When we talk about longevity medicine, the goal is not simply to live longer, but to spend more of those years in good health. For women, that distinction exposes a familiar paradox: they live longer than men on average, yet spend more years living with chronic illnesses and disabilities.
An important part of the explanation, and potentially part of the solution, lies in the years around age 50. Yet while conversations about longevity are filled with supplements, biological age tests and ice baths, menopause is barely mentioned. It is time to connect the two.
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Menopause is not a disease, but its effects on health and quality of life deserve attention
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A review published in early October in the journal Science, as part of a special issue devoted to women's health, makes precisely that connection. Researchers from Professor Liisa Galea's group in Toronto describe menopause as a turning point in aging, a hormonal transition whose effects extend far beyond the reproductive system to the brain, heart, bones, muscles and metabolism.
Medically, menopause is defined as 12 consecutive months without menstruation and occurs at an average age of 51. But the transition surrounding it, during which estrogen and progesterone levels decline, can last up to a decade.
A turning point in women's health
The connection to longevity begins with a simple fact: women spend roughly 40% of their lives after menopause. What happens during these years can therefore have consequences for a substantial portion of their lives.
There is also the pace of aging. According to the review, menopause is associated with an acceleration of biological aging clocks, measures used to estimate whether the body is aging faster or more slowly than its chronological age. During this period, bone density and muscle mass decline, while fat increasingly accumulates around the abdomen and internal organs. These are precisely the processes that longevity medicine seeks to slow.
Dr. Nitzan AnuPhoto: Ofer HajayovThe timing of menopause and the severity of its symptoms may also offer clues about future health. Early menopause is associated with higher risks of dementia, heart disease, osteoporosis and mortality. Severe hot flashes, particularly at night, have been linked to poorer memory and cognitive performance, as well as early signs of brain changes detected through blood tests and imaging.
The review rightly urges caution. Researchers still cannot determine which of these relationships are causal and which reflect other underlying processes. Nevertheless, the practical message is important: menopausal symptoms may provide early information about future health risks, beyond the discomfort they cause.
Timing matters especially when it comes to brain health. Alzheimer's disease, for example, can begin developing in the brain decades before a diagnosis. Menopause falls within this window, when there may still be opportunities to influence long-term health outcomes.
Effective treatments exist, but few women receive them
What are we doing with this opportunity? Far too little.
As many as 72 different symptoms have been associated with menopause, ranging from hot flashes to "brain fog," a term describing difficulties with memory and concentration that up to 80% of women report experiencing. Effective treatments are available, yet fewer than 15% of women experiencing menopausal symptoms receive treatment.
Research funding is also remarkably limited. Over a 15-year period, just 0.2% of federal health research funding in North America was directed toward the subject. Canadian data suggest that approximately one in 10 women leaves the workforce because of menopausal symptoms. Most of these figures come from the United States and Canada; the review does not provide equivalent Israeli data.
Brain fog, including difficulties with memory and concentration, is reported by up to 80% of women
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For years, menopause was treated as the end of one stage of life. Today, it should be understood as the beginning of its second half. If women receive medical attention only after their quality of life has deteriorated significantly, or after declines in bone density and cardiovascular health have already begun, an important opportunity for earlier intervention may be lost.
As physicians, we believe women's health care must become more proactive. Conversations should begin during perimenopause, before menopause itself, allowing each woman to develop an individualized plan designed to preserve her physical function, vitality and quality of life for decades to come.
Hormone therapy: Who needs it, and when?
Part of the explanation for low treatment rates lies in the fear surrounding hormone therapy.
In 2002, the publication of findings from a major American study, the Women's Health Initiative, linked hormone therapy to breast cancer, heart disease and dementia. Prescriptions subsequently fell by more than 60%.
Dr. Vered KleitmanPhoto: Adi AzranHowever, the study examined a specific form of oral hormone therapy in women who were, on average, older and more than a decade past the typical age of menopause. The increased breast cancer risk was associated with a particular combination involving a synthetic progestin, rather than estrogen alone.
According to the Science review, more than 200 hormone therapy formulations are now available, differing in hormone type, dosage, method of administration and timing.
Estrogen delivered through the skin, using patches or gels, for example, is associated with a two- to fourfold lower risk of blood clots compared with oral estrogen. This is why asking whether hormone therapy is dangerous is much like asking whether blood pressure medication works. The answer depends on the medication, the patient and when treatment begins.
The one-size-fits-all approach is no longer appropriate. The availability of different formulations, including transdermal and local treatments with carefully adjusted doses, allows physicians to tailor care to each woman's symptoms, medical history and individual risk profile.
For women experiencing hot flashes and sleep disturbances, appropriate treatment can provide substantial relief and help restore a sense of control and confidence in their bodies.
Regulatory approaches are changing as well. In 2025, the U.S. Food and Drug Administration (FDA) announced a move to remove certain prominent boxed warnings from menopausal hormone therapies, warnings introduced following the earlier Women's Health Initiative findings.
The decision remains controversial. The International Menopause Society supports removing such warnings from local hormone treatments, but not from systemic therapies that affect the body as a whole.
It is equally important to avoid overstating the benefits. Hormone therapy is not a miracle anti-aging treatment, nor is it appropriate for every woman. It remains the most effective established treatment for hot flashes and can reduce fracture risk by 20% to 40%.
However, randomized controlled trials comparing hormone therapy with a placebo have not demonstrated that it improves memory or cognition or protects against heart disease.
For women who cannot or prefer not to use hormones, nonhormonal treatments for hot flashes are also available. The central message of the review is personalized care, not a blanket recommendation that every woman receive hormone therapy.
The foundation for tomorrow's health begins today
Healthy aging can be understood as a form of compound interest: relatively small decisions made at age 45 can accumulate into substantial differences by age 80. Menopause may be one of the clearest examples.
It is a decade during which sleep, bone health, muscle mass, blood vessels and brain function undergo significant changes. Women who navigate these years with reliable information, appropriate monitoring and individualized treatment may gain health benefits that last for decades.
The ultimate goal of longevity medicine is not merely to extend life expectancy, but to reduce the number of years spent living with illness toward the end of life. For women, much of that work begins during the menopausal transition.
To achieve this, the review's authors suggest a simple comparison: just as pregnancy and childbirth receive structured medical monitoring, menopause should also be treated as a major life transition deserving coordinated medical attention.
That requires genuine continuity of care between gynecologists and primary care physicians. It also means recognizing the full range of menopausal symptoms, including changes in sleep, emotional well-being, memory and cognition.
Three measures should form the foundation of this approach. The first is proactive communication. Every woman approaching age 45 should receive information from the health care system to help her understand the changes she may experience.
The second is professional training. Primary care physicians need to become familiar with the full range of menopausal symptoms and available treatments, rather than focusing exclusively on hot flashes or a single medication.
The third is measurement. A health care system capable of tracking diabetes management should also be able to measure how many women experiencing menopausal symptoms receive appropriate evaluation and treatment.
Menopause is not a disease, and it does not need to be "cured." But neither is it simply another birthday. Any serious discussion of longevity that overlooks menopause misses one of the most important opportunities to protect the long-term health of half the population.
Dr. Nitzan Anu is director of longevity medicine at Maccabi Healthcare Services. Dr. Vered Kleitman is a gynecologist and director of women's health at Maccabi Healthcare Services.