Bridging the Research Gaps in Menopause: A Conversation with Dr. Annina Burns

Susan Sly: 00:00

Well, hello, Susan here, and welcome to this episode of the Menopause Health Podcast. I am so happy you are here. And in this episode, we are going to talk about evidence-based research. I know. I know what that means is that it isn't necessarily something that's trending on TikTok. Yes, it is evidence-based, meaning that research is illustrating that these specific interventions are really ameliorating the lives of women in perimenopause and menopause. We are going to talk about research gaps. We are going to talk about resources, and we're going to also talk about our wish for the future for the next generation of women. My guest today is an expert in all of these things. We bonded at the Women's Health Innovation Summit in Boston, and we bonded over our shared passion for nutrition, being moms, and women's health. She is a health science policy analyst at the Office of Research for Women's Health at the National Institutes of Health, and her areas of research include fertility, maternal health, and menopausal transition. Currently, she is spearheading a collaborative project aimed at identifying research gaps on women's nutritional needs through their lifespan. Her mission is to improve the health span for women through the various stages of life, including the menopausal transition. And so I want to welcome you to this episode of the Menopause Health Podcast with my guest and friend, Dr. Annina Burns.

Voiceover: 01:39

The opinions expressed by the guests on this podcast are their own and do not necessarily reflect the views of the show or its hosts. This podcast is for informational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional regarding your specific health needs. Welcome to the Menopause Health Podcast, your go-to resource for practical advice, brought to you by credentialed health professionals and industry experts. Here is your host, Susan Sly.

Susan Sly: 02:20

Well, first and foremost, Dr. Burns, I am so excited. I feel like we had this conversation over lunch in Boston, and I just kept thinking, I wish everyone could hear what we were talking about. We were both speaking at the Women's Health Innovation Summit, and we sat down to lunch as moms, as professionals, and we started to talk about perimenopause and menopause. And you, in addition to having a PhD, are also a registered dietitian; you're just incredible. When I think of you, I think of you as a shining light of possibility, like you truly are. I want to jump right in and talk about this concept of perimenopause and menopause and really around lifestyle. One of the things you and I spoke about is that perimenopause hasn't really been researched, but there are a lot of lifestyle interventions that can be done. So let's jump in right there, just in terms of your experience. What are some of the things that women, if they have been listening to these episodes and are thinking, “Okay, yes, I need to do something,” should consider? Just because something is common sense does not make it common practice. What are your thoughts?

Dr. Burns: 03:34

Thank you, Susan. It was also so nice to talk with you in Boston at that meeting. I just gave a talk at the Menopause Society titled Beyond the Scale: Nutrition for Perimenopause, and in reviewing the available research, it is clear that while we do have research, we do not have as much as we have on menopause, particularly post-menopause. However, there are things that can be done with diet and lifestyle that are supported by evidence. For instance, dietary changes, such as reducing inflammatory foods and incorporating soybeans, have been shown to improve vasomotor symptoms. We have data on that, and also on the benefits of exercise. One of the changes that occur during perimenopause and menopause is an increase in visceral fat and a shift in body fat distribution—from a pear shape to an apple shape due to the loss of estrogen. Strength training, which you are also an expert in, can help prevent some of these body composition changes during the perimenopausal years.

Susan Sly: 04:48

I love that you said evidence-based. I want to jump in there a little more. I was having a conversation with Dr. Lisa Larkin, who is the president of the Menopause Society, and she recently gathered a group to discuss common myths. There is a lot of information out there that is not evidence-based. One of my key recommendations for women is to start with evidence-based approaches. As you mentioned, there is evidence indicating a reduction in vasomotor symptoms, which include hot flashes and night sweats. You referenced soybeans—so for someone listening and thinking, “Okay, what do I even do with soybeans?” could you expand on those nutritional interventions?

Dr. Burns: 05:46

Absolutely. People often get caught up in focusing on one intervention while ignoring others or not viewing research in perspective. An anti-inflammatory diet encompasses various aspects. For instance, research shows that women who consume more fruits and vegetables and maintain a diet lower in saturated fats but higher in omega-3 fatty acids, such as from salmon, flaxseeds, and nuts, experience fewer vasomotor symptoms. One intervention trial even showed that women following a vegan diet with cooked soybeans had a statistically significant reduction in vasomotor symptoms. This does not mean everyone needs to do this, but there is evidence supporting its effectiveness.

