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Straight talk: Why we need to talk about hormones beyond reproduction

Knowing that our hormones are fluctuating in a healthy pattern is important at any life stage

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When we say hormones, we often think about the reproductive hormones testosterone and oestrogen. Very few know that hormones are, in fact, responsible for every function in our bodies.

Hormones are chemicals secreted by our glands in order to send “messages” through the bloodstream, simply letting the body know what to do to run smoothly. Indeed, they regulate growth, sex drive, reproduction and metabolism, but they are also integral to our digestive, immune, urinary, nervous, cardiovascular, respiratory and skeletal systems.

When it comes to hormonal fluctuations – during menstruation and beyond – experts agree that there is a big education gap. A report published by the female-founded cycle company Fewe found that, of the 2,000 participants interviewed, more than half believed the menstrual cycle was just one week long, while 90 per cent did not see a correlation between their hormones and their health. The same number did not consider management of hormones as an important way to improve their health and wellness.

“What really surprises me is that even us, as women, don’t understand our hormones,” says Sarah Bolt, founder of the biomarker tracking platform, Forth. “Often hormones are talked about in relation to reproduction, but they are so important to our everyday health.”

The lack of knowledge is even more prevalent in regard to perimenopause and menopause. “The two are used very much interchangeably,” Bolt explains. “We see more conversations around periods, but there’s still such a long way to go. Menopause is getting a lot of publicity at the moment, helped by figures like Davina McCall and her recent programme, but we know we need to do a lot more to educate women about the importance of their hormones, how they fluctuate and how they impact all areas of their health. It’s not just about having children.”

Her company, Forth, offers a full range of tests – from liver function tests to immune system, thyroid and hormone tests, providing detailed insights and advice on how to help your body perform to its best. MyFORM, a female hormone mapping test available to women who want to check if their hormones are fluctuating in the correct pattern, is one of them.

The test is suitable for women who want to check their fertility, identify or manage a hormone-related condition such as polycystic ovary syndrome (PCOS), but also for those wanting to check if their hormone network is healthy or for sportswomen who may be at risk of relative energy deficiency in sport (RED-S).

The idea behind the at-home test came after Sarah, working for the NHS, noticed how often women’s symptoms and hormonal imbalances were ignored. “Women were not being listened to particularly during perimenopause and menopause,” the founder tells me. “Our chief medical officer, Dr Nicky Keay, is an endocrinology specialist and she was frustrated because the tests at that time  were not able to capture whether a woman’s hormones were fluctuating in the correct pattern during the entire length of her cycle.

“I myself had been going through perimenopause and I listened to all of my friends going through it. Very often they weren’t being given the correct information by GPs or they ended up being put on antidepressants. So, we decided to look at how we could come up with a solution.”

By combining blood analysis and information about your cycle length, the hormone test mathematically maps how each of your four ovarian hormones fluctuate across your entire cycle and it gives you a detailed, personalised report with next step actions.

MyFORM home kit

“Knowing that your hormones are fluctuating in the healthy correct pattern is important at any life stage and for general wellbeing,” Bolt points out. “So, our bigger goal is to educate women about these hormones and how important they are to their everyday well-being. We recognise those who are on fertility journeys, but we also look at women experiencing conditions like PCOS that they may not even know about.”

MyFORM can also be particularly useful for women who are doing a lot of exercise and who can develop relative energy deficiency syndrome that causes fatigue, low energy, disordered eating, menstrual dysfunction and low bone mineral density.

“Their periods just stop completely,” the founder says. “And that really starts to compromise their health. If you’ve got an imbalance in energy in and energy out, your body will start to go into survival mode. The test identifies if there is a drop in hormones and help you understand the relationship between those variations and how you feel.”

Once they order the blood test, women need to collect a sample on day 14 and day 21 of their cycle and then post it back to the company’s lab. The results are then available on their online account within two working days. Sarah says that women are very surprised when they get the results, because they’ve never been given this kind of information before. “They find it really insightful.”

