Menopause

Overview

Menopause, typically occurring between the ages of 45 and 55, marks the end of a woman’s reproductive years and is defined by 12 consecutive months without menstruation, typically due to naturally declining estrogen and progesterone levels. Menopause – and perimenopause, the period of months or years leading up to a woman’s last period – can cause hot flashes, night sweats, sleep disturbances, mood changes, vaginal dryness, joint pain, and cognitive symptoms. The severity of these symptoms varies, with some women experiencing mild discomfort while others suffer more severe effects. Menopause also increases the risk of cardiovascular disease, decreased bone density, osteoporosis (where bones become weak and brittle), stroke, changes in weight distribution, and urinary issues. Mental health may also be impacted, with anxiety and depression being common. Socioeconomically, menopause poses problems including workplace challenges and increased healthcare costs. Addressing issues that arise from menopause requires efforts on many levels, from mental health support, workplace policies and better social understanding and consideration. Women with menopause symptoms that negatively impact their health can also benefit greatly from symptomatic management through biomedical intervention.

Unmet needs

Research-driven advancements in menopause care are needed to improve the quality of life and health outcomes of women negatively impacted by their menopausal and perimenopausal symptoms, alongside better diagnostics to personalise treatment plans. Current options center on hormonal therapy (HT), which is effective and considered safe, although it carries some risks for those with hormone-sensitive cancers. While a long-misrepresented association with elevated breast cancer risk left a generation of women without the medicines they need, recent research challenging this link has led to a resurgence in HT use. Costs and limited availability mean it remains out of reach for many, however, particularly women in LMICs. Non-hormonal options, such as antidepressants (SSRIs, SNRIs), and neurokinin-3 receptor (NK3R) antagonists, are useful alternative options for managing symptoms. Still, gaps remain if we are to better meet the myriad needs of women with menopausal symptoms that are negatively impacting their health and well-being. A better understanding of the systemic consequences of menopausal transition on women’s bodies, as well as new drug delivery systems to lower hormone doses and new non-hormonal therapeutics, is needed to address long-term risks for cardiovascular, cognitive, and musculoskeletal health.

Funding

Menopause received $28m in 2023 R&D funding, representing (though only narrowly) the largest recipient among the gynaecological conditions we cover. Most menopause funding was allocated to either drug development ($8.6m, 30%) or basic research ($16.5m, 58%), the latter reflecting growing interest in better understanding the condition and its symptoms.

The US NIH was the primary funder, contributing 85% of the total. Mirroring the overall distribution of funding, most of this was directed towards basic research ($15m, 64%) and drugs ($7.9m, 33%), targeting a range of menopause-related conditions, including perimenopausal mood disorders and Alzheimer’s prevention. Most of the remaining funding was in the form of industry’s clinical development of intravaginal hormone rings ($2.3m, 8% of the total).

Innovate UK was the sole funder of diagnostics R&D for menopause, contributing $0.3M, most of it for Tuune, a tool aimed at enhancing diagnosis and care pathways for perimenopausal women in the UK, but with potential relevance to women in LMICs.

The only funding for devices came from industry, much of it supporting the development of a monthly bioidentical hormone intravaginal ring for menopause management. This innovative device aims to provide sustained, targeted hormone delivery, helping to alleviate symptoms and support hormonal balance.

Funding for menopause