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Reframing the Importance of Studying Reproductive Ageing

By studying ovarian ageing, we can gain insights into overall ageing processes that potentially progress men’s and women’s health: Ovaries age faster than other organs, serving as an early indicator of ageing processes. Studying these early changes could provide critical insights into general ageing mechanisms, which could help men and women progress to living better for longer.

Gaining Insights into Overall Ageing Processes Through Studying Ovarian Ageing

The rapid ageing of the ovaries, compared to other organs, makes them a pivotal marker for studying the broader ageing processes that affect both men and women. Because the ovaries decline functionally at a much earlier age, they provide a unique window into the cellular and molecular pathways that drive ageing across the human body.

Potential for Broader Health Impacts: By studying ovarian ageing, researchers can potentially uncover new ways to mitigate ageing in other ways. The mechanisms behind the decline in ovarian function—such as oxidative stress, telomere shortening, and changes in inflammatory responses—are also common factors in general systemic ageing.

Implications for Men’s and Women’s Health: Although ovarian ageing is specific to women, the general mechanisms of ageing it highlights are applicable to both sexes.

Living Better for Longer: The ultimate goal of studying ovarian ageing is to extend life and improve the quality of life as we age. By identifying how ovary changes correlate with broader health declines, interventions can be designed to maintain health and vigour, regardless of gender.

Promoting Health Equity through Understanding Female Reproductive Ageing

As life expectancy increases and societal norms evolve, more women are choosing to delay childbearing. This shift, coupled with the fact that women live longer, underscores the importance of a deeper understanding of female reproductive ageing. However, extending lifespans without addressing the specific health transitions that women experience, such as menopause, inadvertently widens health disparities.

Enhancing Systemic Health by Understanding Reproductive Ageing

The ageing of ovaries encompasses more than just a decline in fertility; it has profound implications for overall systemic health that extend far beyond the reproduction capability.

• As women age, the quality of their eggs deteriorates, and pregnancies later in life can face increased risks of complications. These direct effects are significant, yet the impact of reproductive ageing spreads even more comprehensively, influencing various other aspects of health.
• Menopause and related conditions represent significant health transitions with a profound negative effect on women’s health. These transitions are not merely about fertility decline but involve systemic physiological changes that can impact long-term health outcomes.
• The incidence of conditions like osteoporosis, cardiovascular disease, arthritis, and changes in brain function such as cognitive decline, insomnia and depression are linked to oestrogen deficiency in women. Other changes include weight gain, increased visceral fat, and profound changes in gut microbiome diversity,

So though modern medicine has achieved remarkable gains in how long women (people) live, going through menopause in midlife means 1/3 of life is spent in an estrogen-deficient state, with accompanying poorer health.

Addressing the unique aspects of female health transitions through dedicated research and tailored healthcare interventions is essential for achieving health equity in our increasingly ageing world.

The Path Forward:

Promoting research into the systemic effects of reproductive ageing can lead to more effective preventive measures, therapies, and health strategies for women and men and an increase in precisely addressing the needs of ageing women. This comprehensive focus could significantly improve quality of life and reduce the burden of age-related diseases, marking a significant step forward in women’s health care.

The Global Consortium for Reproductive Longevity and Equality (GCRLE) is reframing the importance of studying reproductive ageing, effectively marrying the two fields of geroscience and reproductive longevity. The GCRLE’s focus is to catalyse research into reproductive ageing and facilitate an ecosystem that helps accelerate reproductive longevity and equality progress. To bring together scientists, clinicians, and funders, GCRLE seeks to develop interventions to slow or reverse reproductive decline, promoting better health outcomes for women.

The focus on reproductive ageing extends beyond fertility and encompasses a woman’s quality of life, influencing career, family planning, and long-term health. Addressing this with adequate funding and research could lead to significant advancements in gender health equity and quality of life for women as they age.

Women, wellness, and work.

Women over 50 are one of the fastest-growing groups in the workforce, but menopausal symptoms can significantly affect their quality of life, work performance, and attendance. Despite this, the specific impacts of menopause on work and career development have been understudied. Symptoms like fatigue, difficulty sleeping, poor concentration, and memory issues frequently impact work and are linked to reduced performance, attendance, and career progression decisions.

Mood and menopause.

Mood changes during perimenopause and menopause are due primarily to fluctuating hormone levels, particularly oestrogen. Hormone replacement therapy (HRT), which stabilises these hormone levels by giving replacement oestrogen and, for some women, testosterone, is one of the most effective treatments.

The correct dose and type of HRT can significantly improve mood, restoring motivation, energy, and a sense of well-being. Many women report feeling calmer and happier within a few months of starting HRT, alongside improvements in other menopausal symptoms like hot flashes, night sweats, insomnia, and vaginal dryness.

Research also suggests that starting HRT during perimenopause can lower the risk of developing clinical depression. Women who have previously been prescribed antidepressants often find that their mood improves with the suitable HRT, enabling them to reduce or even stop their antidepressants as their symptoms improve.

Health risks and oestrogen decline.

Postmenopausal women face a range of health challenges, to name a few: increased risks of cardiovascular disease, osteoporosis, and dementia.

