The complexities of menopause have long been overshadowed by misconceptions, with little attention given to how it affects not just women but also the men around them. However, a recent panel discussion hosted by Dr. Kwadwo Kyeremanteng, an ICU physician and founder of the Solving Healthcare podcast, is shifting this narrative.
The conversation—which took place the Eudēmonia Summit in West Palm Beach, Florida, earlier this month—brought together renowned experts in the fields of neuroscience, women’s health and aging to explore the impact of menopause on both women’s and men’s health, as well as the emerging science surrounding longevity.
“Why is an ICU doc here talking about men in menopause?” Kyeremanteng asked. “As the person that is all about justice, this is one of the areas in medicine that I think we’ve been criminal in terms of our approach.”
Menopause and the workforce
Kyeremanteng explained how he observed a significant number of his staff leaving during the pandemic due to burnout; many of these individuals were midlife women in healthcare, driven by the challenges of managing menopausal symptoms.
“When I learned that about 10% of women leave the workforce as a result of their menopausal symptoms, I felt strongly about being an ally, about trying to be a voice because this such an important topic,” he said.
Kyeremanteng went on to introduce the panel, which included Dr. Jennifer Garrison, a neuroscientist and aging researcher at the Buck Institute for Research on Aging; Dr. Jessica Shepherd, Flow Space Advisory Council member, author and OB-GYN; and Dr. Cynthia Thurlow, a nurse practitioner and menopause expert.
The panel delved into groundbreaking research on menopause, its connection to aging and the overlooked impact on male health, particularly regarding how menopause influences the health span of both genders.
When Garrison originally began her research on aging, she cared “much more about the brain.” However, after understanding how the mechanisms of aging could target a whole range of age-related diseases, Garrison was intrigued.
“As it turns out, most of the chronic diseases in the modern world, age is the number one risk factor for things like cancer, cardiovascular disease, neurodegenerative disease,” Garrison says. “It’s not your cholesterol. It’s your age that is a bigger risk factor.”
The science of health span
Garrison stressed the importance of distinguishing between lifespan and health span, particularly in the context of menopause. While extending lifespan in lab animals is possible, she underscored that the real focus should be on extending health span—enabling people to stay healthy and vibrant for as long as possible.
She further explained that aging is the primary risk factor for chronic diseases, with menopause acting as an accelerant for this process in women. Although women generally outlive men, Garrison noted they often spend a greater portion of their later years in poor health, largely due to the rapid aging of their ovaries.
Shepherd went on to say that as menopause sets in, the body goes through a series of changes—sometimes gradual, sometimes abrupt—that affect everything from our mood to our physical health.
“Estrogen is a wonder drug, in my opinion, and [as estrogen begins to fluctuate and eventually decrease] that’s really where we start to see the decline in longevity or the health span of women,” Shepherd says. “This is why we see heart disease is still the number one killer of women, but it also has a really interesting play and a direct correlation with inflammation and aging.”
Menopause isn’t solely a women’s issue—it impacts everyone, including men who are often partners, siblings, or friends of those experiencing this transition. By educating themselves about the symptoms and challenges of menopause, men can play a vital role in providing understanding and support to the women in their lives.
Shepherd continued to highlight the complex relationship between the decline of estrogen and aging, noting that 70 to 80% of Alzheimer’s cases occur in women. The decrease in estrogen during menopause is a key factor in increasing the risk for neurodegenerative diseases, heart disease and cancer, all of which disproportionately affect women.
The HRT debate
As a nurse practitioner, Thurlow recalls revisiting her physiology textbooks from undergraduate and graduate school when she first sought to deepen her understanding of menopause. To her surprise, she found only two sentences dedicated to the topic. She reflected on how her career coincided with the release of the 2002 Women’s Health Initiative (WHI) study, which claimed that the risks of hormone replacement therapy (HRT) outweighed the benefits for healthy postmenopausal women.
The study’s findings led to widespread fear, resulting in many women discontinuing HRT out of safety concerns. However, Thurlow emphasized that the WHI study has since been debunked, with subsequent research showing that HRT is safe and can be a highly effective treatment for managing menopause symptoms.
“You have an entire generation of clinicians that were fearful of hormones,” Thurlow says. “In many instances, patients who were fearful of hormones. I feel like now the pendulum is swinging back, and we’re bringing greater awareness and greater information is available, not just to clinicians, but the amplification of women in perimenopause and menopause who are demanding better care.”
Additionally, Thurlow reflected on how the WHI study, which linked estrogen to breast cancer risk, had lasting consequences. The study’s flawed conclusions, amplified by media coverage, led to a widespread reduction in HRT use, despite later studies showing no conclusive evidence that estrogen causes breast cancer.
Recognizing symptoms early
The panel also discussed the wide range of symptoms that accompany perimenopause and menopause, emphasizing how these changes can begin for women in their late 30s, often with subtle signs like fatigue, mood swings and insomnia. These symptoms can be easily mistaken for lifestyle or stress issues, making diagnosis challenging.
Shepherd and Thurlow stressed the importance of recognizing these signs early and offering treatments, such as HRT, to address the root cause rather than just the symptoms.
“I hear more women talking about fatigue, brain fog, weight loss resistance, crime scene periods, insomnia, anxiety and depression,” Thurlow says. “Many of my patients come to me, and they’re on antidepressants, anti-anxiety agents, perhaps appropriately, but in many instances, what they need is progesterone. I guess the conversation really should start around what’s happening at the beginning of perimenopause that’s driving a lot of those early symptoms.”
Shepherd echoed Thurlow’s sentiments, noting that addressing menopause symptoms is one of the most challenging aspects of her practice. She emphasized the complexity of managing the wide variety of symptoms and determining how much they might be influenced by lifestyle factors.
“There needs to be this blend in a practice. What are the things in your life, if we were to really look at it, could be dealt with in a lifestyle fashion?” Shepherd says. “Our bodies take fuel differently through nutrition. Could it really be the stress factor? Which we do know now from research that there is an increase in mood disturbances, depression, anxiety, through the perimenopausal phase due to these fluctuations of hormone, but do we necessarily just want to put everyone on antidepressants, which is a very big thing that happens now as well”
Greater education and awareness
The panel ended with a call to action for greater education and awareness about menopause and its far-reaching effects on both women and men. The need for improved treatment options, better communication between healthcare providers and patients and a greater understanding of the hormonal changes at play were highlighted as crucial steps in supporting individuals through this often-overlooked life stage.