Co-founder of Women Living Better, Nina Coslov is committed to furthering research on the diverse hormonal changes (and their impacts?) that take place on the path to menopause.

We spoke to her about her research on the late reproductive stage (LRS) and why understanding this stage is key to improved patient-provider interactions and ultimately better health outcomes.

What inspired you to co-found Women Living Better?

In the beginning, there was no intent to co-found anything. My interest in the subject was born out of personal experience.

In my early 40s, I started to experience what I now know are symptoms associated with the path to menopause, including changes in sleep patterns and mood, but I was still getting a regular period. When I asked my primary care doctor and OBGYN if my symptoms could be related to hormonal changes, they both responded with: “Are you still getting a regular period?” When I confirmed that I was, they dismissed the possibility of my symptoms being related to menopause. But something in my gut told me that wasn’t right.

Then, I spoke to a close friend and graduate school colleague who was experiencing similar changes. Together, we dug into the existing research (not surprisingly, there wasn’t much), and learned more about this normal life transition.

We felt compelled to share what we had learned with others and created Women Living Better to increase education on the subject. Since then, the mission has expanded to include research as well.

Part of your research examines the symptoms that people experience in the late reproductive stage (LRS) before the menopausal transition. Why is this data important?

At a certain point, I realized that the primary reason that health care providers can't validate the common symptoms many of us experience is that the research simply doesn't exist yet. For providers it’s understandable how difficult it is to support patients experiencing a broad range of symptoms during the late reproductive stage (LRS), while periods are coming monthly when there isn’t much data to establish this as part of the path to menopause. We are hoping to spur more research here.

I’m very fortunate and grateful to work with two collaborators who are as passionate as I am about furthering research in this area. Dr. Nancy Woods,​​ has long been a pioneer in health research and Dr. Marcie Richardson is an OBGYN who has been director of a menopause clinic in Boston for more than 25 years. Over the past few years, the three of us have been working together to learn more about this important life transition, and the first paper on our research has been recently published in The Journal of the North American Menopause Society.

How do you hope this research impacts the way physicians care for their patients experiencing these symptoms?

Our hope is that this research will help contribute to a greater understanding of the many years leading to menopause so that providers and patients alike will have a better grasp of what to expect and how to best anticipate, support, and mitigate symptoms.

Menopause is clinically marked as your final menstrual period. However, you don’t know that it was your final menstrual period until twelve months have passed without another period. In other words, you can only identify menopause retroactively.

But what about the changes that some people experience in the many years before that point? We know that some people don’t experience any symptoms during this transition, but others struggle with changes that interfere significantly with their day-to-day life. Our research shows that people who do experience symptoms in the LRS have symptoms that are strikingly similar to those typically associated with the menopausal transition. Because most people don’t expect these changes until age 50, they’re surprised to encounter such symptoms before reaching a point of noticeable cycle irregularity.

These findings suggest that irregular periods might not be the first marker of this transition and that a wide array of symptoms and changes are possible prior to this point.

The more data we collect on the diverse and subtle experiences that people have during this transition the better able providers will be to support patients. And for those going through this transition, understanding more about what to expect allows for normalization and if needed, they can better advocate for their needs with a healthcare provider.

What’s more, a recognition of this earlier stage presents an opportunity to emphasize preventative care. For example, beginning to change self-care habits (including sleep, nutrition and movement) around 40 versus mid 50s or when early markers of chronic conditions arise could likely have significant impacts on our health.

How does your work impact greater gender and health inequalities?

Firstly, we hope that this work helps to normalize people’s experiences and give them the information they need to understand what's happening to their bodies and know they aren’t alone.

But another goal of this work is to provide evidence for physicians so they can better validate patients' experiences and provide support. After the childbearing years, the first time that many people return to healthcare is for symptoms like disrupted sleep and mood changes related to hormonal fluctuations. In many cases, their experience is invalidated or they feel not heard or unsupported. Often this rupture causes patients to seek care elsewhere, or in some cases, stop seeking care altogether. Many chronic diseases develop in the years following menopause, so a solid patient-provider partnership is especially important. A patient-provider connection in the earliest part of this transitional phase represents a significant opportunity to improve healthcare and future health outcomes for over 50% of the population.

What else should we know about your work?

Even as evidence-based research on menopause and LRS increases, it can be difficult for the non-medical person and consumer of healthcare to understand it. I'm committed to improving the knowledge translation of this body of research because I believe that we all benefit from a better understanding of this phase of life.

My vision will be realized when every person who's going to go through this transition has anticipatory guidance to know what to expect by age 35.

Further reading