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From Brain Fog to Weight Loss: 5 Menopause Research Updates
New findings that could shape menopause
9-minute read
Naomi Elliott
At the Menopause Society’s annual meeting this week, researchers are presenting new data on everything from effective menopause treatments to GLP-1 use and ADHD medications. Here are five new pieces of research that may change how clinicians treat perimenopause and menopause.
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1. GLP-1s plus hormone therapy boost weight loss
About 1 in 5 women ages 50-64 have taken a GLP-1, the highest use of any age bracket. Yet women in menopause who take GLP-1s tend to lose less weight than premenopausal or perimenopausal women, explains Dr. Stephanie Faubion, director of the Mayo Clinic Center for Women’s Health and medical director of The Menopause Society.
But according to emerging research, when paired with hormone therapy, a GLP-1 is as effective at sustained weight loss during menopause as it is for women at other stages of life. “It’s not like you’re losing oodles more [weight],” explains Faubion. Rather, hormone therapy enables menopausal women to “catch up to what their peers might have lost.”
Faubion cautions that the research, on 2,400 women, is based on observational data. That means there may be other, outside factors unrelated to the combination of medications that could be causing that additional weight loss.
And, Faubion says, there is still a lot to learn about GLP-1s during perimenopause and menopause. “When you lose fat, you also lose lean muscle mass and bone mass,” which occurs during menopause because of estrogen depletion. Researchers don’t yet know if the muscle and bone loss that accompanies fat loss on GLP-1s is more pronounced in women than in men, for instance.
Because midlife weight gain tends to accumulate in the belly, increasing glucose, cholesterol and blood pressure, Faubion’s research group hopes to study the optimal timing for prescribing a GLP-1. Perhaps, she says, prescribing women in perimenopause a small dose of a GLP-1 to prevent weight gain may “prevent some of these adverse metabolic changes.”
“Stay tuned,” Faubion adds. “We don’t have the answers yet.”
Faubion also strongly recommends against taking a GLP-1 from a compounded pharmacy. Because the drugs are difficult to make, popular online compounding pharmacies may not be selling semaglutide. That means even your clinician may not know what it is in the medication or what other effects it might have.
And while she recognizes that midlife weight gain can be frustrating, she emphasizes that exercise and diet are important tools that women can use to address those changes. “We don’t know the consequences yet” of GLP-1s, she says, which typically must be taken for the rest of a person’s life to maintain their efficacy.
2. ADHD medications may help with executive function during menopause
Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed among girls and women, and a generation of women are getting diagnosed as adults. That can be tricky for women in midlife, because symptoms look similar to the brain fog that an estimated 44 to 60 percent of perimenopausal women experience.
A key difference? Perimenopausal brain fog generally resolves with time. ADHD does not.
Whether ADHD medications can address brain fog caused by hormone fluctuations isn’t clear. But a new review of studies presented at The Menopause Society’s annual meeting suggests that the ADHD medications Vyvanse (lisdexamfetamine) and Strattera (atomoxetine) improved women’s subjective perceptions of executive functioning. They did not, however, affect working memory or sustained attention, the researchers found.
That does not mean ADHD medications should be prescribed in an OB-GYN setting, says Jennifer Tat, the study’s lead author from the University of Tennessee Health Science Center in Memphis. Instead, these clinicians might offer a screening tool for ADHD to a patient experiencing brain fog.
“If someone screens positive, then maybe we don’t try the hormone therapy for brain fog, but refer the person to a psychiatrist who can do a longer structured interview,” prescribe medication and taper them appropriately, Tat says. Plus, it’s important to note that the medications aren’t without side effects.
What’s not yet clear is whether ADHD worsens in perimenopause or menopause, says Tat.
And while brain fog and inattentiveness are real problems for women in midlife, Faubion also notes that the culture overall doesn’t help. “We’re expected to be attentive to all things at all times — your watch buzzes, your phone rings, the email is crazy. Does that mean I have ADHD? Absolutely not.”
As with GLP-1s, Tat cautions women from “self-diagnosing” and ordering medication from online pharmacies. If you’re experiencing brain fog or ADHD symptoms, have an “open conversation with your doctors so we can figure out how we can help you.”
3. Not just hot flashes: Gas, bloating and anxiety are common symptoms of menopause
Hot flashes may be the symptom most commonly associated with menopause, but it isn’t the only one. Fluctuating hormone levels can also wreak havoc on the gut and the digestive process, causing gas and bloating.
