Hello everyone! As a nurse practitioner and menopause specialist, I'm excited to share some groundbreaking menopause research from 2024. Let's explore the latest findings that are changing how we understand and treat menopause.

Hormone therapy (HT) has been a hot topic in menopause research, and 2024 brought us some fascinating insights:

1. Slows Down Biological Aging: A large study published in JAMA Network Open highlights found that women who used hormone therapy were biologically younger than those who didn't. This means HT might help you stay healthier for longer! Chronological age is simply the number of years you've been alive, calculated from your birth date. Biological age, measured in various ways, on the other hand, reflects how your body is aging at the cellular and molecular level. It's influenced by factors like genetics, lifestyle, and environmental exposures.

2. Mood and Brain Boost: Testosterone therapy, which we often think of just for men, showed promising results for perimenopausal and postmenopausal women beyond just improving libido. Recent studies revealed significant improvements in both mood and cognitive symptoms. A 2024 study found that 47% of women reported improved mood, while 39% experienced enhanced cognition after using transdermal (administered through the skin) testosterone for 4 months. Testosterone's effects on the brain include strengthening nerves, improving mental sharpness, and regulating neurotransmitters like serotonin and dopamine (brain chemicals that affect mood).

While this recent research is exciting for women, the FDA (Federal Drug Administration) has not yet approved any testosterone formulations specifically for women in the United States. This lack of approval by the FDA despite the growing body of research that supports the safety and efficacy of testosterone therapy for various aspects of women's health remains a significant barrier for women to get the help they may need. As a result, healthcare providers often prescribe testosterone therapy for women using off-label male formulations or compounded products. Scientists and healthcare providers are working hard to change this!

3. Heart Health: A Large Swedish study revealed that modern hormone therapy might actually lower the risk of heart disease in menopausal women. This is great news, as heart health is a major concern during menopause! This study offers compelling insights that I find particularly impressive! It was conducted over 13 years (2007-2020) with a massive sample size of 919,614 women, and the research stands out for its comprehensive approach examining various HT formulations and administration routes, providing a nuanced understanding of their effects.

The results revealed that transdermal estrogen therapy, with or without progestogen, showed the most favorable cardiovascular risk profile. Conversely, oral combined continuous therapy and tibolone (unavailable in the US) were associated with increased heart disease risk. These findings underscore the importance of personalized HT approaches.

The study's long duration, large sample size, and diverse HT formulations tested lend significant credibility to its results. It highlights that not all HT types are equal when it comes to heart health, emphasizing the need for tailored treatments based on the individual's health profiles and risk factors. This research is a valuable step forward in optimizing menopause care and women's cardiovascular health!

4. Long-Term Brain Health: We've always wondered about the long-term effects of hormone therapy on the brain, and studies have shown mixed findings when it comes to HT and cognition, yet, two studies in 2024 gave us some helpful answers:

• The KEEPS continuation study found that hormone therapy started early in menopause (closer to the final menstrual period) might have positive effects on thinking and memory years later.

• A big review of many studies showed that hormone therapy generally doesn't harm cognition and might even help in some cases.

5. Safety for Breast Cancer Survivors

Good news for breast cancer survivors! A safety report found that some women who've had certain forms of breast cancer might be able to use hormone therapy safely. Of course, this needs to be decided carefully with a healthcare provider!

6. Long-term benefits: A study presented at the 2024 Annual Meeting of The Menopause Society showed that HT can be beneficial for women over 65, helping manage symptoms like hot flashes and improving quality of life. Further, the benefits were seen when HT was used in low to moderate doses! The Menopause Society no longer recommends routine discontinuation of HT at a certain age, but rather HT can be continued as long as the benefits continue to outweigh the risks.

7. Insulin resistance reduction: A meta-analysis of 17 randomized controlled trials found that HT significantly reduced insulin resistance in healthy postmenopausal women, potentially lowering the risk of prediabetes. As women go through menopause, their estrogen levels drop, which can make their bodies less sensitive to insulin. This puts them at higher risk for developing conditions like prediabetes and type 2 diabetes. The study suggests that hormone therapy might be a useful tool in keeping women's bodies more responsive to insulin, potentially lowering their risk of these health issues. This is another exciting finding  that could impact how we approach women's health during and after menopause!

Despite growing evidence supporting the benefits of (HT) when initiated close to menopause, and increased awareness of the flaws in the Women's Health Initiative (WHI) studies, HT usage among postmenopausal women in the U.S. has significantly declined. A recent study revealed a striking drop in HT use from 26.9% in 1999 to just 4.7% in 2020! This decline is perplexing given that current clinical guidelines support HT use for menopausal symptom relief in younger postmenopausal patients and for mitigating premature estrogen loss in women who reach menopause before age 45. The most substantial decrease was observed among women aged 52 to 65, with prevalence dropping by 88%. There are several factors that may be contributing to this trend:

• Lingering concerns from the initial WHI findings in 2002
• Lack of awareness of updated evidence-based practices
• Lack of clear guidelines on optimal HT duration
• Persistent negative perceptions about hormone therapy

This significant decline in HT use, particularly among women who could benefit the most, highlights a critical gap in menopause care. In my experience as a menopause specialist, I've observed that the risks of HT are often overstated, while its benefits are frequently undervalued for women without contraindications. This imbalance in perception underscores the pressing need for better education and awareness about current, evidence-based practices in menopause management. Healthcare providers and patients alike need access to up-to-date, accurate information about HT. This would enable more informed decisions, potentially helping many women improve their quality of life during and after menopause. It's essential that we work to bridge this knowledge gap, ensuring that women have access to all appropriate treatment options based on their individual health profiles and needs.

Moving on, several new non-hormonal therapies made their way to the menopause care scene in 2024! Two exciting new treatments are Veozah and elinzanetant. Veozah (fezolinetant) was approved by the FDA in 2023 for treating hot flashes and night sweats due to menopause. Here's how it works:

• It targets a brain chemical called neurokinin B (NKB) that triggers hot flashes.
• Veozah blocks NKB in the brain's temperature control center.
• This helps reduce the frequency and intensity of hot flashes.

Elinzanetant is another promising drug that's still being studied. It works similarly to Veozah but targets two brain receptors instead of one. In studies, compared to placebo elinzanetant has shown to:

• Significantly reduce hot flashes and night sweats
• Improve sleep quality
• Enhance overall quality of life for menopausal women

These new treatments are exciting because they offer alternatives for women who can't or don't want to use hormone therapy. They work directly on the brain's temperature control system, providing relief without adding hormones to the body. Research on these drugs is ongoing, but early results show they could be game-changers in menopause care, offering new options for managing symptoms and improving women's quality of life.

What This Means for You

Both hormonal and non-hormonal therapies offer exciting possibilities for managing menopause symptoms and potentially providing long-term health benefits. Hormone therapy has shown promise in reducing risks of heart disease, type 2 diabetes, osteoporosis, and even certain cancers when started early in menopause. Non-hormonal options, like Veozah and elinzanetant, are offering new ways to address symptoms without using hormones.

However, it's crucial to remember that every woman's experience with menopause is unique. What works well for one person may not be the best choice for another. Both hormonal and non-hormonal treatments come with their own sets of benefits and risks that need to be carefully considered, which is why its important to consult with your healthcare provider before starting any new treatment. They can help you weigh the pros and cons based on your personal health history and individual needs.

As research continues to evolve, we're learning more about making the menopausal transition smoother for everyone, including postmenopausal women. Whether you're experiencing perimenopause, menopause, or postmenopause, staying informed and working closely with your healthcare provider is key to managing symptoms and maintaining overall health!

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