Making menopause and women’s health a public priority

Last month, the Biden administration announced the White House Initiative on Women’s Health Research, the first-ever federal mandate to close the long-standing and vast gender gap in medical research. High praise with a dose of disbelief ensued: How has women’s health been so vastly neglected for so long?   

The lack of funding tells part of the story. Last year, the National Institutes of Health (NIH) allocated only 10.8 percent of its $45 billion budget to women’s health research, despite the fact that women make up more than half of the U.S. population. In some cases, the imbalance is even more profound. For example, women are two-thirds of all Alzheimer’s cases, yet only 12 percent of NIH funding for Alzheimer’s and related dementia research is focused on women.   

For women over 65, cardiovascular disease is the No. 1 cause of death. Though younger women have half the risk as men, in the decade after menopause, their rate of cardiovascular disease equals or exceeds that of men. According to Dr. Howard Hodis of USC’s Keck School of Medicine, unrecognized heart disease in women has deadly consequences: more women than men die of sudden cardiac arrests often with no previous history; even when diagnosed, women are still more likely to die within the first five years than their male counterparts. 

Uterine cancer is on the rise with rates for women of color outpacing that of white women. When it comes to the more aggressive and often lethal subtype, the rate for Black women is twice that of white women. This has contributed to one of the largest disparities in cancer deaths. By 2040, it is estimated that the incidence of uterine cancer will exceed that of colorectal cancer. 

We need answers — and fast. The White House Initiative calls upon agencies across the federal government, including the U.S. Departments of Health and Human Services, Veterans Affairs, and Defense, as well as executive offices such as the Office of Management and Budget and the Office of Science and Technology Policy, to deliver concrete recommendations by the end of 2023. This will include establishing priority areas for federal research and investments, as well as creating opportunities for private-public partnerships.   

The president’s ambitious charge is reinforced by a new commitment in Congress to specifically address perimenopause, menopause, and midlife women’s health. The Menopause Research and Equity Act of 2023, spearheaded by Rep. Yvette Clarke (D-N.Y.), will require the NIH to convene a multidisciplinary team of health professionals to assess the status of menopause research in particular, and recommend new, needed studies.  

Menopause is among the most misunderstood life stages despite its universality. Women will spend the majority of their years post menopause, if they are lucky to live that long. The average age of menopause is 51, though the time leading up to and one year past the cessation of menstruation, known as perimenopause, can last as long as a decade.   

A crucial component of the bill is a focus on menopause hormone treatment (MHT). The NIH needs to issue updated, accurate guidance about the safety and effectiveness of MHT, as well as its overall long-term health benefits and potential risks.  

There is no disagreement that MHT is the most effective treatment for the symptoms of menopause such as hot flashes, vaginal dryness with accompanying painful sex, and urinary symptoms. There is also no better preventative medication for the ravages of osteoporosis than hormone therapy. The FDA has approved its use for these indications.  

In effect, Congress would be righting the wrong NIH instigated in 2002 when it abruptly terminated a sweeping research initiative (also named the Women’s Health Initiative, commonly referred to as the WHI). The largest study ever done on postmenopausal women, the WHI was designed in 1991 to confirm whether an observed decrease in cardiovascular disease seen in previous studies was indeed true. When it failed to show an improvement in the incidence of heart disease — and reported a slightly higher risk of breast cancer — the confusion generated by misinterpretations of the study results was seismic. The heart disease finding had more to do with the study design (the average age of participants was 63 and more than 10 years after menopause) than with the ineffectiveness of hormones. Almost overnight, hormone therapy usage plummeted from almost 40 percent it to about 5 percent.  

A generation of women has since suffered unnecessarily — not only from menopause symptoms left untreated, but also by the collective denial of potential long-term benefits of hormone therapy. In the decade after the WHI was halted, for example, the decrease in MHT usage led approximately 18,000 to 90,000 women to lose their lives prematurely due to hip fractures alone.  

Among the many questions that deserve robust research commitment: Does MHT decrease the risk of Alzheimer’s? How much does hormone therapy decrease the risk of heart disease — and for whom? Intriguing new analyses suggest that there are real benefits on both fronts. The travesty is twofold: We don’t know the answers because no one in leadership has bothered to ask. 

Until now, that is. We are a physician and a lawyer, respectively, both part of a dynamic working group of experts and advocates convened by the nonprofit Let’s Talk Menopause and committed to making menopause a public priority. What we see occurring — a whole government approach committed to women’s health research, from the White House to Capitol Hill — is nothing short of extraordinary.  

Research is the foundation on which all social and policy reforms must be built. Women deserve to be equipped with that knowledge and confidence as we approach all stages of our lives, including and especially menopause.  

Dr. Sharon Malone is a board certified OB/GYN and a certified menopause practitioner. She is the Chief Medical Advisor to Alloy Women’s Health and author of the upcoming book, “Grown Woman Talk” due out in April 2024. Jennifer Weiss-Wolf is executive director of the Birnbaum Women’s Leadership Center at NYU Law and author of the book “Periods Gone Public.” She serves on the board of the nonprofit Let’s Talk Menopause.