New research from the University of Calgary involving more than 1,800 women between the ages of 40 and 60 found that excessive bloating and gas were the most prevalent menopause-related gastrointestinal (GI) symptoms, with roughly 66 percent of women scoring above the normal severity range.
Anxiety is also common during the menopause transition, with many women experiencing more severe symptoms during perimenopause. Overall, nearly 20 percent of women in the study [17.5 percent] reported moderate to severe anxiety during menopause.
And researchers are questioning whether there is a connection among all of these symptoms. Anxiety is modestly correlated with an increase in GI symptoms, says Sanjana Solomon, lead author on the study.
Going forward, the research group plans to study participants’ microbiomes, Solomon says, to “see if we can better understand the relationship between GI symptoms and anxiety in general.”
Understanding GI symptoms and anxiety during menopause is important, Faubion says, “because fluctuating and declining hormone levels create a disruptive bidirectional interaction in which GI distress worsens anxiety and anxiety triggers further gut symptoms.”
4. Your next prescription could be for exercise
For women in perimenopause and menopause, multiple clinical trials have shown that exercise, including yoga and strength training, can improve metabolic and cardiovascular health, bone density and blood pressure, among other benefits. Other systematic reviews have found that strength training may reduce hot flashes, night sweats and heart palpitations.
But many women are not getting the exercise they need. Data show that only 7 percent of midlife women routinely meet physical activity guidelines, and only 24 percent engage in strength training twice a week.
Getting people to exercise can be challenging, and advice on exercise can be overwhelming, says Dr. Amy Comander, who works with breast cancer patients as medical director and director of breast oncology and cancer survivorship at the Mass General Cancer Center.
Enter exercise prescriptions: a doctor’s specific instructions about what and how much aerobic and strengthening activity to do and how to fit it into your daily routine.
The prescriptions address common obstacles, such as not knowing how to get started, says Comander, who discussed exercise prescriptions at The Menopause Society’s meeting. Patients may say, “‘I don’t want to go to a gym,’ or, ‘I’m scared to go to a gym with the muscle-y guys,’ ” Comander explains.
In that case, a prescription can include specific exercises to be done at home, such as planks, squats, lunges and push-ups.
Another part of exercise prescriptions is the psychology behind the written instruction. “It’s motivating if your doctor hands you a piece of paper with a prescription on it,” says Comander. Put it on the refrigerator — “then you’re committed,” adds Faubion. “And the more commitment there is, the more likely you are to follow through with it.”
Research has shown these prescriptions can move the needle. An older randomized controlled trial involving 1,089 relatively inactive women found that those who received an exercise prescription along with coaching became more physically active and improved their scores on measures of physical and mental health.
5. Women are finding success at shared medical appointments
In a traditional doctor’s appointment, a person sees their clinician on average for less than 20 minutes. But emerging research suggests that shared medical appointments, in which a group of 10 to 12 people meets for 1.5 to 2 hours at a time, may be a promising model for supporting women in initiating beneficial lifestyle changes during menopause.
For the new study, Dr. Karen Adams, clinical professor of obstetrics and gynecology at Stanford University and the Farwell Family Director of the Stanford Program in Menopause & Healthy Aging in Palo Alto, California, led a program that enrolled 28 women. After an initial one-on-one appointment, 14 women split into two groups and met virtually once a week for six weeks.
Six months after the appointments ended, participants in shared appointments were more likely than peers who’d met with Adams one-on-one to report that they had initiated behaviors supporting exercise, sleep, stress management and sexual function.
The length of the appointments is part of what makes them so valuable, says Adams. One-on-one appointments are typically too short to thoroughly explore all of those issues.
Group dynamics also support behavior change. “The science of motivation tells us that group experiences are almost like commitment devices,” Adams says. “If you’ve set a goal for yourself, the week before [you show up for the group] will help you to implement that goal.” The community provided by the shared medical appointment is also therapeutic, she says. “People live longer, they do better, if they stay connected to other people.”
Importantly, Adams was able to make the appointments financially feasible, which can be an obstacle for physicians. And though the approach needs clinical trials to assess its efficacy, particularly regarding behavior change, Adams says, “it really is very exciting to me — the opportunity to make a difference for people in midlife.”
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