by Katherine M. Newton, PhD, senior investigator at Group Health Research Institute
My research colleagues and I recently got some great news: The National Institute on Aging (NIA) has renewed funding for our MsFLASH research network—a group that’s finding healthy ways to help women with symptoms of menopause. The work is part of my passion for midlife women’s health that began more than 20 years ago. As a new nurse in a coronary care unit, I realized that all the educational materials we had were written with men in mind. It was as if women didn’t get coronary disease, but of course they did. My women patients would ask, “What about me?”
Fast forward many years. I changed careers, became an epidemiologist, and began researching the effects of hormones on women’s heart disease risk. The 1990s saw a tremendous push for women to take estrogen replacement—hormone therapy—during menopause. This advice was based on countless observational studies comparing women who chose to use hormones versus those who did not. Observational studies do not directly test the effects of a treatment like estrogen replacement. They just look at what happens when people receive a certain treatment as part of their regular health care. In this case, the studies showed that estrogen was good for women, decreasing risks for heart disease, dementia, urinary incontinence, and osteoporosis. Lurking within these studies was the observation that hormones also seemed to increase the risk of blood clots and breast cancer, an observation that went largely ignored because the benefits of hormone therapy seemed clear. Even older women who were having no menopause symptoms were encouraged to use preventive estrogen therapy, sometimes with a progestin to protect against endometrial cancer.
Then, in 2002, our world was shaken with the release of findings from the Women’s Health Initiative. Researchers in this national program did two studies directly comparing hormone therapy to a placebo. One study looked at the effects of estrogen in women without a uterus, and the other studied estrogen plus progestin in women with a uterus. Estrogen plus progestin increased the risks of heart disease, stroke, pulmonary embolism, invasive breast cancer and dementia. Estrogen alone increased the risks for stroke and deep vein thrombosis.
So, now what? The results put women and providers on a search for non-hormone treatments for menopause symptoms. And the toolkit at that time was pretty small—estrogen therapy was the main effective treatment for menopause symptoms. Women needed options—and not only because of the Women’s Health Initiative results. Many women never liked the idea of taking hormones. And others couldn’t take them, for example, if they had a history of breast cancer or blood clots. Although most women make their way through the menopause transition without the need for treatment, some (then and now) find their menopause symptoms disabling and need low-risk options to manage them.
Enter MsFLASH, a national research network. In 2008, the National Institute on Aging funded MsFLASH (a name that stands for for Menopause symptoms, Finding Lasting Answers for Symptoms and Health) with sites in Boston, Indianapolis, Oakland, Philadelphia, and here in Seattle at Group Health Research Institute, the University of Washington, and Fred Hutchinson Cancer Research Center. The goal was to answer women's and providers’ questions about how to treat common menopausal symptoms. Our three randomized trials collectively compared six strategies against appropriate placebos: low-dose estrogen, low-dose escitalopram or venlafaxine (antidepressants), omega-3 fatty acids, aerobic exercise, and yoga. We found that:
With funding from NIA for another five years of research, MsFLASH will be studying locally applied treatments for vaginal discomfort such as dryness, itching, and pain associated with menopause. We’ll also develop materials to help women choose treatments based on their own needs, preferences and menopause symptoms. I’m thrilled to be part of a program of research that is increasing our toolkit of options to help women manage their health.