This section includes information about key research funded by federal government agencies. Past and current research projects and publications support cross-cutting research in a wide range of disease areas and scientific fields, including menopause.

Agency for Healthcare Research and Quality (AHRQ)

Genitourinary Syndrome of Menopause: A Systematic Review (Published in July 2024) 
A systematic evidence review was conducted on screening, treatment, and surveillance of genitourinary syndrome of menopause (GSM). This report will serve as the basis for the American Urological Association’s clinical practice guidelines related to GSM.

Strategies for Improving the Lives of Women Aged 40 and Above Living With HIV/AIDS (Published in November 2016) 
An evidence map was created to provide a compendium of empirical studies that apply to older women who live with HIV in the U.S., including perimenopausal and postmenopausal women. The research protocol noted the inconsistent and inconclusive reports regarding HIV and menopause.

Menopausal Symptoms: Comparative Effectiveness of Therapies (Published in March 2015)
A systematic evidence review was conducted to evaluate the comparative effectiveness of treatments for menopausal symptoms and the potential long-term benefits and harms of those treatments.

U.S. Department of Defense (DOD)

“Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women” (Published in April 2018)
A case study was created to familiarize physicians with the U.S. Preventive Services Task Force’s 2017 recommendation statement on hormone therapy for the primary prevention of chronic conditions in postmenopausal women.

U.S. Food and Drug Administration (FDA)

Women’s health research
The FDA Office of Women’s Health awards research grants to support FDA regulatory decision-making and advance the science of women’s health through intramural and extramural funding. These programs support cross-cutting research in a wide range of disease areas and scientific fields, including menopause.

“Determinants of Hormone Replacement Therapy Knowledge and Current Hormone Replacement Therapy Use” (Published in December 2022)
This study aimed to understand women’s knowledge of hormone replacement therapy (HRT) as a treatment for menopause symptoms and to assess the factors associated with HRT use.

National Institutes of Health (NIH)

Partnering with the National Library of Medicine, the NIH Office of Research on Women’s Health offers a discovery resource for women’s health research, called DiscoverWHR. This resource simplifies finding information on menopause for patients, caregivers, medical professionals, researchers, and the general public.

U.S. Department of Veterans Affairs (VA)

Women Veteran Menopause Research
This document summarizes some of the key health systems research studies related to menopause. Reference links and study citations are available within the document.

Ongoing

The Relationship of Menopause to the Onset of Glaucoma in Veterans (RRDS-012-23S, 1I21RX004636-01A1, Principal Investigator [PI]: Andrew J. Feola, 2023–2025) 
This study is investigating whether menopause is related to the onset of glaucoma in U.S. veterans and whether hormone replacement therapy delays the onset of glaucoma in postmenopausal women, using a retrospective design.

Effects of Novel Estrogens on Glucose and Lipids in Postmenopausal Prediabetic Women Veterans (ENDA-009-20F, 1IK2CX002225-01A1, PI: Dragana Lovre, 2021–2026)
This study is investigating the effect of a novel menopause hormone therapy (conjugated estrogen/bazedoxifene [CE/BZA]) on glucose and lipid homeostasis in obese menopausal women veterans with prediabetes and early diabetes to provide new insights regarding the use of CE/BZA to prevent or treat metabolic dysfunction.

Diminished Sex Hormone Levels Stimulate Production of Inflammatory Bone Marrow-Derived Adipocytes (ENDA-006-19F, 1I01BX005135-01, PI: Dwight J. Klemm, 2021–2025)
This study is investigating whether estrogen and follicle-stimulating hormone differentially regulate the production of myeloid adipocyte progenitors (MAPs) and alter the cellular composition of adipose in a way that results in significant changes in metabolic and inflammatory phenotypes. A better understanding of this phenomenon will highlight opportunities to control the cellular composition and function of adipose tissue to combat menopausal comorbidities.

Control of Bone Mass by Progranulin (ENDB-009-21S, 5I01BX003212-07, PI: Robert A. Nissenson, 2021–2025)
This study is investigating whether progranulin (PGRN), an inflammation-associated factor produced by macrophages and implicated in age-related bone loss, is a critical upstream regulator of inflammatory cytokine production and whether PGRN-mediated cytokine production promotes bone loss through activation of inhibitory G protein signaling and suppression of canonical Wnt signaling in osteoblast lineage cells. A better understanding of this phenomenon will illuminate the pathogenesis of bone disease associated with inflammatory disorders such as rheumatoid arthritis and postmenopausal osteoporosis. Defining the details of this relationship will lead to identifying new therapeutic targets for preventing or reversing bone loss in these conditions.

Sexual dimorphism, hepatic mitochondrial adaptations, and hepatic steatosis (ENDA-017-19S, 2I01BX002567-05, PI: John P. Thyfault, 2019–2024)
This study is investigating whether enhanced mitochondrial function in females is critical for their inherent protection against steatosis and adaptive responses to metabolic stress and whether differences in bile acid metabolism provide protection against steatosis in females. The overall objective of this study is to determine mechanistic interactions among estrogen, exercise, and mitochondrial function that drive risk for hepatic steatosis, with a goal of determining therapeutic targets for female veterans.

Recently Completed

Improving Health Care for Women Veterans: Addressing Menopause and Mental Health (CDA 17-018, IK2HX002402-01A1, PI: Carolyn Gibson, 2018–2023) 
This study described middle-aged women veterans’ experience of menopause symptoms; described associations between menopause symptom burden and mental health; examined patient and provider preferences, experiences, and practices seeking and receiving menopause-related care in the VA; and developed a veteran-focused tool to activate self-management of menopause symptoms in the VA setting.