Cardiovascular Disease: After menopause, women’s risk of heart disease rises significantly. The loss of oestrogen, which has protective effects on blood vessels, can lead to higher blood pressure and cholesterol and an increased risk of heart attacks and strokes. Studies show that women experience a notable rise in cardiovascular risk factors after menopause, contributing to their higher risk compared to pregnant women.

Osteoporosis: Postmenopausal osteoporosis is common, affecting about 1 in 3 women worldwide. Oestrogen deficiency accelerates bone loss, making women more susceptible to fractures. Around 50% of women over 50 may experience a bone fracture due to osteoporosis​(

Dementia: There is growing evidence linking menopause-related changes, particularly in hormones, to an increased risk of cognitive decline and dementia. Oestrogen appears to have a protective role in brain health, and its decline during menopause may contribute to a higher risk of dementia later in life.

What do humans and orcas have in common?

Beyond being mammals, we share an astonishing evolutionary trait: We are part of a rare club that experiences menopause. Others in our group include narwhals, belugas, and short-finned pilot whales.

Why do such vastly different creatures share this trait?

We do not know, however; research suggests menopause evolved to boost species survival and longevity, allowing older females to support future generations. This is called the grandmother hypothesis.

Orca Social Structure

Orcas live in matriarchal pods, where male and female offspring remain with the group throughout their lives. Grandmother orcas provide intergenerational support for their grand-calves, boosting the entire pod’s survival and ultimately helping future generations.

• Menopausal whales live decades longer, seeing their grandchildren mature, whereas non-menopausal whales die much earlier.
• This extended life doesn’t apply to males, who prioritise mating with multiple partners over family care.
• Adult male orcas are more likely to survive when their mothers are present.

This parallel evolution in humans and toothed whales reveals how menopause evolved to boost intergenerational support and survival. Perhaps menopause is a superpower in improving the security of our species.

The common use of antidepressants over HRT ignores the crucial impact of hormonal changes on women’s mental health during perimenopause.

There is a persistent trend of prescribing antidepressants rather than hormone replacement therapy (HRT) for menopause symptoms like depression and anxiety.

The symptoms arise because oestrogen levels drop quickly during the transition period of perimenopause. The brain (like just about every cell in the human body) contains oestrogen receptors. So as oestrogen plummets, a rollercoaster ride of emotion is unleashed.

Prescription of antidepressants for these symptoms raises essential questions about knowledge and gender biases in medicine.

Have historical misconceptions surrounding menopause influenced treatment approaches?

In the Victorian era, the term “climacteric insanity” encapsulated the view of menopause as a form of mental illness, leading to radical cures like oophorectomy or institutionalisation. This period was characterised by a profound misunderstanding of female health and reflected broader societal stigmas regarding the direct connection between women’s reproductive health and mental stability.

Moving back further to the Middle Ages, the notion of a “wandering womb” causing physical and psychological ailments further illustrates how archaic and misguided perspectives have plagued women’s healthcare. So, how far have we come?

Today, despite a significant shift in understanding, there remains a notable reliance on antidepressants to treat symptoms more directly associated with hormonal changes rather than addressing the root cause through HRT.

This approach overlooks substantial evidence that HRT is more effective in not only stabilising hormone levels but also in alleviating the full spectrum of menopausal symptoms, including mood disturbances.

Organisations like The Menopause Charity and a growing chorus of doctors working in the menoverse advocate for HRT as the first-line treatment, emphasising its benefits over antidepressants..

The prevalent issue of antidepressants being overprescribed to perimenopausal women can be attributed to a multifaceted set of challenges within the healthcare system.

A critical factor is the inadequate training that healthcare providers receive regarding the nuances of perimenopause and menopause and the effective use of hormone replacement therapy (HRT). This educational gap, combined with insufficient funding dedicated to women’s health research, perpetuates outdated treatment approaches.

Moreover, societal and medical ignorance surrounding menopause lingers. We are still trying to escape the long shadow cast over menopause management that arose from misinterpretations of the Women’s Health Initiative. Additionally, there is an inherent gender bias in medical treatment; psychological symptoms in women are perhaps too readily diagnosed as mental health issues without investigation into possible hormonal or physiological origins.

More broadly, social views of aging, particularly in women, make this oversight worse. The role of the grandmother is precious, but women become silent and silenced, and the health concerns of women of ‘a certain age’ are minimised. Menopause is hot flashes, right? This reductionist view overlooks the broader spectrum of menopausal impacts and fails to address the role and needs of ageing women comprehensively.

Addressing these issues requires a concerted effort to enhance medical education, increase funding for women’s health research, and shift societal attitudes to recognise and adequately treat health conditions unique to women during menopause.

The historical trajectory from viewing menopause as a disease to a life stage progresses, yet the current prescribing practices suggest that more strides are needed to transcend outdated notions and provide care that aligns with contemporary medical understanding.

It is crucial to challenge these persistent gaps in understanding and bias and ensure that treatment options are rooted in the best available science, advocating for patient-centred care that genuinely addresses the complexities of women’s health during menopause.