years from the onset in menopause, that risk benefit profile starts to shift a little bit, where we start to see more risk associated with long-term hormone therapy use. And those risks are actually increased in cognitive decline, increased in cardiovascular risk, stroke, blood clots like pulmonary embolism or deep vein thrombosis, increased in gallbladder disease, and an increased risk in breast cancer, especially with estrogen and a progesterone, So it's not just an easy answer. Do different experiences of menopause correlate with or cause

different long-term health outcomes? Yes, we do see that. From the data in SMAWN, this is, I think, one of the most pressing research questions that we have now about the menopausal transition and understanding what the experience of menopause is and how it relates to one's long-term health. We certainly know that individuals who go through a very early menopause before age of 40, 42, have earlier incidents of some major health care outcomes, including cardiovascular disease and osteoporosis. But we do need to understand better how those changes in physiologic health outcomes across the board, including brain health, cardiovascular health, metabolic health that do occur during the menopausal, transition, whether or not those are persistent and associated with long-term health outcomes for

major age-related diseases. And those changes that we might be looking at during the menopause include things like the timing of the menopausal transition, how quickly one goes through the menopausal transition, and how symptomatic their transition is. After the break, why the way we talk about menopause matters. It's not always a negative experience. But if we portray it that way, then, you know, our minds are very powerful. If we tell people that this is horrible, they believe it. Don't go away. You know, I know that we're learning a ton more every day, thanks to you two.

And at the same time, I also know that medical research has historically sidelined women, ignored women. And I wonder how you think that has affected our knowledge of this process that affects half the population. You know, absolutely, and it does impact things. One of the benefits to menopause having its moment right now, as you said, is that it is shedding more light. And hopefully with shedding more light, it sheds more money because that's how we promote and have more research findings. Yeah, I want to go back to something that Monica said that I think is really important. It's not that we have a wax. of understanding of menopause. But I think the work to do now is to really turn this time, this menopause is a movement, into action. And this also leads into policy. There's now more

than a dozen states in the country that have legislation being considered related to menopause, whether it's increasing training for health care providers in menopause science, whether it's workplace accommodations or something of the sort. I, I, I, I, love allowing for workplace accommodations that support women that are going through this time frame that are not penalizing because just because, and I'm in this age group myself, just because we're menopausal does not mean that we're not productive contributors to the fields that we are in. And so I definitely don't want to get to a point where we have created for a natural condition that happens to 50% of the population that we are over-medicalizing.

it to and then penalize in women. I think that when we think about, you know, menopause support, it's both ways. How do we create a medical system, not just the physician part of it, that we accommodate coverage for the visit itself as the support, mental health service support, as well as drug support. So that's my two sense. Before we go, what is the biggest piece of misinformation you deal with around menopause or perimenopause? always makes the hairs stand up on the back of my neck when I hear, we don't know anything about menopause, there's no research. That's absolutely not true. Now, with all things in medicine, we are constantly looking for new innovative treatments or understanding novel ways to manage things.

And that's just the beauty of science, which both why Carrie and I are in this field probably because it's ever changing. But we build on the heels of all of the research and information that we've had that's come before. Carrie, do you have a hill? I do have a hill. I think one of the most common myths related to menopause is that it's always a negative experience. I think we talk a lot about the symptoms and it does. It brings challenges. Many people find it to be bothersome in many ways. But I think the reality is that many people often find freedom and new possibilities and improvements in some health conditions as they transition through the menopause. It's freedom from periods and menstrual symptoms. It is bringing relief, perhaps,

from certain health conditions like fibroids or PMS or endometriosis. It's often an opportunity for a health reset. The menopausal transition will often be a time period when women take restock of their health and make positive changes. And we often do see that with the greater focus on relationships, children might be leaving the home. It's an opportunity for a new chapter. And with that is sometimes seen as a time of renewal. We actually do see that some mental health metrics tend to improve as one goes beyond the menopausal transition. And so it's an opportunity for women to really take care of themselves and foster their health in a way that will improve their life and their well-being for the decades to come.

Carrie, that's so important. And in many cultures, this is a time frame where women are, you know, held to a different even level of esteem. You've reached this age and this wisdom period. It's really respected. Unfortunately, I think in our country, though, that, you know, aging women are often stigmatized in a negative way. and that fuels this more negative conception or connotation of menopause.

So I'm so glad you said that because it's very true. It's not always a negative experience. But if we portray it that way, then, you know, our minds are very powerful. If we tell people that this is horrible, they believe it. I get lots of patients now in their 30s asking me what they can do to prevent menopause. And I often look and say, die. And I don't think we want. Okay.

Well, I think that's the perfect place to leave it. Thank you both so much for being with me today and for this thoughtful conversation. Thanks for focusing on menopause. I think it's an important topic and glad to have been here. This has been wonderful. I'm honored to have been asked and thank you. Dr. Monica Christmas, Associate Professor of Obstetrics and Gynaecology at the University of Chicago and Director of the Menopause Program at UChicago Medicine.

and Dr. Carrie Carvinan Gutierrez, Associate Professor of Epidemiology and the Director of the Center for Midlife Science at the University of Michigan based in Ann Arbor. If you like the show, rate and review us wherever you listen, or just go straight to guerrilla marketing. Take a friend's phone and subscribe them to this podcast. Today's episode was produced by Shoshana Bucksbaum. I'm Flora Lichtman. Thanks for listening.