Review Identifies Research Gaps in Menopause and Advocates for a Revised Definition

A team of international experts has called for a new definition of menopause, more research and improved treatments following a comprehensive review published in the journal Cell.

Led by Monash University Women’s Health Research Program head Professor Susan Davis, the review summarised menopause knowledge, called for more research into its timeline and treatment, and encouraged individualised, holistic treatment that addressed symptoms and systemic body changes.

“The road to menopause is not difficult for all, but for some, symptoms may be severe or even disabling and disruptive to work and family,” the Australian, Italian and US-based authors wrote.

“Recognition that menopause, for most women, is a natural biological event, does not exempt the use of interventions to alleviate symptoms. Optimising health at menopause is the gateway to healthy aging for women.”

The researchers looked at more than 200 sources across 71 years to synthesize current knowledge. Key takeaways included:

• A proposed new definition for menopause as “final cessation of ovarian function,” rather than the traditional focus on menstruation. Among other things this would encompass those without regular periods before menopause, who used certain types of contraception like IUDs, and had hysterectomies.
• The timeline of menopause phases isn’t well understood and varies from person to person, so age restrictions on prescriptions and therapies are problematic and not always logical.
• Menopause treatments range from hormone therapies to lasers to plant products, but few have been studied over long enough timespans.
• Each treatment type has potential side effects and health concerns. Even the most effective and well-researched—hormone therapy targeting estrogen—is far from a perfect solution for all.
• Symptoms vary widely, from severe to none. Even if someone has no noticeable symptoms, there can still be significant “silent health consequences,” including bone loss and a higher risk of diabetes, cardiovascular diseases, and certain cancers.
• Some symptoms, like short-term memory loss, can be temporary, and others, like depression and anxiety, can be pre-existing conditions falsely attributed to menopause due to stigma surrounding it.
• Regular exercise and maintaining a protein-rich nutritious diet can reduce the likelihood of symptomatic health complications.
• Socio-economic factors such as lower quality of life and the potential negative impact of menopausal symptoms on a woman’s work performance aren’t often acknowledged.

Despite decades of menopause research, Professor Davis and her colleagues said researchers needed to look deeper into when the process started and focus on making treatments more effective and safer overall.

They also underlined the importance of research outside high-income countries, and studying the impacts of menopause on work from home and in an office, as well as the impacts on people with less traditional career paths such as caregivers and volunteers.

Professor Davis and her co-authors said menopause treatments needed to be holistic and individually tailored, addressing physical and mental health impacts, as well as underlying associated health risks and any other relevant health concerns.

“Optimal menopause-related care involves shared decision making which means quality, evidence-based information needs to be available for the general community and health care providers,” Professor Davis said.