Fighting For Women’s Health

As you know from reading Holos, I am deeply interested in women’s health. Following this interest led me to Jennifer Garrison, PhD. Jennifer is a researcher passionate about helping women and the Founder and Director of the Global Consortium for Reproductive Longevity & Equality (GCRLE) and an Assistant Professor at the Buck Institute for Research on Aging.  

In today’s issue Jennifer and I discuss the state of women’s health, why a one-size fits all approach to health does not work, the truth about HRT, and her work with the Global Consortium for Reproductive Longevity & Equality.

Karyn: What makes women’s health care unique?

Jennifer: Women’s ovaries age 2.5 times faster than the rest of their bodies. This means in your 20s and early 30s, while the rest of your body is functioning at its peak, your ovaries are already showing signs of aging. Long before the rest of your organs! This is in comparison to men, whose reproductive aging is in sync with the aging of the rest of their bodies.

In addition, menopause can make a woman’s body age faster and can have a dramatic impact on a woman’s health. Menopause symptoms, like hot flashes and brain fog, can last for up to 10 years and can have a profound impact on the quality of a woman’s life.

By 2025 there will be over 1 billion women in menopause, 12% of the world’s population! As we make progress is pushing out health span, if we don’t do something women will be living more of their lives after menopause than before! This is one reason why we need to address and better understand what is happening to women’s ovaries.

Karyn: Describe the situation around women’s health in the US.

Jennifer: Although women make up half the population, unfortunately women’s health has been treated as a niche area of medicine for too long. It needs to be front and center, and we need to reframe the narrative to talk about women’s bodies from a holistic point of view.

And for women in midlife, the information available about how to navigate their health is paltry. All too often women get wrong information from their health provider, or the provider doesn’t have the information to give them – particularly around perimenopause and menopause. Even the most diligent, committed OBGYNs don’t always have access to all the information they need.

This information doesn’t exist for two main reasons. The first is a historic lack of funding for basic research in this area of science. And the second is systemic sex bias in biomedical research where most research has been done on men and male animals. This means we don’t have the data we need. The good news is that both these problems can be solved.

Karyn: What is the Global Consortium for Reproductive Longevity & Equality (aka GCRLE)?

Jennifer: The purpose of the consortium is to advance research to better understand the causes of female reproductive aging. Specifically, we are building a network of women’s health advocates, providing grants for research, and creating a knowledge hub for scientists, physicians, and patients.

The network is comprised of clinicians, scientists, early-stage founders, funders, biotech companies, and anyone with an interest in this space. Conversations with all these people have highlighted the chasm between what health care providers have in their toolbox and what they need to address women’s health concerns.

This has led to the creation of a knowledge hub on our website to make sure clinicians and individuals have the most current information. All the information is vetted by scientists, and either written by the hub or curated from existing sources on women’s health topics.

Karyn: One of the great disservices to women’s health was the erroneous press around the initial findings on Hormone Replacement Therapy (HRT) from the Women’s Health Initiative. Can you talk a little about what happened so my readers can get clear on this important topic.

Jennifer: Absolutely. I want to make clear to everyone that the results of the one paper the press picked up in 2002, that the risks of HRT outweigh the benefits, has been completely debunked by subsequent research, data, and dozens of other papers. Its unfortunate so much misperception still exists.

The impact of this misinformation was devastating. Almost overnight physicians stopped prescribing HRT and women became terrified of HRT. And this is truly unfortunate because it is a useful tool for women as they go through perimenopause and menopause, and it can be helpful in promoting healthy aging.

Flaws in the WHI Study

That 2002 research paper was so flawed that you can’t conclude anything about HRT from the data.

The study fell short in many ways, of which I will highlight a few. First, the average age of women in the study was 63, more than 10 years older than when you would normally start HRT. We know now there is a window of opportunity to start HRT, and the closer to the age of menopause the better.

