“The notion of the brain at the helm of menopause, that is a different concept.” Gradual halt “We think of menopause as being driven by changes in the ovary,” says Hadine Joffe, who studies mental health and ageing in women at Harvard Medical School in Boston, Massachusetts. They increasingly recognize that menopause and the transition to it, a phase labelled perimenopause, could set the stage for brain health in later life, and there are even hints that it could correlate with the risk of neurodegenerative diseases, such as Alzheimer’s disease.įezolinetant and similar drugs in the pipeline also represent a shift in thinking: from menopause as a condition of the female reproductive organs, to one that focuses on neurological causes and effects. Armed with improved animal models and a growing literature on the effects of existing treatments, more researchers are coming into the field to fill that gap. But many women still struggle to access care related to menopause, and research into how best to manage such symptoms has lagged behind. In the next few years, the global number of postmenopausal women is expected to surpass one billion. Women’s health: end the disparity in fundingįor Rance and others in the field, fezolinetant’s progress to this point is a sign that research into the causes and effects of menopausal symptoms is finally being taken seriously. (This article uses ‘women’ to describe people who experience menopause, while recognizing that not all people who identify as women go through menopause, and not all people who go through menopause identify as women.)

If approved, fezolinetant could be a landmark: the first non-hormonal therapy to treat the source of hot flushes, a symptom that has become nearly synonymous with menopause and one that is experienced by about 80% of women going through the transition. Thirty years later, a drug called fezolinetant, based on Rance’s discoveries, is being evaluated by the US Food and Drug Administration, with an approval decision expected in the first half of this year. Rance forged ahead on her own, painstakingly unravelling what the neurons were doing and finessing a way to study menopause symptoms in rats by tracking tiny temperature changes in their tails as a measure of hot flushes, a common symptom of menopause that is thought to be triggered in the hypothalamus.

This was the 1990s, and few other researchers were interested. “This was changing so much in postmenopausal women,” says Rance, a neuropathologist at the University of Arizona in Tucson. In studies of post-mortem brains, she had found neurons in a region called the hypothalamus that roughly doubled in size in women after menopause 1. And what she was discovering surprised her. When Naomi Rance first started studying menopause and the brain, she pretty much had the field to herself.

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