Research tackles a major question in women’s health: why does menopause cause health problems for some women but not others?
The menopausal transition begins as the ovaries’ hormone production declines and oestrogen levels in the body fall.
These changes affect almost the entire body. Body fat increases, particularly around the waist. Inflammation increases, sleep quality declines, and the risk of cardiovascular disease and type 2 diabetes rises. Fatigue or joint pain may also lead to less physical activity.
“Menopause is a process with fundamental implications for women’s health,” says Professor Eija Laakkonen of the University of Jyväskylä. “It is remarkable how many key questions remain unanswered.”
Laakkonen started as a Professor at the Faculty of Sport and Health Sciences on 1 November.
She leads a research team whose work has also attracted recognition from funders. This year, she has received two major funding awards to investigate menopause-related changes and their effects.
“Every new insight helps us develop better, more personalised preventive care.”
Improving our understanding of menopause has considerable significance for society. In Finland, there are over half a million working women aged between 45 and 64, meaning they are either going through the menopause or have already passed it. As the population ages, this proportion is growing.
Menopausal symptoms can create a vicious circle
Menopause brings major changes to women’s bodies that can adversely affect their health.
Heart disease in women differs from that in men and is less well understood, Laakkonen says.
Before menopause, women have a lower risk of cardiovascular disease than men,” Laakkonen explains. “After menopause, their risk approaches that of men and eventually exceeds it.”
Menopause often coincides with other sources of stress.
At this stage of life, women’s careers are often gathering pace. At the same time, their children are becoming adults and their parents are growing older.
Stress, sleep problems, fatigue and other symptoms can easily form a vicious circle. This can leave women without the energy to get enough exercise or maintain other healthy habits.
Understanding which treatments benefit whom
Researchers already have a fairly good understanding of the wide-ranging health changes associated with menopause. Much less is known about what causes them.
The effects of menopause vary from person to person, but researchers do not yet know why.
“Why does the same hormonal change cause significant health problems for one woman but hardly any for another?” Laakkonen asks.
What drives this individual variation? This is the biggest unanswered question in menopause research.”
More knowledge is needed to address risks to women’s health more effectively. Researchers need to identify early on who would benefit from each treatment or preventive measure, whether hormone replacement therapy, lifestyle changes or other approaches.
Current Care Guidelines aim to standardise menopause care
Laakkonen believes that the clinical symptoms and treatment of menopause are reasonably well understood in Finland.
Menopause is no longer seen simply in terms of hot flushes and sleep disturbances, but as a range of symptoms that can affect quality of life, the ability to carry out everyday activities, and health.
Symptoms are no longer regarded as merely an inevitable, passing phase in a woman’s life. However, health concerns related to menopause can still be difficult to recognise.
Finland’s national Current Care Guidelines on menopause, published last year, aim to standardise care and support doctors’ clinical decisions. Laakkonen helped develop the guidelines.
One recommendation is that women can receive hormone therapy from a general practitioner or an occupational health physician without seeing a gynaecologist, provided there are no medical reasons that make the treatment unsuitable. A specialist should be consulted if such reasons exist or if it proves difficult to find an effective treatment regimen.
During this transition, practices vary between hospital districts and individual doctors.
“Some doctors may also avoid prescribing hormone therapy because it increases the risk of breast cancer,” Laakkonen says. “Research suggests, however, that the increase in breast cancer risk is small compared with other health risks associated with menopause. Before the age of 60, the risk is marginal compared with the risk associated with obesity, for example.”
Finland’s menopause debate remains narrow
Menopause has become a particularly prominent topic in the UK, the United States, Australia and Canada. Organisations promoting menopause awareness and care have emerged internationally, alongside workplace programmes. The UK published its first care guidelines on menopause ten years ago.
In Finland, understanding of the biology of menopause, its societal implications and its effects on the ability to work remains limited, Laakkonen says.
Public debate in Finland already acknowledges that menopause affects the ability to work, performance at work and public health. However, the discussion remains one-sided, often focusing on drawing attention to the problems. Fear of stigma has made women reluctant to discuss their symptoms.
Occupational health care practices vary in Finland. Treatment for menopausal symptoms is not always covered by occupational health services.
That is unfortunate, because for some women menopause causes significant difficulties that also affect their ability to work,” Laakkonen says.
“These difficulties usually improve once the right treatment is found or small adjustments are made at work.”
The situation may change in the coming years. The Ministry of Social Affairs and Health has begun preparing a women’s health strategy that will also address menopause. Laakkonen hopes this work will lead to guidance on accommodating menopause in the workplace.
Greater awareness of treatment options is needed
Laakkonen says there needs to be greater recognition that menopause is not solely a gynaecological issue. It is a broader process with long-term implications for women’s health and ageing.
More attention should also be given to the fact that symptoms can be treated and that no single type of medication suits everyone.
Every woman experiences menopause differently, so care should also be individualised,” Laakkonen says.
“Hormone therapy is not suitable for everyone, but non-hormonal treatments are also available. These options receive too little attention.”
Growing media discussion of menopause is a positive development.
“It helps normalise menopause and makes it clearer that no one should have to face difficult symptoms alone: treatment really is available.”
A new study design opens up opportunities for menopause research
In their new studies, Laakkonen and her team sidestep a difficulty associated with defining menopause.
Menopause is defined as having occurred once 12 months have passed since a woman’s last menstrual period. Laakkonen considers this definition problematic because it is often difficult to establish when the last period occurred. This introduces uncertainty into study designs.
“Many women cannot reliably track their cycle because it is irregular, or because they have no periods owing to an intrauterine device or a hysterectomy,” Laakkonen explains. “Even a natural cycle becomes irregular during the menopausal transition, and bleeding, including withdrawal bleeding, can occur without ovulation.”
The new study follows women undergoing surgical menopause, both before and after their ovaries are removed. The operation may be performed because of an inherited cancer risk, for example.
For the women taking part in the study, we know exactly when menopause begins,” Laakkonen says. “This allows us to study the biological effects of menopause with exceptional precision.”
When the ovaries are removed, the body no longer produces oestrogen.
“This allows us to investigate which symptoms result from declining hormone production and which are due to ageing.”
Building a comprehensive understanding of menopause
The new study design offers an opportunity, novel even internationally, to investigate changes caused by declining hormone production and those caused by ageing. Researchers have not yet been able to separate these effects.
The research aims to build as comprehensive an understanding of menopause as possible.
It examines both the biological effects of menopause and its effects on how the body functions, as well as women’s experiences of surgical menopause.
To assess how the body functions, the researchers examine metabolism, body composition, the ability to use fat during exercise, blood vessel function and characteristics, muscle strength, and the ability to produce maximum force in a jump test, among other measures.
The biological research investigates the mechanisms and effects of menopause at the cellular and molecular levels, which remain poorly understood.
Using interviews the research explores women’s experiences ovary removal and menopause, changes in their womanhood and sexuality, and how openly these matters are discussed.