The estrogen receptors in your body are like little catchers’ mitts for estrogen. When your ovaries stop making estrogen, the receptors also decline and eventually stop being made. You need both the estrogen and the receptors. Unfortunately, this process can’t be reversed. Therefore, if you start HRT too late, HRT won’t be effective and has even been shown to be detrimental when started 10 years after menopause. So again, there is a window of opportunity for beginning HRT.

Second, the study did not screen for underlying health issues and the women in the study were sicker than the average population. Many were smokers, had diabetes, or heart disease. And third, they used synthetic estrogen (from horse urine) and progesterone versus the bioidentical hormones we use today. And the dose they used was what would typically be given to a younger woman.

And fourth, the way they analyzed the data and looked at absolute v. relative risk was flawed.

The Case for HRT

The current thinking is that HRT can be very beneficial for most women. It is protective for your heart, your brain, your bones, your muscles, and can alleviate many menopausal symptoms. Essentially all aspects of women’s health benefit from estrogen.

In terms of associated risks, research shows that on average, you have an increased risk of breast cancer of 1% per year on HRT but risk of all other negative health consequences (such as heart attack) declines significantly. For example, your risk of heart attack after menopause goes up 4x, and in fact after menopause heart attack is the #1 killer of women. Taking HRT also lowers risk of osteoporosis.

But I want to be clear, HRT may not be right for every woman, and all medical decisions are personal and the conversation with your doctor should be around your relative risks. For some women HRT may not be appropriate due to their health history and genetic background (for example those with an increased risk of reproductive tissue cancers).

And I also want to acknowledge that HRT is not perfect. It needs to be personalized and how it is delivered, the components and the amounts, needs to be refined. This is an area of active research where we can make progress quickly to improve the benefits of HRT.

Karyn: Where can women go to find information on current best practices on treating menopause, including HRT?

Jennifer: Our consortium has a beta version of the knowledge hub, which we are building in real time and hope to launch fully in 2023.

There is also a new resource for women, the National Menopause Foundation, a non-profit created for women “to gain knowledge, be inspired, connect with others, and ultimately, feel as prepared as possible for the changes that come with perimenopause, menopause and post menopause.”

And lastly, in the US there is the North American Menopause Society (NAMS) which publishes guidelines for HRT and is a resource for both doctors and patients.

Parting Thought

Momentum is building around the topic of women’s health. People like Jennifer and the Global Consortium for Reproductive Longevity & Equality are leading the way. This is critical as solutions for women’s health issues are lacking the data to answer some of the most pressing questions.

If you want to help build the ecosystem around women’s health and join the consortium, you can connect with Jennifer and learn more about the consortium below.

Jennifer L. Garrison, PhD, is Founder and Director of the Global Consortium for Reproductive Longevity & Equality (GCRLE) and an Assistant Professor at the Buck Institute for Research on Aging. She also holds appointments in the Department of Cellular and Molecular Pharmacology at UCSF and the Leonard Davis School of Gerontology at the University of Southern California. She is a passionate advocate for women’s health and is pioneering a new movement to advance science focused on female reproductive aging with the ultimate goal of ending menopause. This initiative, by focusing research on understanding how and why women go through reproductive decline in mid-life, has the potential to dramatically and significantly improve the health and well-being of women worldwide.

She received her BA in Molecular Cell Biology from the UC Berkeley then completed her PhD at UCSF in Chemistry and Chemical Biology where she was a National Science Foundation Fellow and an ARCS Scholar, then was a Helen Hay Whitney Foundation Postdoctoral Fellow at the Rockefeller University. She was named an Alfred P. Sloan Foundation Fellow and an Allen Institute for Brain Science Next Generation Leader and is the recipient of a Pathway to Independence Award and a Maximizing Investigators’ Research Award for Early Stage Investigators from the NIH, a Glenn Medical Foundation Award for Research in Biological Mechanisms of Aging, a Junior Faculty Award from the American Federation of Aging Research, and a Healthy Longevity Catalyst Award from the National Academy of Medicine.

Please reach out! drjennifergarrison@gmail.com and gcrle.org