Menopause, hormones, inequality and health
The menopause and related health issues have become the subject of intense media focus in recent times. However, questions remain over whether the evidence supports claims about the health benefits of taking HRT.
Academics in the School of Sport, Exercise and Health Sciences are investigating whether there is evidence to support claims that the long-term use of Hormone Replacement Therapy (HRT) can significantly reduce the likelihood of post-menopausal women developing dementia and heart disease.
Media coverage of the potential impact of HRT on women's health has led to growing public concern over a shortage of hormone replacement therapy.
The appointment of a ‘hormone tzar’ and a commitment by the UK Government to study and improve women’s health and ability to work - as part of the Government Equalities Office 2019 roadmap on gender equality - is also driving debate about the use of HRT.
However, despite research into the potential benefits of the treatment stretching back to the 1950s, there does not appear to be definitive evidence to suggest that the long-term use of HRT can significantly reduce the likelihood of post-menopausal women undergoing natural menopause between 45-55 years of age developing dementia and heart disease, as highlighted in a recent article in The Conversation.
Researchers in the School of Sport, Exercise and Health Sciences believe that a more effective way to reduce this risk of dementia and heart disease is by practising a healthy lifestyle - to include regular exercise, a balanced diet, good sleep hygiene and reduced stress.
We know that oestrogen - a key component of HRT - beneficially affects all factors known to impact heart disease and dementia. However, there is no conclusive evidence to state that the long-term use of HRT will protect women undergoing menopause naturally against heart disease or dementia."
Research in focus
Mind and Menopause
While much of the focus is on hormones to treat menopausal symptoms, we are currently investigating lifestyle changes such as nutrition in improving memory, mood and stress resilience. Contact person: Prof Eef Hogervorst.
- Hogervorst E, Kassam S, Kridawati A, Soni M, Xin X, Shifu X, Rahardjo TB. (2017). Nutrition research in cognitive impairment/dementia, with a focus on soya and folate. DOI: 10.1017/S0029665117000404
- Menopause: HRT’s brain-protecting effect may be overstated - The Conversation
- Hogervorst E, Craig J, O'Donnell E. (2022). Cognition and mental health in menopause: A review. Best Practice & Research Clinical Obstetrics & Gynaecology, Volume 81, May 2022, Pages 69-84. DOI: 10.1016/j.bpobgyn.2021.10.009
Mental health, activity and Menopause
We investigate effectiveness of a self-managed home-based moderate intensity walking intervention on psychosocial – including mental-health outcomes among breast and cervical cancer. Contact person: Prof Fehmidah Munir.
- Gokal K, Wallis D, Ahmed S, Boiangiu I, Kancherla K, Munir F. (2016). Effects of a self-managed home-based walking intervention on psychosocial health outcomes for breast cancer patients receiving chemotherapy: a randomised controlled trial. Support Care Cancer. 2016 Mar;24(3):1139-66. DOI: 10.1007/s00520-015-2884-5
- Millet N, McDermott HJ, Munir F, Edwardson CL, Moss EL. (2022) ACCEPTANCE: protocol for a feasibility study of a multicomponent physical activity intervention following treatment for cervical cancer. BMJ Open. 2022 Jan 3;12(1):e048203. DOI: 10.1136/bmjopen-2020-048203
Exercise and Menopause
While Cochrane meta-analyses found no effect of exercise on vasomotor menopausal symptoms in randomised controlled studies in a recent qualitative study, women did report that exercise had improved hot flushes and night sweats, sleep, and health. Contact person: Prof Amanda Daley.
- Daley A, Stokes-Lampard H, Thomas A, MacArthur C. (2014). Exercise for vasomotor menopausal symptoms. Cochrane Database Syst Rev. DOI: 10.1002/14651858.CD006108.pub4
- Thomas A, Daley AJ. (2020). Women's views about physical activity as a treatment for vasomotor menopausal symptoms: a qualitative study. BMC Womens Health. DOI: 10.1186/s12905-020-01063-w
Cardiovascular disease and Menopause
Cardiovascular disease risk increases after menopause in association with the loss of the cardioprotective effects of estrogen. However, the effects of hormone replacement therapy in reducing cardiovascular risk are unclear. We are currently investigating the effect of lifestyle changes, such as exercise, on weight gain and cardiovascular health, including blood pressure and vascular reactivity. Contact person: Dr Emma O’Donnell.
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Mark A. Geyer, Charles A. Marsden, Bart A. Ellenbroek, Thomas R.E. Barnes, Susan L. Andersen. Current Topics in Behavioral Neurosciences (CTBN). DOI: 10.1007/978-3-031-12184-5
Self identity, body image and Menopause
The physical changes associated with the menopause may initiate and/or exacerbate disturbed body image and eating behaviours. The extent to which this occurs, and how increased body appreciation may serve as a protective factor is, as yet, unknown. We will be investigating this, including with trans and gender-diverse individuals. Contact person: Dr Gemma Witcomb.
Social inequality and Menopause
Observational studies linking menopause, hormone use, and health need to look across the life course to account for pre-existing differences between women who use hormones and those who do not. Socioeconomic position is one such factor, as women from disadvantaged social circumstances are more likely to suffer from poorer health than more advantaged women. They are also more likely to reach menopause earlier, to undergo a hysterectomy, to suffer symptoms at menopause, and have different patterns of HRT use. In addition, recent research demonstrates that menopause can have a detrimental impact on employment. Contact person: Prof Rebecca Hardy.
- Hardy R, Potischman N, Kuh D. (2013). Chapter 9 - Life Course Approach to Research in Women’s Health. Women and Health (Second Edition). DOI: 10.1016/B978-0-12-384978-6.00009-1
- Hardy R, Kuh D. (2009). Menopause and gynaecological disorders: A life course perspective. Medicine. DOI: 10.1093/acprof:oso/9780192632890.003.0004
- Bryson A, Conti G, Hardy R, Peycheva D, Sullivan A. (2022) The consequences of early menopause and menopause symptoms for labour market participation. Soc Sci Med. DOI: 10.1016/j.socscimed.2021.114676
Meet the experts
The subject of menopause, its symptoms and treatments has become a more prevalent topic in recent years. To myth bust and outline what the evidence says around aspects of menopause, the National Centre of Sport and Exercise Medicine has run a lecture series, featuring experts from the School of Sport, Exercise and Health Sciences, which are now available to listen to online:
- Menopause and your heart - Dr Emma O'Donnell
- Menopause and the brain - Prof Eef Hogervorst
- A life course approach to menopause - Prof Rebecca Hardy
You can find out more about our experts in the area of Sex, Hormones, Inequality and Health below:
Amanda is Director of the Centre for Lifestyle Medicine and Behaviour. Her work is focused on investigating the effects of lifestyle interventions on health outcomes.
Rebecca uses a life course approach in epidemiology to study health and ageing, to identify potential intervention to maximise the chances of living a healthier, independent life for longer.
Eef's research interests are in early dementia screening and treatment. She is currently investigating risk and protective factors for dementia and age-related cognitive decline.
Professor Munir’s current research focuses on the promotion of health and management of ill-health and well-being in occupational and community settings.
Emma’s primary research interest is centered on the cardiovascular consequences of estrogen deficiency in premenopausal women with amenorrhea (absence of menses).
Gemma's research focuses on the psychological impact of menopause on body image, disordered eating behaviour onset in later life, and trans and non-binary experiences of the menopause.