Susan Sly: 06:50

I started laughing because so many focus on just one thing. I remember back in the 90s, there was a trend of eating only rice or following a cabbage soup diet. It’s not about doing one thing obsessively, like eating salmon or soybeans daily. One of my favorite studies is the Framingham study, which supports consuming five to seven servings of fresh fruits and vegetables daily. Despite the evidence supporting these habits, most people don’t achieve them. When you mention cooked soybeans, are you referring to tofu or soy milk as well?

Dr. Burns: 08:01

The study I am referencing involved cooking whole soybeans in an Instant Pot, without any additional ingredients, which is different from tofu or soy milk. The mixed data on soy can sometimes make recommendations difficult, but this specific trial focused on whole soybeans.

Susan Sly: 08:30

My husband loves our Instant Pot, but I had a mishap once when releasing the steam valve, so I avoid using it now. We will include that research in the show notes. One goal of this podcast is to provide evidence-based information, and that is why having you as a guest is so valuable. You also mentioned the NIH, an institution not everyone is familiar with. Could you share what the NIH is and what it does?

Dr. Burns: 09:31

Of course. The NIH, or National Institutes of Health, is the world’s largest biomedical and behavioral research funder, with an annual budget of $50 billion. We fund research both in the U.S. and globally, and we have supported menopause research for over 30 years. The NIH has 27 institutes and centers, each focusing on different areas of health and disease states. For instance, we have the National Institute on Aging, the National Cancer Institute, and the National Institute of Mental Health, among others. Each institute supports research aligned with its particular focus.

th Initiative, which began in: 1991

We also conduct clinical research like M-FLASH (Finding Lasting Answers for Symptoms and Health), which tests new and existing treatments for menopausal symptoms. The study spans interventions from antidepressants and omega-3 supplements to exercise and cognitive behavioral therapy. One of the highlights of M-FLASH is that it has demonstrated benefits in managing symptoms through multiple types of interventions.

Lastly, we have studies like MsBrain (Menopausal Symptoms and Brain Aging), spearheaded by the National Institute on Aging, which explores how menopausal symptoms might correlate with short- and long-term brain health, including potential links to cognitive decline. These research initiatives are crucial because they help us understand not only the immediate impacts of menopause but also how it affects aging and the risk of conditions such as dementia and chronic disease.

Susan Sly: 12:50

The focus on brain health and cognitive decline is particularly intriguing. The implications for women are significant, given their higher risk for dementia and Alzheimer's compared to men. This line of research resonates deeply, as it touches on not only our understanding of aging but also preventative measures that could be implemented early on. I love that NIH’s research spans such a wide range—from the broad scope of the Women's Health Initiative to the specificity of studies like MsBrain.

Interventions are key, right? It's not just about one solution, but recognizing that there are multiple approaches that can be considered. This is one of the reasons I appreciate the NIH—looking holistically at women’s health. For example, Dr. Mitzi Krakauer and I had a conversation about acupuncture. She’s an internist, and even she supports acupuncture as an evidence-based intervention. Personally, it has helped me, and I grew up in a household where acupuncture was a regular practice. For women navigating perimenopause and menopause, starting with lifestyle interventions, like diet and exercise, is essential. We have seen more research coming out about hydration, the effects of alcohol, and even protein intake, as presented at the Menopause Society Conference. Despite progress, there are still significant research gaps. One key gap is defining perimenopause. Could you elaborate on that challenge?

Dr. Burns: 14:18

Certainly. One of the main research gaps is that we don’t have a formal definition for perimenopause. Menopause is defined retrospectively, meaning a woman is considered to be in menopause only after she has not had a menstrual period for over a year. This does not help women understand what they are experiencing during the transition, which can last, on average, four to seven years, or even longer for some. The lack of a clear, agreed-upon diagnostic marker for perimenopause is a significant issue. Women often don’t know if their symptoms are related to perimenopause or something else.

