If puberty is like climbing a physiological cliff, then menopause can be like falling off one.
A new study, published in Natural medicineargues that the end of menstruation is not a gradual part of aging, as previously thought, but an abrupt physiological transition.
Using more than 300 million laboratory tests performed on more than a million women, the new study identifies a number of sudden “jumps” that occur throughout the body at the onset of menopause.
Some of the most obvious changes are related to sex hormones, which the ovaries help produce, but there are also sudden changes in bone health, liver function, kidney function, blood chemistry and blood fats.
“Menopause reshapes female physiology, but current understanding is
limited by small longitudinal cohorts which characterize it as a
transition,” explain the authors, led by molecular cell biologist Glen Pridham of the Weizmann Institute of Science in Israel.
This may be a misconception.
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Pridham and colleagues instead used a computational framework to analyze the menopause transition in two large cohorts of women, one in the United States and another in Israel.
Their method is designed to disentangle a person’s chronological age from their reproductive timeline, which previously complicated population-wide studies.
According to both cohorts, the final menstrual period is marked by a “step-like physiological cliff” in almost all physiological systems.
Changes are most pronounced in systems such as bone metabolism, liver tests and lipid handling.
“While previous longitudinal studies… have established bone loss and specific hormonal surges, the scale of this study, covering 90 types of tests, demonstrates that this transition is abrupt and systemic,” the authors conclude.
In the US dataset, for example, 52 of 90 laboratory tests showed a statistically significant and sudden change with menopause.
“Notably,” the authors add, “we find that male individuals do not experience these abrupt physiological changes, suggesting that the cliff is a consequence of the menopausal transition rather than general aging.”
Not everyone agrees that these changes should be described as a precipice.
Martha Hickey, professor of obstetrics and gynecology at the University of Melbourne in Australia, who was not involved in the study, says this description is “potentially alarming for women and implies dramatic physical and mental decline, which this study does not demonstrate.”
Other studies that show widespread changes at menopause have reframed this transition not as a setback, as a “reproductive retirement,” but as a sudden “career change” for the body and brain.
During a person’s reproductive years, the ovaries work to develop follicles that produce and release eggs.
But this is not their only role.
The hormones released by these organs, such as estrogen, progesterone, and testosterone, have widespread effects on the rest of the body, which could have significant consequences on a person’s health as they age.
During menopause, one hormone in particular seems to be pulling a lot of the strings: estrogen.
“The systems where the most significant changes were observed (e.g. bone health or the liver) are very sensitive to estrogen, and the systems that did not show detectable changes have a much weaker known link to estrogen,” says physiologist Mia Schaumberg, who was not involved in the study.
Schaumberg, of Australia’s University of the Sunshine Coast, also finds another interesting result. In the study, around 15 and 12 years before the end of menstruation, anti-Müllerian hormone (AMH) and estradiol showed signs of decline.
While about 14 years before menopause, follicle-stimulating hormone (FSH) increases.
“This shows that the systemic changes observed during menopause could be predicted by hormonal changes much earlier than initially thought,” says Schaumberg.
These findings are supported by recent research in mice, which suggests that the ovaries begin to age decades before the onset of menopause.
But this study is only observational, and health specialist Andrew Shelling of the University of Auckland in New Zealand cautions that while these results are interesting, they are not conclusive.
Menopause is a major transition in human health that we still know so little about.
“The study opens up a new way of thinking about menopause and provides a new framework for future research,” says Shelling, who was not involved in the study.
“As we work to better understand how menopause reshapes female physiology, this research will likely be the start of many new discoveries to come.”
The research was published in Natural medicine.
This article was fact-checked by Fiona MacDonald and edited by Fiona MacDonald. Although we are proud of our process, we are only human. If you spot an error, please let us know.
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