Assessing the usability of a Veteran-focused mobile application for menopause symptom tracking and psychoeducation (IVI 22-242, PI: Carolyn Gibson, 2022–2023)
This study refined and assessed the usability, acceptability, and relative validity of a menopause-focused mobile app with evidence-based psychoeducation and symptom tracking for research and clinical applications.

Gibson, C. J., Li, Y., Huang, A. J., Rife, T., & Seal, K. H. (2019). Menopausal symptoms and higher risk opioid prescribing in a national sample of women Veterans with chronic pain. Journal of General Internal Medicine, 34(10), 2159–2166. 
This study examined the relationships between menopause symptoms and long-term opioid prescription patterns among middle-aged women veterans with chronic pain. It found that among this population, evidence of menopause symptoms was associated with potentially risky long-term opioid prescription patterns, independent of known risk factors.

Gibson, C. J., Li, Y., Bertenthal, D., Huang, A. J., & Seal, K. H. (2019). Menopause symptoms and chronic pain in a national sample of midlife women veterans. Menopause, 26(7), 708–713.
This study examined relationships between indicators of menopause symptoms and chronic pain among middle-aged women veterans. It found that women with menopause symptoms had nearly twice the odds of having chronic pain and multiple chronic pain diagnoses, raising the possibility that women with higher menopause symptom burdens may be the most vulnerable to having chronic pain.

The Effect of Estrogen Deficiencies on Vision Loss in Glaucoma (1IK2RX002342-01A2, PI: Andrew J. Feola, 2018–2023)
This study investigated whether an estrogen deficiency contributes to the etiology of glaucoma by altering ocular biomechanics and thus increasing an individual’s risk for developing glaucoma in menopause. It will inform the use of estrogen as a novel therapeutic treatment for glaucoma of female and male veterans in the VA clinical population.

Signals controlling tissues homeostasis in the ovary (1I01BX004272-01A2, PI: John S. Davis, 2019–2023)
This study investigated how Hippo signaling events (the Hippo pathway controls organ size by regulating cell proliferation, apoptosis, and stem cell self-renewal) regulate ovarian function, including follicle development, oocyte maturation, and ovarian hormone production.

Past

Gerber, M. R., King, M. W., Pineles, S. L., et al. (2015). Hormone therapy use in women veterans accessing Veterans Health Administration care: A national cross-sectional study. Journal of General Internal Medicine, 30(2), 169–175.
This study investigated the frequency of hormone therapy (HT) use and whether mental health was predictive of HT use in women veterans using VA care. It found that the prevalence of HT use among women veterans using VA care was more than twice that of the general population and that a mental health–related diagnosis was associated with HT use.

Haskell, S. G., Bean-Mayberry, B., Goulet, J. L., Skanderson, M., Good, C. B., & Justice, A. C. (2018). Determinants of hormone therapy discontinuation among female veterans nationally. Military Medicine, 173(1), 91–96.
This study assessed the use of HT among female veterans before and after the release of the Women’s Health Initiative clinical trial results. It evaluated whether the structure of women’s health care services within the VA system affects the use of HT. It found that patients with any use of VA women’s clinics were less likely to discontinue HT, indicating a practice setting variation that may indicate either more specific care or differential implementation of the new HT guidelines.

Katon, J. G., Gray, K. E., Gerber, M. R., et al. (2016). Vasomotor symptoms and quality of life among Veteran and non-Veteran postmenopausal women. The Gerontologist, 56(Suppl 1), S40–S53.
This study investigated whether veterans are more likely to report vasomotor symptoms (VMS) than nonveterans and whether the association of VMS with health-related quality of life (HRQOL) varies by veteran status. It found that having any VMS was associated with decreased HRQOL at Year 3, particularly among veterans.

Ryan, G. L., Mengeling, M. A., Summers, K. M., Booth, B. M., Torner, J. C., Syrop, C. H., & Sadler, A. G. (2016). Hysterectomy risk in premenopausal-aged military veterans: Associations with sexual assault and gynecologic symptoms. American Journal of Obstetrics & Gynecology, 214(3), 352.e1–352.e13.
This study assessed the prevalence of hysterectomy in premenopausal-aged female veterans compared with the prevalence in the general population. It examined associations between hysterectomy and sexual assault, post-traumatic stress disorder (PTSD), and gynecological symptoms in this veteran population. It found that premenopausal-aged veterans may have higher overall risks for needing a hysterectomy and needing a hysterectomy at a younger age than their civilian counterparts. Veterans who have experienced completed sexual assault with vaginal penetration in childhood or in the military and those with a history of PTSD may be at a particularly high risk for needing a hysterectomy, potentially related to their higher risk of having gynecological symptoms.

Schapira, M. M., Gilligan, M. A., McAuliffe, T. L., & Nattinger, A. B. (2004). Menopausal hormone therapy decisions: Insights from a multi-attribute model. Patient Education and Counseling, 52(1), 89–95.
This study identified decision factors for and utility rates of hormone replacement therapy (HRT). It found that among people who were currently receiving HRT, the main factors supporting use were concerns about heart disease, osteoporosis, and symptoms of menopause. Among people who had formerly received HRT, side effects weighed heavily against use, and among those who had never received HRT, breast cancer concerns weighed heavily against use.

Rouen, P. A., Krein, S. L., & Reame, N. E. (2015). Postmenopausal symptoms in female veterans with type 2 diabetes: Glucose control and symptom severity. Journal of Women’s Health, 24(6), 496–505.
This study examined the influence of Type 2 diabetes on the symptom features of menopause. It found that in postmenopausal female veterans with diabetes, glucose control was associated with the severity of those symptoms commonly attributed to menopause. Joint pain is an important part of the postmenopausal symptom complex in this population.