Hormone changes, such as rising follicle-stimulating hormone (FSH) levels and declining estrogen, are known to occur, but there is no consensus on when these changes definitively indicate the start of perimenopause. Without a diagnostic marker, it is difficult to provide targeted interventions early enough, which is a critical gap that researchers, including those at NIH, are looking to address.

Susan Sly: 15:48

That’s such an important point. The retrospective nature of menopause as a diagnosis doesn’t provide clarity when symptoms start showing up, and social media certainly doesn’t help. There’s so much misinformation out there, and women are often left self-diagnosing without clear, evidence-based guidance. Dr. Larkin mentioned how much this can complicate understanding and managing symptoms effectively.

Even with personal and professional experience, it can be challenging to navigate this space. The various stages defined in models like STRAW +10 attempt to classify phases, but there are still no definitive milestones to guide women. What has come up in the research that excites you the most or seems most promising for women navigating perimenopause and menopause?

Dr. Burns: 17:19

I find the studies on brain health particularly exciting. We know that women are at a higher risk for dementia and Alzheimer's, and that has drawn significant interest from the National Institute on Aging. The key questions are: What is the relationship between menopausal symptoms and later cognitive decline, and can lifestyle or dietary interventions during perimenopause alter those outcomes?

Cognitive decline affects different populations at varying rates, so it is vital to understand these disparities and address them with tailored interventions. It’s an area ripe for more exploration, as it could yield insights that inform strategies to mitigate chronic conditions and improve long-term health outcomes for women.

Susan Sly: 18:26

I love that. It resonates with me on a personal level because my mother-in-law has dementia, and navigating her care has been challenging. Many of our listeners are in the sandwich generation, dealing with both their children and aging parents. It underscores the importance of early intervention to change outcomes. That’s on my wish list—early intervention that impacts long-term health.

For those listening who may be practitioners, funders, or even entrepreneurs in the health space, what NIH resources would you recommend?

Dr. Burns: 19:29

Great question. For those looking for accessible, evidence-based information, the Office on Women’s Health, which is part of the Department of Health and Human Services (HHS), recently launched a resource called menopause.gov. It provides foundational information about menopause, symptoms, treatment options, and more.

Within NIH, the Office of Research on Women’s Health (ORWH) offers resources like the Menopause and Midlife page, which includes NIH-specific resources, highlights, and symposium recordings, such as the Vivid Pin Symposium and the recent roundtable discussions. These are great starting points for understanding what’s happening in the field and for finding evidence-based tools and data.

Susan Sly: 20:41

One place for resources—how refreshing! That simplifies the search for evidence-based, reliable information, which is especially valuable when navigating perimenopause. My last question, which is personal for both of us as mothers of daughters: When we think about the future, what is your wish for them when they eventually go through perimenopause and menopause?

Dr. Burns: 22:09

Thinking about my daughters going through perimenopause and menopause feels distant yet deeply significant. My wish, both as a mother and a researcher, is that they will have access to better data and clear, evidence-based interventions. I want them—and all women—to have accurate information and accessible resources to make informed decisions about their health. This should be the norm, not a luxury, so that no one has to suffer needlessly or make decisions based on incomplete or misleading data.

Susan Sly: 22:44

I love that. Evidence-based, precision-guided approaches are essential, especially when considering the diversity of experiences and genetic backgrounds. I share that vision for my daughters. The goal is that they will receive specific recommendations that are tailored to their needs so that they do not have to endure unnecessary suffering. Thank you so much for being here, Dr. Burns, and for the incredible work NIH is doing. I hope our listeners learned something valuable today. Check out the resources in the show notes, and thank you again for joining us.

Dr. Burns: 23:55

Thank you for having me.

Susan Sly: 23:58

This has been another episode of the Menopause Health Podcast. Check out other episodes this season, and if you have feedback or want to leave a review, we’d love to hear it. Go rock your day, and I will see you in the next episode.

Voiceover: 25:34

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This transcript has been generated using AI technology. There may be minor errors or discrepancies in the text.

The opinions expressed by the guests on this podcast are their own and do not necessarily reflect the views of the show or its hosts. This podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific health needs.