When it comes to menopause, ‘it’s not all in your head,’ and Pittsburgh-based research is proving it – Bradford Era

PITTSBURGH (TNS) Julie Bonnett has been a personal trainer and group fitness instructor for 22 years, amassing a list of certifications too numerous to name and a client list that includes some high-profile, and beloved, Pittsburgh athletes.

By happenstance, she trains mostly women, which is convenient, as she has 53 years of experience as a female herself and just as much experience supporting other women, as a friend, sister and daughter.

But none of that fieldwork prepared her for what confronts women as they approach midlife.

When people talked about perimenopause and menopause, no one really knew the answers. Theyd just turn to their friends, who also didnt have any answers, Bonnett said. Its been such a taboo topic. People didnt talk about it, and people in my age range, most people didnt talk to their moms about it.

As a trainer, she heard these concerns from her clients, not only because they sought the slimmer, more toned physiques of their younger years, but because they often werent getting satisfying answers from their medical practitioners.

These gaps in knowledge are an unfortunate equalizer, as research shows they exist for both women and those who care for them, on multiple continents and across demographic groups, with 80% of women under 40 reporting no knowledge at all or just some knowledge of the menopausal transition, as shown in a 2022 study.

But the tide is turning, and some University of Pittsburgh researchers are at the helm, proving that menopause is far more than hormones and hot flashes, but a profound physiological change in womens bodies worthy of focus, funding and a cultural shift toward acknowledging this stage of life differently.

Taming tabooPitt researcher Rebecca Thurston is a nationally recognized leader in womens health, particularly at the intersection of menopause, cardiovascular disease and brain health.

She, too, hears pleas from midlife women to feel understood.

Oftentimes, women are running around to different providers to figure this out, and then they run into some providers who are relatively uninformed about the perimenopause and menopause transition, she said. In that context, they can feel dismissed about what theyre experiencing due to, potentially, these information gaps between the scientific literature around menopause and it not quite making it out into clinical dissemination.

That educational lag may also speak to a well-documented history of womens concerns being dismissed in society at large, particularly around a topic such as this one, which highlights both ageism and sexism, Thurston noted.

But as new generations of women reach midlife, those conventions are changing.

You see Millennials and Gen Z, theyre like, forget it. Were not going to hide this very normal and natural life transition, she said. I also think there are more women who are in positions of power and authority across multiple different industries, and theres increasing impatience in having this transition be something thats cloaked in silence, shame and taboo.

Because of cultural and scientific stumbling blocks to fuller discussions about menopause, the change was often generalized to merely mean the end of menstrual periods and the vague idea that hormones are involved.

Its true that menopause occurs when a woman has been without a period for 12 consecutive months, and perimenopause is recognized as the body gears up for that change, which is orchestrated by hormonal changes. Also true: Women often suffer in silence as they experience a plethora of other symptoms, such as brain fog, the redistribution of fat, and changes in sleep and mood.

Science is catching up. Researchers are beginning to explain not only the signs and symptoms associated with perimenopause and menopause the differences that women can sense in their bodies or that others might notice but underlying physiologic changes, many of which were either unrecognized or previously thought to be age-related rather than unique to women in this stage.

Science as validation

After noticing how many of her clients and friends were trying to reinvent the same wheel in their 40s and 50s, Bonnett pursued a Menopause Coaching Specialist certification through Girls Gone Strong, an organization dedicated to women-focused certification programs and coaching, as informed by professionals from Yale, Johns Hopkins and Baylor universities and more.

The experience further proved how specialized this set of knowledge is.

For a long time, Ive known all of the things that can happen if you dont eat enough protein, but I learned, for instance, that it can contribute to the brain fog women deal with, she said.

She also learned these symptoms can be subtle, and start much earlier than many think, in womens late-30s.

While its validating to hear that others are experiencing similar symptoms, the emerging science might lead to the most significant forms of support, and maybe a hint of uncomfortable reality.

Samar El Khoudary, a Pitt epidemiologist and pharmacist, researches cardiovascular disease in midlife women, and how menopause may contribute.

Through her research, and some performed by others, the scientific community now knows that women experience an increase in LDL (the so-called bad cholesterol), total cholesterol and the main fatty-protein carried by LDL during this stage of life, contributing to atherosclerosis and cardiovascular disease.

Further, HDL cholesterol, or good cholesterol, may change as women progress through menopause, rendering it less cardio-protective than previously thought.

When I go to my PCP, they say, At least your HDL is high, El Khoudary said. But me, researching this, I know that doesnt necessarily mean Im protected.

Her teams research also showed that, within two years of the final menstrual period, women begin to accumulate fat in their abdomens, a more dangerous area due to the inflammatory markers and the higher risk of metabolic disease associated with it.

Its interesting because research shows that women gain weight with menopause, but the research also shows that gaining weight is an aging phenomena, she said. What is related to menopause is where we put the fat in our bodies.

That fat also deposits around the heart, shes discovered, where inflammatory markers, and increased cardiovascular risk, follows.

Further, its now understood that the carotid artery one of the bodys largest vessels, which brings fresh oxygen and nutrients to the brain increases in thickness and gets wider around menopause, making the artery less able to accommodate changes.

Thurstons research shows that women are having more hot flashes than they think as monitored by an innovative sweat gland-assessing device worn on the sternum and higher numbers of hot flashes are indicators of cardiovascular disease risk, while ones experienced overnight are indicators of poor brain health.

The last thing I want to do is scare women, but these hot flashes are telling us something, she said. The action item is to start being on top of your cardiovascular health, by knowing blood pressure and lipid numbers, monitoring insulin resistance, maintaining a heart-healthy diet and adhering to medical therapies.

Thurston sits on the advisory board for Astellas Pharma, the company that developed Veozah, an alternative to hormone replacement therapies for the treatment of hot flashes, approved by the FDA in May 2023.

And she completely agrees with newly published findings showing that hormone replacement therapy, for the relief of menopausal symptoms, isnt as dangerous as propounded in 2002, which stated that HRT was linked to an increased risk of blood clots, stroke and breast cancer.

As El Khoudary interacts with this body of research, she thinks of her mother.

When she was in this stage, we didnt know what she was dealing with, she said. She thought she was just having a hot flash, but never thought that could have implications for heart health.

El Khoudary believes research on the menopausal transition empowers women in ways not available to previous generations, even if some practitioners are still catching up.

When you go to your PCP, ask, I have heard this can happen to my lipids, can we check that? And thats really what the goal is, she said. Women should have informed discussions with their PCPs, so that conversations can lead to better checking, screening and making sure everything is going the way we want in that stage of their lives.

Menopause coaching specialists like Bonnett are available to reroute home-based lifestyle habits and refer to medical practitioners as needed. If those practitioners seem underprepared, Thurston recommends looking up The Menopause Society, a nonprofit that compiles a directory of menopause-trained providers.

But first, women are best served to listen to their bodies and their instincts.

Its not all in your head. If you think something is changing, it probably is, Thurston said. But while we tend to think about menopause and midlife aging as all doom and gloom, I will tell you that midlife can be a wonderful time for women.

Our job as providers is to help women harness the good, decrease the bad and sail through midlife, which can be a great time.

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When it comes to menopause, 'it's not all in your head,' and Pittsburgh-based research is proving it - Bradford Era