Study finds abrupt 'cliff-like' menopause changes; Australian experts urge caution

Left · 2A study published in Nature Medicine reports that menopause-related biological changes across multiple body systems are sudden and "cliff-like" rather than gradual. 1 2 Left · 1Researchers analysed more than 300 million laboratory tests from more than 1 million women in the United States and Israel between 1999 and 2024. 1 Left · 1The senior author, Uri Alon of Israel's Weizmann Institute of Science, says the data show an abrupt, body-wide transition across bone, liver, kidney, blood chemistry and blood fats; some changes, such as iron and haemoglobin, were positive, likely because monthly bleeding stops. 2

Left · 2Alon says his team tested the finding: applying the method to men of the same age distribution showed no jumps, and records from the US and Israel showed similar patterns. 2 1 Left · 1The finding challenges earlier work such as the US Study of Women's Health Across the Nation (SWAN), which suggests the changes are gradual, over about three years; Alon says his method of aligning data at the final menstrual period allowed more data and more advanced analysis. 1 Left · 1Martha Hickey, head of menopause services at The Women's Hospital Victoria, who was not involved, called the "cliff-like" claim "unnecessarily alarming" and said "physiological cliff" is not a scientific or medical term; she also called retrospective studies "poor quality" for this question. 1

Left · 1The ABC notes the study used existing data and relied on self-reported information about the last period, whereas SWAN was designed to follow women through the transition. Elina Safro of the Australasian Menopause Society said the "cliff" theory is not plausible. 1 Left · 1The Australian experts did highlight accelerated change in many body systems beginning about 15 years before menopause, which Safro said is about seven years earlier than SWAN indicated and underscores vigilance about midlife health. 1 Left · 2Women on menopausal hormone therapy (MHT) showed smaller jumps, especially in bone, liver and kidney tests, and Alon suggests some women might benefit from starting earlier, including bone density checks around age 40 or 45, on a physician's advice. 2 1

Left · 1Hickey said there is good evidence MHT can reduce osteoporosis and fracture risk but none that it prevents cardiovascular disease or dementia, and that healthier women are more likely to use MHT, so the groups may have differed beforehand. 1 Left · 2Ada Cheung, a University of Melbourne endocrinologist, said the study shows "health checks matter around menopause" and recommended women talk to a GP in their 40s. All four experts quoted by the ABC agreed more research is needed, and Alon said his team plans a clinical trial of MHT taken before menopause; Scientific American says it remains unclear why the jumps occur. 1 2