She tells me that the next step is to expand Forth beyond the UK and develop “an ecosystem” that takes care of women’s health. “I’m also hoping to raise more awareness and help women spot some of the conditions that they might have,” the founder continues. “One of the things that women don’t realise is that the drop in their hormones can really impact their bone health. That is why athletes, for example, have a drop in their hormones and get more injury-prone, because their bone health becomes compromised. That is also why many women develop osteoporosis post-menopause.

“So, we want to open up this conversation because it’s just a natural part of women’s life. There’s nothing embarrassing. Why would it?”

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US virtual care clinic Midi Health to expand in all 50 states

The clinic provides insurance-covered, expert care for women in perimenopause and menopause

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The US virtual care clinic Midi Health will expand its services in all 50 states in an effort to help women navigate menopause.

Midi Health aims to provide holistic perimenopause and menopause care and help women navigate the midlife hormonal transition through virtual care.

The company offers personalised care plans and services, including hormonal and non-hormonal medications, supplements, lifestyle coaching and vital preventative health guidance.

Over 6,000 women in the US reach menopause every day, which is defined as starting 12 months after a woman’s last period.

On average, they reach menopause at 51, but perimenopause can occur much earlier. This lead-up period, when hormones can fluctuate wildly and symptoms may be at their worst and most unpredictable, lasts four to seven years, although in some cases it can extend as long as a decade.

Symptoms, which may include hot flashes, insomnia, anxiety, depression, brain fog, memory loss and genitourinary problems, have a significant impact on women’s quality of life and career growth.

“We can’t talk about women’s success at work without talking about menopause,” said Joanna Strober, CEO and co-founder of Midi Health.

“With far too few practitioners trained in managing menopause, women are underdiagnosed, undertreated and underserved.

“Midi provides an insurance-covered solution that focuses on women’s unique needs, closing a major gap in health access, quality and equity.”

She added: “We are expanding rapidly to ensure that we can support employers and employees in all 50 states with Midi’s care.”

The expansion comes weeks after Strober announced a US$25m funding round from Google Ventures (GV) aimed at accelerating partnerships with hospital systems and major US employers, bringing the company’s total funding raised to date to US$40m. 

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Updated menopause toolkit to help doctors provide better care

The toolkit includes new advice and therapies for assessing and treating menopause-related health issues

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An updated toolkit that guides health professionals in treating menopause health issues has been published in an effort to improve care for women globally.

Endorsed by the International, Australasian and British Menopause Societies, the Endocrine Society of Australia and Jean Hailes for Women’s Health, the 2023 practitioner’s toolkit for managing the menopause is designed to be used anywhere in the world.  

The toolkit, published originally in 2014, has been updated with new advice and therapies based on a systematic review of the latest menopause research and best practice.

The new version includes bone health guidance, such as recommendations about when menopause hormone therapies might be needed to prevent bone loss and osteoporosis in asymptomatic women.

The update also incorporates new medications including fezolinetant for hot flushes, ospemifene for painful sex, and vaginal DHEA for vaginal dryness.

First author and Monash University women’s health research programme head professor Susan Davis, who also led development of the toolkit in 2014, said the update included some new therapies but did not support menopause hormone therapies for cognitive symptoms or clinical depression.

“Clinical trials have not shown a benefit of menopause hormone therapies for cognitive function,” she explained.

“The most robust studies have shown it to be no better than placebo.”

She added: “Regarding depression, menopause may cause symptoms such as low mood, anxiety, irritability, and mood swings, but clinical depression needs to be assessed and managed in its own right.

“Menopause might exacerbate underlying depression but should not be assumed to be the cause of clinical depression.”

Davis said the advice was now much clearer around preventing bone loss and fracture.

“To our knowledge this is the only document that provides guidance for using hormone therapy to prevent fracture. Other recommendations have been vague such as ‘can be used to prevent bone loss/fracture’ or ‘use to treat osteopenia’.”

