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Should menopause be optional?

The midlife change raises the risk for a variety of health problems. Some researchers say women shouldn't have to live in this “compromised health state.”
/ Source: TODAY

Longevity researcher Jennifer Garrison calls menopause the worst thing that can happen to a healthy woman’s body.

She’ll have a higher risk for heart disease, stroke, osteoporosis and cognitive decline, and begins to age faster at a cellular level, Garrison says.

“Ovaries normally secrete and produce a whole host of different hormones and signaling molecules that are important for general health,” Garrison, an assistant professor at the Buck Institute for Research on Aging in Novato, California, tells

“When the ovary stops producing these hormones, it really has a detrimental effect.”

Garrison envisions a time — perhaps a decade or so down the road — when science will make menopause optional.

The aim isn’t to enable women to have babies when they’re 70 — “practically speaking, you need a lot more than just functioning ovaries to carry a child,” she says — but to keep ovarian function going later in life to maintain optimal health.

Even though menopause is a natural biological process, it may not be biologically necessary, she argues.

“As a species, we’re odd. There are very few other species that go through menopause — most animals don’t do it,” Garrison says. “That would argue to me that no, it’s not a biological imperative.”

The negative health effects of menopause

After a woman stops having menstrual cycles, her ovaries make very little estrogen. That raises the risk for a variety of health problems, including:

Heart disease: Estrogen helps keep blood vessels relaxed and open, and helps maintain a healthy balance of good and bad cholesterol, so when it’s gone, cholesterol may start building up on artery walls, according to the U.S. Department of Health & Human Services Office on Women’s Health.

“Overall, our cardiovascular risk increases after menopause,” says Dr. Stephanie Faubion, medical director for The North American Menopause Society and director of the Mayo Clinic’s Center for Women’s Health.

“Probably the biggest adverse changes are that our blood pressure tends to go up and our lipid profile tends to look worse.”

Even the years leading up to menopause are a time of increasing heart disease risk for women, the American Heart Association warns.

Stroke: Lower levels of estrogen may play a role in cholesterol build-up on artery walls leading to the brain, the Office on Women’s Health noted.

Osteoporosis: Estrogen is the key regulator of bone metabolism.

“Women lose the most bone density they’re going to lose in their entire lives in the first five years after the menopause transition,” Faubion said. “It continues with a slow downward decline after that, but the loss is most steep right after menopause.”

Cognitive health: Estrogen is a protective hormone that actually goes inside a woman’s brain, stimulating growth, health and plasticity, and keeping it expanding rather than shrinking as a woman ages, said Lisa Mosconi, associate director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College/NewYork-Presbyterian Hospital. The natural drop in estrogen during menopause means women lose this extra “crucially important” layer of protection, she noted.

The menopause transition is associated with verbal memory changes, so women complain of brain fog, but whether that resolves after menopause and whether those women go on to have a higher risk of dementia is unknown, Faubion says. “No one has gone on to prove that changes in memory in midlife represent an Alzheimer’s disease risk,” she noted.

Still, postmenopausal women represent about 70% of all people with Alzheimer's disease, an investigation published JAMA Neurology in April 2023 points out.

Researchers found early age at menopause — defined as happening spontaneously before 40 or due to surgical intervention before 45 — may be a risk factor for Alzheimer's dementia. But women who were prescribed hormone therapy close to when it happened didn't show increased risk.

Would making menopause optional be beneficial for women’s health?

Doctors don’t know — they’d need the science to back that up, Faubion said.

“Just to extend the reproductive lifespan — not even for reproduction, just health — we have no idea what the impact would be and that would have to be studied,” she noted.

Life expectancy was around 50 in the 1900s, Faubion pointed out, so women living a third or more of their lifespan after menopause is a relatively new phenomenon. “Is it right for women to be without hormones for that long? We don’t have that answer,” she said.

The average age at menopause is 52. Overall, longer exposure to estrogen is linked with a higher risk of breast cancer.

But studies already show that the older a woman is when she goes through menopause, the more likely she is to live longer, Garrison said.

“Reproductive aging in women is a critical thing to address,” she noted. “This is something that everyone should be talking about… (yet) there’s a dearth of research in this area.”

As it stands now, she worried women are living more of their lives in a “compromised health state” after menopause, impacting their chances of achieving healthy longevity.

Is there any way now to delay, prevent or reverse menopause?

No, Faubion said.

“Getting rid of menopause is a moon shot,” Garrison said. The aim would be to keep the ovaries running or find a way to mimic what they’re doing — promoting ovary functions important for health, but not necessarily for fertility, which means menstruation later in life could be avoided. She believed that could happen in a decade or so.

Faubion was skeptical: “We’re not anywhere close,” she said.

Does hormone therapy prevent the health impact of menopause?

It can relieve hot flashes, but it doesn’t help prevent the higher risk of heart disease or other health problems, according to the U.S. Department of Health & Human Services Office on Women’s Health. It may raise the risk for blood clots, stroke and some cancers.

Once called hormone replacement therapy, the name has been shortened because “we’re not actually trying to replace what the ovaries used make. We’re just trying to treat the symptoms related to menopause,” Faubion said.

There’s data on the risks and benefits of short-term hormone therapy, but little is known about its effects longer term, Faubion said. There seems to be a favorable effect on the heart when taken in the 50s and it reduces bone loss and fracture risk, she noted.

The 2023 JAMA Neurology investigation into women's Alzheimer's disease risk suggests they shouldn't wait to start hormone therapy when they stop having periods in midlife.

The highest levels of tau, a protein involved in Alzheimer’s, were only observed in women who reported a long delay — five years or more — between age at menopause onset and their initiation of hormone therapy.

“When it comes to hormone therapy, timing is everything,” said Dr. JoAnn Manson, co-author of the paper and chief of the division of preventive medicine at Brigham and Women’s Hospital in Boston, in a statement.

Previous findings suggest that starting hormone therapy early rather than later in menopause provides better outcomes for heart disease, cognitive function and all-cause mortality — "and this study suggests that the same is true for tau deposition," she added.

Garrison called hormone therapy a Band-Aid, but said “we need to take advantage of every Band-Aid that’s available.” The goal is “to craft interventions that will truly make a difference,” she added.