What if you could delay menopause and all its associated health risks? Would you? Editor Trudi Brewer shares health news that could impact every woman.

The United States recently announced a White House Women's Health Initiative highlighting a seemingly obscure research question. Scientists are studying how to keep the ovaries working longer — and potentially, prevent age-related disease.

The question comes from a field of research that has started to draw attention over the last few years. Scientists studying longevity and women's health have realised that the female reproductive system is far more than just a baby-maker. The ovaries, in particular, appear to be connected to virtually every aspect of a woman's health. They also abruptly stop performing their primary role in midlife. Once that happens, a woman enters menopause, which accelerates her ageing and the decline of other organ systems, like the heart and the brain. While women, on average, live longer than men, they spend more time living with diseases or disabilities.

The ovaries are "The only organ in humans that we just accept will fail one day," said Renee Wegrzyn, director of the Advanced Research Projects Agency for Health, a government agency tasked with steering this initiative. "It's actually kind of wild that we all just accept that."

“The ovaries are the only organ in humans that we just accept will fail one day.”

— Renee Wegrzyn

The ovaries' truncated life span also makes them a promising site for experimentation. Researchers think prolonging their function and better aligning the length of their viability with that of other organs could alter the course of a woman's health and longevity research overall. Dr. Wegrzyn said she hoped the White House initiative, in which researchers and startups compete for a slice of the program's $100 million budget, would highlight the connection between menopause and longevity while attracting more funding and talent. "If you don't think about ovarian function during ageing," said Jennifer Garrison, an assistant professor at the Buck Institute for research on ageing, "Then you're kind of missing the boat."

How Ovaries Are Linked to Ageing

The ovaries function like the control centre."A complex network of signalling in a woman's body," Dr Garrison said. “The ovaries communicate with and influence virtually every other organ through hormones like estrogen, progesterone, and other chemicals.” Scientists don't know precisely how the ovaries do this, but they know that when they stop functioning normally, all kinds of problems arise. In young women, for example, that can manifest as polycystic ovary syndrome, which increases the risk for metabolic conditions, heart disease, mental health problems and more.

As a woman's eggs are depleted, eventually triggering menopause, the ovaries' chemical communications seem to go quiet. That corresponds to an increased risk for dementia, cardiovascular disease, osteoporosis and other age-related diseases. “The earlier a woman enters this life phase, the higher her risk for developing those conditions and the shorter her life will likely be. In women who enter menopause prematurely because their ovaries are surgically removed, the risks for chronic conditions are greater still. That suggests that even after the ovaries stop releasing eggs in menopause, they may still be somewhat protective of a woman's overall health”, said Dr. Stephanie Faubion, the medical director of the Menopause Society. It's just unclear how.

As of now, these connections are correlational. “Scientists don't know if the ovaries themselves are the drivers of health in ageing or is there something else accelerating ageing that leads to ovarian dysfunction,” says Dr Faubion. Studies have found that several factors, such as smoking, body mass index, and adverse stressors throughout life, all contribute to the early onset of menopause.

Black and Hispanic women tend to hit menopause earlier than white women. Genetics might also play a role." Is the ovary just a marker of overall health? Or is the ovary timing out and causing poor health?" Dr. Faubion said. "I mean, it's chicken-egg."

How Delaying Menopause Could Extend Life Span

Some evidence, mostly in animals, suggests that prolonging ovarian function can improve health and increase longevity. In mice, for example, transplanting an ovary from a younger animal into an older one lengthens the older mouse's life. Scientists are now experimenting with different ways to prolong ovarian function and delay the onset of menopause in humans.

One company, Oviva Therapeutics, is in the early stages of testing — mainly in mice and cats—whether a pharmaceutical version of anti-Müllerian hormone (AMH), which modulates how many follicles mature in each menstrual cycle, could be used to reduce egg loss. (Typically, a woman loses dozens of eggs per cycle even though, in most cases, she only ends up ovulating one of them.)

Think of AMH as "A porous cloth that you cover around the ovary," said Daisy Robinton, co-founder and chief executive of Oviva, who is competing for some of the funding from the White House initiative. The level of AMH dictates the size of the holes in the cloth; if there are huge gaping holes (in other words, there's low AMH), a bunch of eggs can be left in each cycle. But if there are only small holes (meaning there's high AMH), fewer eggs can get out.

Dr Robinton said that if a woman loses fewer eggs, she can hold on to her ovarian reserves and the ovaries' functionality for longer.

A clinical trial at Columbia University is also trying to slow the rate women lose their eggs. The study is testing the use of an immunosuppressive drug called Rapamycin — used to prevent organ transplant rejection and has become a darling of the longevity movement — in women between the ages of 35 and 45 to see how it affects their ovarian reserve. Rapamycin influences the number of eggs that mature each month, and the drug has been shown in mice to extend ovarian function.

The study is ongoing, and the researchers don't know which participants received the medication or a placebo. Still, the lead scientist on the trial, Dr S. Zev Williams, said that two patterns had already emerged: “Some women appear to have a normal decline of ovarian reserve, which can be measured via ultrasounds and AMH levels, but in others, it seems to have been altered," he said. "So, you know, that's promising." Dr. Williams, an associate professor of women's health at Columbia, is also applying for that health agency funding.

The experts were explicit that the goal of this type of research was not to prolong women's periods indefinitely nor to make pregnancy possible at age 70 — though the treatments could potentially extend fertility.

The accelerated decline of the ovaries during midlife also makes them "A good model for studying ageing and being able to do so within a limited period of time," Dr Williams said. Other anti-ageing scientists are also experimenting with Rapamycin, for instance, but it's virtually impossible to determine if the drug is extending human life without conducting a study over several decades. With the ovaries, researchers can see if there's an effect much faster.

Moreover, "If we can understand why ovaries age prematurely and what's driving that, that will almost certainly tell us something important about ageing in the rest of the body," says Dr Garrison. "And then that, of course, becomes important not just for females but also for males."

Understanding menopause

What are perimenopause and menopause?
Perimenopause is the final years of a woman's reproductive years that leads up to menopause, the end of a woman's menstrual cycle. Menopause begins one year after a woman's final menstrual period.

How long does perimenopause last?
Perimenopause usually begins in a woman's 40s and can last for four to eight years. The average age of menopause is 51, but for some, it starts a few years before or later. The symptoms can last for a decade or more, and at least one symptom — vaginal dryness — may never get better.

What are the symptoms of menopause?
Symptoms of menopause can begin during perimenopause and continue for years. Among the most common are hot flashes, depression, genital and urinary symptoms, brain fog and other neurological symptoms, and skin and hair issues.

How can I find some relief from these symptoms?
Menopausal hormone therapy and the selective serotonin reuptake inhibitor paroxetine can also ease some symptoms.

What is Veozah?
Veozah is the first nonhormonal medication to treat hot flashes in menopausal women; the F.D.A recently approved it. The drug targets a neuron in the brain that becomes unbalanced as estrogen levels fall. It might be beneficial for women over 60 because, at that age, starting hormonal treatments can be considered risky.

What can I do about vaginal dryness?
There are several things to try to help mitigate the discomfort: lubricants, to apply just before sexual intercourse; moisturisers, used about three times a week; and estrogen, which can plump the vaginal wall lining. Unfortunately, most women will not get 100 per cent relief from these treatments.

What’s on offer for menopause symptoms in New Zealand?

It’s a life stage that 1.1 billion women worldwide will go through by 2025. So why are so many of us in the dark about menopause and treatments on offer? Editor Trudi Brewer shares advances in hormone replacement therapies and her journey in a hormonal stage that, for some, impacts every aspect of their lives.