The author said it was important for women to see their GP if they experienced troubling physical or mental health symptoms.

“We have updated this as part of an NHMRC Grant to upskill GPs and to embed the care algorithms into GP practice software in the MenoPROMPT study programme, which aims to improve care for women who need it. This is a very important feature of this update.”

Senior author Dr Rakib Islam, from the Monash University School of Public Health and Preventive Medicine women’s health research programme, said the updates would make a difference for many.

“The 2023 practitioner’s toolkit is the most up-to-date evidence-based practical guidance for health care providers to menopause care globally,” he said.

The paper’s authors said the recommendations needed to be applied in the context of local availability and the cost of investigations and drug therapies.

“Most importantly, the toolkit provides the full spectrum of available options and therefore can be used to support shared decision making, and patient-informed care,” they added.

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US fertility benefits provider to introduce perimenopause and menopause support

Patients will be able to have access to specialist health providers trained in menopause and perimenopause care

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The US fertility benefits company WIN is to launch a new initiative to help women access perimenopause and menopause support.

The WIN PowerPause programme aims to provide women with perimenopause and menopause support and help patients access specialty care through the virtual menopause clinics Midi Health and Visana Health.

Nurse care advocates will be able to discuss with women perimenopause and menopause symptoms and help them prepare questions to ask their provider during doctor visits. They can also match patients with providers best suited to treat their symptoms.

Patients in all 50 states will have access to providers who are specially trained in menopause and perimenopause care.

WIN says its PowerPause project will also ensure patients have access to behavioural health coaching, nutritional guidance, and prescription medications.

“We are proud to roll out WIN PowerPause to simultaneously address both health and business concerns,” said Roger Shedlin, president and CEO at WIN.

“At WIN, our clients recognise that overlooking menopause care widens the equity gap, given the impact perimenopause and menopause can have on women at a critical time in their careers.

“This is especially true for members in the BIPOC community who tend to experience longer transition periods with more intense symptoms.

“Employers offering comprehensive women’s healthcare to employees is a strategic investment in supporting diverse workforces and fostering a healthier, more productive and engaged team.”

Shelly MacConnell, chief strategy officer at WIN, said: “The population navigating menopause and perimenopause have been underserved, misdiagnosed, or even mistreated due to lack of specialised support and care coordination—until now.

“Through WIN PowerPause and the partnerships with Midi Health and Visana Health, WIN’s goal is to help patients minimise the impact of their symptoms and support them in finding the highest levels of care through seamless coordination.

“This creates a positive patient experience during what can be a stressful and uncertain time in a woman’s life.”

Joe Connolly, co-founder and CEO at Visana Health, added: “We are proud to partner with WIN, a long-standing and trusted fertility benefit company, to provide our patients with access to fertility care and family-building resources.

“This partnership also provides employer partners with the most comprehensive women’s health solution that meets the needs of all women in the workplace, regardless of what stage of life they’re in.”

Joanna Strober, co-founder and CEO of Midi Health, said: “Midi is excited to partner with WIN to expand access to expert-level care for women. Perimenopause and menopause symptoms are treatable, and there is no reason for women to just power through.

“With care protocols created by world-class specialists and a team of highly trained clinicians, Midi’s treatment ensures women are heard and treated appropriately.”

Each year in the U.S., nearly US$1.8bn is lost in work productivity due to menopause symptoms and the associated chronic, yet preventable, conditions, but quality menopause care is hard to find.

Only 1,500 providers worldwide are menopause certified, less than 20 per cent of OB/GYNs receive menopause training, and nearly three-quarters of women report not receiving the necessary treatment for menopause symptoms.

“Menopause is a profound and transformative period in a woman’s life, and it deserves the same level of specialised attention and expertise,” said Dr Lubna Pal, professor of obstetrics, gynaecology and reproductive sciences at Yale School of Medicine and consulting medical director and at WIN.

“Offering dedicated menopause care allows women the knowledge and support they need to navigate this transition in life.”

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