UH Research & Education Update

With more than 1.3 million women entering menopause each year, and women living longer, potentially spending a third of their life in menopause or post menopause, researchers and clinicians are also paying closer attention to how this biological process affects women’s long-term health, especially around cardiovascular disease and bone health.

Examining menopause more broadly, well beyond the management of symptoms that arise with estrogen loss - like hot flashes, mood swings, sexual dysfunction, sleep disturbances, and brain fog – drives new questions and fosters opportunities for new research.

“Women's health research has lagged decades behind men's and there's certainly so many unmet needs in terms of how we treat postpartum depression, how we treat female sexual function, and how we treat menopause,” says Sheryl Kingsberg, PhD, Division Chief of Behavioral Medicine at University Hospitals MacDonald Women’s Hospital and Professor in Reproductive Biology, Urology and Psychiatry at Case Western Reserve University School of Medicine. As clinicians and researchers, “we are trying to find ways to promote health and quality of life, maximizing the options available to women of all ages.”

New Initiatives Fuel Patient-Centered Approach to Menopause Management and Research

To date, menopause has been an understudied, under-researched and underfunded area of medicine. Amid increased awareness and patient needs, UH is mobilizing resources and menopause expertise, leading community-focused research to better serve women and advance the field by improving clinical outcomes and women’s quality of life. 

Erika Kelley, PhD, a clinical psychologist in University Hospitals Department of Obstetrics and Gynecology- Division of Behavioral Medicine, and an Associate Professor in the Department of Reproductive Biology, was awarded the Eugene Washington Engagement Award from the Patient-Centered Outcomes Research Institute (PCORI) to convene a yearlong advisory board to understand the challenges surrounding menopause-related healthcare and develop a prioritized project agenda to address the gaps.

The advisory board is set to bring together a wide cross section of stakeholders, including women who have or have not engaged in menopause healthcare, clinicians, and national menopause advocacy organizations, to coalesce differing perspectives to develop a research agenda and to identify critical next steps that focus on patient-centered menopause healthcare.

“Menopause is a hugely hot topic, but there's a lot of misconceptions,” says Dr. Kelley. “For this entire year, we will convene together to identify what the prioritized research agenda items are, like what do all of the stakeholders think we really need to focus on, to inform our work and goals moving forward.”

Aside from embarking on the PCORI menopause project, UH recently launched a Midlife Women's Health Center under the leadership of newly recruited Sally MacPhedran, MD, MS, an esteemed obstetrics and gynecology expert. The new Center is designed to support the whole woman through her midlife transition, with specialized experts and resources to address cardiovascular health, autoimmune disorders, bone health, rheumatology, obesity and dermatology, among other concerns.

In addition to mobilizing a multidisciplinary network of physicians and specialists trained in perimenopause and menopause, the Center also provides a basis and resource for developing studies to further examine the health issues that often arise during this transitional biological period, which can last anywhere from four to ten years.

“The big concept is having people who are trained in their specialty take care of that element of menopause,” says Dr. MacPhedran. “Our key theme for research within the Midlife Women's Health Center is reducing cardiovascular risk for midlife women through preventative measures,” using a holistic approach to cardiovascular risk reduction, employing lifestyle interventions to improve overall health.

For instance, guiding patients to lose weight will result in a healthier diet, lower cholesterol and blood pressure levels, and reduce diabetes risk or impact, says Dr. MacPhedran. The Center is prioritizing cardiovascular health and disease prevention because it is fundamental to good overall health and positive clinical outcomes, though other studies may develop or tap into the resources or expertise housed within the Center. Dr. MacPhedran has tapped Menopause Society Certified Practitioner and Gynecological surgeon Rachel Pope, MD, MPH, to lead the Center’s research initiatives. Dr. Pope aims to make as many studies as possible available to women who seek care through the Center.

“We hope that our patients will help us do the important work of answering the many research questions that will improve health care for women,” says Dr. Pope.

Building Upon a Rich History of State-of-the-Art Women’s Health Care and Research

UH has a longstanding history of being at the forefront of women’s healthcare, from reproductive medicine to helping patients navigate the symptoms of perimenopause and menopause, particularly around sexual health, impacting care not just locally, but nationally. Three of our health care professionals, including Dr. Kingsberg, have served  as past presidents of the North American Menopause Society.  Dr MacPhedran is president-elect of the International Society for the Study of Women's Sexual Health (ISSWSH), which also includes focus on sexual health in the context of menopause.

Throughout her career, Dr. Kingsberg has been integral to the clinical development and randomized trials of several pharmacologic agents for female sexual dysfunction, with UH serving as a clinical site for many of them.

Looking forward, menopause research is moving beyond the management of symptoms, side effects, and hormone therapy to explore menopause within the broader context of aging and women’s health, focusing on outcomes that women themselves prioritize and promoting deeper clinical understanding.

Development of the new Midlife Women’s Health Center provides a robust and engaging vehicle for new research focused on specific health challenges and needs among women in perimenopause or post menopause will undoubtedly shed greater light on the wide health impact of this life transition and how to more effectively address it.

“There are so many areas where we are in the dark about care for women's health in their midlife, for example, how can women improve their cardiovascular risks during the decades we see risk increase,” says Dr. Pope. “Doing research on these areas will help to engage women in their healthcare and lead to more answers for future generations.”