In divide on women's health care, a consensus on menopause

WASHINGTON — Despite deep partisan divides on issues like abortion and contraceptive access, lawmakers from both parties appear to have forged a cautious consensus on another women’s issue: menopause.

The agreement became evident earlier this year, when a bipartisan group of female senators introduced legislation that would increase federal research on menopause and coordinate the federal government’s existing programs related to menopause and midlife women’s health for the first time.

At a press conference with actress Halle Berry in May, Sens. Tammy Baldwin, D-Wis.; Patty Murray, D-Wash.; Lisa Murkowski, R-Alaska; Susan Collins, R-Maine; Sen. Amy Klobuchar, D-Minn.; and Shelley Moore Capito, R-W.Va., touted the bill outside of the Capitol. On Wednesday, Murray joined Denise Pines and Tamsen Fadal, national advocates for improving menopause care and executive producers of the documentary “The M Factor: Shredding the Silence on Menopause” to highlight the bill at a panel on Capitol Hill — the first time, according to Murray, that such a discussion about menopause took place in the U.S. Capitol

“As one of my Republican colleagues said, that if men were experiencing this, it would already be funded (at NIH), but it’s not,” she said.

Kathryn Schubert, the CEO of the Society for Women’s Health Research, said the issue is one drawing consensus during a time of divisiveness on other women’s issues.

“We’re seeing this as an issue where people can sort of coalesce around in the women’s health space,” she said.

Schubert said a key issue hindering research on menopause is the inability to track it to begin with. Unlike other chronic or debilitating health conditions, menopause lacks Research, Condition and Disease Categorization codes at the National Institutes of Health.

The codes are the system that sort NIH-funded projects into scientific categories for reporting to the public. The Senate bill would, among other provisions, establish new codes for chronic or debilitating conditions among women related to menopause and midlife women’s health.

Another reason advocates say there’s been a lack of research on menopause is the fallout from the Women’s Health Initiative, a series of clinical trials from the NIH that began in 1991 and focused on strategies for preventing heart disease, breast and colorectal cancer and osteoporosis in postmenopausal women.

The findings of a portion of the Women’s Health Initiative, which have since been found to be flawed, found that there was an increased risk of developing breast cancer, cardiovascular disease, stroke and pulmonary embolisms in those who took hormones.

Since then, further research has demonstrated that hormone replacement therapy does not necessarily lead to an increased risk of breast cancer and that the benefits of hormones can outweigh the risks. But the findings linking hormone therapy and breast cancer led to a drop-off in treatment for some of the more disruptive side effects of menopause, Schubert said.

“We’re pretty behind when it comes to menopause in particular, and I think now we’re having a much more open and public dialogue about that time in a person’s life and coming to the realization that we really do need to know more, but we also need to know more about the other health risks associated with healthy aging,” Schubert said.

Schubert said support for federal research on menopause spans both sides of the aisle, and other women’s health issues, like research on conditions such as endometriosis, are emerging in a similar way.

In April, California Sen. Laphonza Butler, a Democrat, and Alabama Sen. Katie Britt, a Republican, introduced a bill that would fund maternal mortality research annually for seven years as well as approve research that would target disparities associated with maternal mortality and reduce preventable causes of deaths, among the bill’s other provisions. The House has its own version of the bill.

“I do think when people hear the words ‘women’s health,’ they may think that they are politically charged,” Schubert said. “I think we have to shift the thinking on that and make sure that we all understand that we’re really thinking about health across the lifespan in a variety of different ways. It’s really not a matter of one specific disease, condition or organ, it really is all connected together.”

The focus on menopause has united members of Congress who might not typically work together. Unlike abortion, lawmakers have been able to come together on the issue without controversy and the partisan divides that often plague their work.

“It hasn’t had the same divide within the pro-choice and what others would call the pro-life community,” said Samara Daly, the co-founder and board chair at Let’s Talk Menopause, a national nonprofit focused on menopause. “It’s a different medical issue that sort of crosses literally all political, social, economic lines. It’s a natural part of one’s life … as a result, you know, we’ve really been able to have people from both sides of the aisle join forces.”

Underrepresented

Women have been underrepresented in medical research for decades — with it even being the policy at one point.

In 1977, the Food and Drug Administration created a policy to exclude women who could biologically have children from Phase 1 and Phase 2 clinical trials unless they had a life-threatening medical condition.

After pregnant women who took the drug thalidomide gave birth to babies with limb deformities, researchers adopted a cautious approach to female participation in clinical trials. Thalidomide was a sedative that was never approved for use in the U.S. but was used widely in Europe and Canada. The resulting FDA policy recommended excluding even women who used contraception, were single or whose husbands had had vasectomies.

The NIH did not establish a policy encouraging researchers to include women in studies until 1986, and it wasn’t until 1993 that Congress passed a law that required women to be included in clinical research.

“There are other health issues that may only affect some women. This is one that’s universal. Over the last couple of decades, we’ve seen more and more stigmas drop around women’s health issues of different sorts,” said Cindy Hall, president of the Women’s Congressional Policy Institute.

A 2022 study by Harvard Medical School found that as recently as 2019, women made up roughly 40% of participants in clinical trials for the three diseases affecting women the most: cancer, cardiovascular disease and psychiatric disorders, despite women being 51% of the U.S. population.

Only roughly 30% of U.S. residency programs offer a formal menopause curriculum, according to a survey from The Menopause Society.

“We’re just actually at the very beginning of trying to figure out what we need in terms of what happens during the menopause transition, which hormone therapies work, which don’t,” said Stephanie Faubion, the medical director of The Menopause Society and the director of the Mayo Clinic Center for Women’s Health.

Another bipartisan bill would require the NIH to evaluate the results and status of completed and ongoing research related to menopause, perimenopause or midlife women’s health, as well as support that research.

“It’s really significant because it would actually mandate the NIH to review existing research, but also invest dedicated funding for additional research around not only treatments and health outcomes but also really correcting the (Women’s Health Initiative) study,” Daly said.

White House involvement

In addition to bipartisan bills in Congress, the departing Biden administration has backed increased research funding for menopause as part of President Joe Biden’s investment in women’s health. It’s unclear, however, whether the incoming Trump administration will follow up on that work.

In November 2023, Biden announced the White House Initiative on Women’s Health Research, led by first lady Jill Biden and the White House Gender Policy Council.

On Oct. 23, the Biden administration announced $110 million in awards from the Advanced Research Projects Agency for Health (ARPA-H) to accelerate research and development for women’s health across 23 research teams.

Two of those awards focused on menopause: one aiming to construct a novel ovarian therapy to prevent disease in menopause and another aiming to develop a drug that would eliminate the adverse effects of menopause.

One award, which received $3.5 million, would fund a study to test the development of a drug to extend ovarian function and lifespan. The other, which received $10 million, would fund research on a cell therapy implant that would replace deficient ovarian function, restore normal hormonal processes, manage menopause-associated symptoms and minimize the adverse health outcomes related to menopause.

Jill Biden launched ARPA-H’s Sprint for Women’s Health in February, making it the first major deliverable of the White House Initiative on Women’s Health Research.

The nature of the awards means the projects have the potential to be commercialized and widely used sooner, rather than decades down the road, according to the White House.

Advocates say they hope the shared understanding among female lawmakers of what it’s like to go through menopause will continue movement on the issue.

“It’s a universal experience. Obviously, each woman has a different individual experience of menopause, but the symptoms and the experience of embarrassing hot flashes and different symptoms that make it a tough thing to go through is kind of a uniter,” Hall said.

_____