Extreme weather, air pollution, and a host of chemicals found in the environment and our homes can have negative impacts on pregnancy and early childhood. We know this. But what about menopause?
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A history of neglect
“I would say almost nobody is studying this,” says Alexandra Scranton, Director of Science and Research at the organization Women’s Voices for the Earth. “Menopause overall, along with numerous other women’s issues, just doesn’t get the attention it deserves. It’s an older women’s issue. We just don’t think about it.”
In addition to ageism and sexism, it wasn’t until 1992 that the National Institutes of Health (NIH) began to pay attention to vaginal research. That’s when two women took over posts previously held by men in the Sexually Transmitted Diseases Branch at the National Institute of Allergy and Infectious Diseases and the Contraceptive Development Branch in the NIH Center for Population Research—and started to focus.
Menopause-specific research
Still, menopause-specific research remains rare today. Sung Kyun Park, ScD, MPH, a professor of epidemiology and environmental health sciences at the University of Michigan School of Public Health, is an outlier. He’s the principal investigator of the Study of Women’s Health Across the Nation Multi-Pollutant Study (SWAN-MPS). He’s examining the health effects of various chemicals in midlife women, including PFAS “forever chemicals,” metals, phthalates, phenols (found in consumer products and personal care products), and pesticides.
Dr. Park acknowledges a general lack of focus on menopause. “It’s not a disease and thus less attention has been paid to this life stage,” he says. So far, his research has revealed an association between PFAS exposure and earlier menopause. “Our data suggests that women with higher blood concentrations of PFOA and PFOS reached menopause earlier … than those with low exposure. This is equivalent to the effect of cigarette smoke, a known reproductive toxicant, where we compared current smokers and nonsmokers,” he says. His research has also revealed an association between toxic metals, such as lead, arsenic, cadmium, and mercury, and earlier menopause.
Menopause symptoms and environment
Scientific evidence on menopausal symptoms and environmental causes is currently scant. Research conducted in the Midlife Women’s Health Study found an association between phthalates and hot flashes, says Dr. Park.
Another recent study found air pollution could potentially exacerbate menopause symptoms, linking PM2.5 to estrogen decrease. “Air pollution is a difficult factor because we cannot control it at the individual level, but many chemicals that can affect not only reproductive health but also other chronic diseases can be avoided with lifestyle changes,” says Dr. Park. Individual attempts to reduce exposure to toxic chemicals are rarely as impactful as broader policy change and legislation.
Unsafe chemicals in “menopause products”
Menopause may not be getting enough attention in the research world, but businesses are plenty attentive. There are many products marketed specifically to menopausal women. Unfortunately, these can contain chemicals that hurt rather than help. “PFAS exposure for example happens in three ways: ingestion, inhalation, and dermal absorption. Vaginal absorption is not discussed; it’s a blind spot,” says Alexandra. Women’s Voices for the Earth is known for its work on getting toxic chemicals out of intimate care products, especially products like douches and period care. Products specifically marketed to perimenopausal and menopausal women that may contain harmful chemicals include:
Incontinence products. “It’s the same companies that make menstrual products. They get to women early, through the reproductive years, and as soon as they stop, it’s, ‘Now you need incontinence pads. You might have leaking.’ This is how they keep their market,” says Alexandra.
While some states like New York require ingredient disclosure for period products, there’s no similar requirement for incontinence items. “They are the same. There might be a few different tweaks to absorb urine versus blood,” notes Alexandra, who is concerned about increased exposure to potentially harmful chemicals, especially as incontinence products are worn 24/7, while period products are used less frequently.
Vaginal moisturizers and lubricants. Menopause comes with many unfair symptoms, including vaginal dryness (experienced by more than 50% of women!), plus itching and painful intercourse. Companies monetize this discomfort with moisturizers and lubricants that can contain chemicals, including perfumes, that harm rather than support vaginal tissue. Formulas of many conventional lubricants can actually remove moisture from delicate vaginal tissue, which can further irritate it—and increase risk of sexually transmitted infections.
We need to know more
“The whole approach to menopause is we are just patching it together. We need a more comprehensive understanding of what’s happening and how to treat things for comfort,” says Alexandra. Dr. Park agrees, adding, “It’s very well-known that women become susceptible to various chronic diseases after menopause, including cardiovascular disease, because of decline in estrogens. What makes me interested in menopause and women’s health is that women could be more susceptible to environmental chemical exposures and potential toxicity.”
For example, women typically have lower blood PFAS concentrations because menstruation is a “key elimination pathway.” After menopause, women no longer have this pathway and can be exposed to higher toxicants. “There may be more mechanisms that [increase] women’s susceptibility to heightened chemical exposures and toxicity. However, we do not know much about the role of menopause in environmental health.”
Dr. Park believes environmental factors play a crucial role in women’s health. We are now at the precipice of learning more about this role. “As life expectancy increases and the aging population grows, I think understanding the modifiable factors that influence the timing of menopause and menopausal symptoms is essential, as these can significantly affect women’s health in later life.”
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