Menopause is a life transition that all women experience. However, not all women have the same experience with menopause. Some women have difficult menopause symptoms. Some have very few. Researchers at the University of Pittsburgh and elsewhere are looking into what women’s experiences with menopause are, why women have different experiences and whether menopause can shed light on women’s overall health.
Menopause is a natural part of aging and marked by the end of women’s menstrual periods. It typically happens somewhere between the ages of 40 and 60, with age 51 being the average age of the last menstrual period. (Though some women—because of certain medications, chemotherapy, radiation or certain diseases—transition through menopause at an earlier-than-average age.) Women usually begin the menopause transition by skipping or having irregular periods. Menopause is complete when women have not had a menstrual cycle for one year. But the transition can last between a few months and more than 10 years for some women. Women’s experiences with menopause symptoms also vary greatly.
Many of the menopause research findings have come out of a study called SWAN (Study of Women’s Health Across the Nation). It is funded by several National Institutes of Health (NIH) agencies. Begun in 1994, SWAN is a study of 3,300 women from five different racial and ethnic groups at seven sites around the country. The University of Pittsburgh is one of those sites. Other important studies of menopause at Pitt include the MsHeart Study and the MsBrain studies. They are also NIH studies and are focused on how menopause may affect women’s heart and brain health. Rebecca C. Thurston, PhD, professor of psychiatry, School of Medicine, and of clinical and translational science, University of Pittsburgh, heads the MsHeart and MsBrain studies and will be lead investigator of SWAN in its next funding cycle.
SWAN research has documented menopause symptoms that can include vasomotor symptoms (hot flashes and night sweats) and sleep problems (falling asleep, staying asleep, or waking earlier than you mean to). Menopausal women may experience mood changes, especially anxiety, depression and irritability. Women can also have a decline in bone density, which can lead to bone fractures. Both the SWAN and MSHeart studies track changes in women’s cardiovascular health. These changes include rises in low-density lipoprotein, or LDL, cholesterol and adverse changes in blood vessels like stiffening and widening of the vessel walls.
Research findings from SWAN indicate that more than 70 percent of women will have hot flashes during menopause. African American women have the most frequent, severe, early-onset and persistent hot flashes. Asian women tend to have the fewest hot flashes. Latinas and white women have hot flashes at rates that are in between these two groups. Research is ongoing about how to decrease the likelihood of extreme symptoms.
The general thinking used to be that hot flashes in menopause were benign and that women had to suffer through them. However, research findings are showing that hot flashes may provide insights about women’s vascular and brain health during the menopause transition.
“What we’re learning through MsHeart and SWAN is that having very frequent vasomotor symptoms or having them early in the transition are associated with worse vascular health,” says Dr. Thurston. “The MS Heart study has also shown that more sleep problems are associated with poor underlying vascular health. Women who have both hot flashes and sleep problems appear to have worse vascular health.
“Also, early research suggests that women with a lot of hot flashes have poorer cerebrovascular health. We’ve seen something called ‘white-matter hyperintensities’ in the brain. They indicate small-vessel disease. Women often report problems with memory, attention and thinking during the menopause transition. In the MSBrain study, we’re using imaging to visualize what’s going on in women’s brains during the menopause transition. We’ll be taking a close look at whether hot flashes are associated with poor cognitive health, particularly memory.”
As a psychologist, Dr. Thurston also studies the psychosocial influences on menopause. She emphasizes that what happens in midlife is not all about hormones or menopause; life experiences have an important impact on how women manage the transition through menopause.
“Research shows that women who have a history of child abuse or neglect, which is at about 30-35 percent of women in my samples, have more menopausal symptoms—hot flashes, sleep problems and poorer vascular health from midlife on,” says Dr. Thurston. “We also know that women who have persistent financial strain over midlife have poorer vascular health at the end of midlife. In MsHeart, I’ve shown that women who have more traumatic experiences in their lives tend to also have poorer vascular health in midlife. If you know you’ve had a particularly traumatic history, make sure you are getting yourself treated as best you can in midlife. You can’t change the past, but you can influence where you go in the future.”
Dr. Thurston notes that, while some of the findings from menopause research may sound scary, some women as they go through the transition experience very few symptoms. Dr. Thurston reports that many women feel personal satisfaction, growth and confidence in their menopausal years.
“And what can be useful about this research is that we are learning that we may need to target women with a lot of hot flashes to support cardiovascular risk reduction and brain health,” she says. “Frequent hot flashes may be a wake-up call to take care of our health. All women experiencing menopause, especially those women at greater risk for more extreme symptoms, should watch their cholesterol level, blood sugars, and blood pressure, eat a healthy diet, stop smoking, exercise, lose weight—all of those good health behaviors we all know we’re supposed to do.”
Dr. Thurston wants women to know that they do not have to suffer through menopausal symptoms by themselves. She suggests discussing symptoms with a health care provider. Women with mood changes can get help through stress reduction techniques, like yoga or meditation, or through the use of prescribed medications.
“There’s so much we didn’t know about menopause that we’re learning now through research,” says Dr. Thurston. “Don’t suffer alone. Get support because there are treatments and ways to improve life through the menopause transition and after.”
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