Healthcare management

1.4.6 Women’s health

Women spend an estimated 25% more time in poor health toward the end of their lives compared to men. This disparity is often referred to as the “morbidity-mortality paradox,” where women live longer but experience a greater burden of chronic illness and disability due to non-fatal, debilitating conditions like arthritis, osteoporosis, cardiovascular disease and dementia. This significant gap highlights the need for health services to focus on proactive care that addresses the unique health risks women face as they age.

Health services have historically focused on reproductive health, but a more holistic approach is needed to address the full range of issues women face throughout their lives. The profound hormonal shifts during perimenopause and menopause, in particular, play a crucial role in determining a woman’s health trajectory, leading to an increased risk of chronic diseases and a reduction in years of healthy living.

The impact of perimenopause and menopause on women’s health outcomes is substantial. Perimenopause, the period leading up to menopause, can last for several years and is marked by fluctuating hormone levels, causing symptoms like hot flashes, sleep disturbances, and mood swings. Once a woman reaches menopause, the dramatic decline in oestrogen leads to a significant increase in the risk of serious health conditions, including osteoporosis, cardiovascular disease, and cognitive decline.

Hormone Replacement Therapy (HRT) is a key treatment that can have a significant impact on both healthspan and lifespan by mitigating the effects of hormonal loss. By reducing the risk of osteoporosis, it lowers the chance of fractures, which are a major cause of disability in older women. HRT also helps to prevent cardiovascular disease and new data demonstrate a role in reducing the risk of cognitive decline. When initiated early in menopause and used for a prolonged period, HRT has been shown to improve a woman’s quality of life and extend her healthspan by mitigating a range of menopause-related issues:

• Osteoporosis: HRT has been shown to be highly effective in preventing and treating osteoporosis, a major cause of fractures in older women, . Studies demonstrate reductions in hip fractures by up to 50% with the use of HRT (Women’s Health Initiative Investigators, 2002). By maintaining bone density, HRT can help a woman remain mobile and independent, directly extending her healthy, active years.
• Cardiovascular Health: When commenced in the early stages of menopause, HRT can have a protective effect, reducing the risk of coronary heart disease. However, the positive effect is only seen with newer transdermal oestrogen HRT preparations and if started early on in menopause (USPSTF, 2022). If HRT is started at later stages of menopause, the beneficial effects are outweighed by an elevated risk of stroke (USPSTF, 2022).
• Alzheimer’s Disease: Initiation of HRT within 5 years of the onset of menopause and continued use for 3-5 years may reduce the risk of developing Alzheimer’s disease, however the beneficial effects are outweighed by the risks if HRT is commenced later in menopause (Song et al., 2025).
• Quality of Life: HRT is highly effective in relieving debilitating menopausal symptoms such as hot flashes, night sweats, and mood swings, with some studies reporting relief in over 80% of users (Maclennan et al., 2002). This improvement in daily well-being directly contributes to a higher quality of life and better healthspan.

The future of women’s health is focused on more targeted and personalised treatments. Novel treatments on the horizon aim to address the specific symptoms of menopause without the use of hormones. One such class of drugs is Neurokinin 3 receptor (NK3R) antagonists, which are being developed to treat hot flashes and night sweats by targeting the brain pathways responsible for temperature regulation.

Furthermore, research into selective oestrogen receptor modulators (SERMs) is ongoing to create drugs that provide the benefits of oestrogen in certain tissues, like bone, while avoiding risks in others, such as the breast and uterus. The aim is to create safer, more effective treatments that can be tailored to an individual woman’s unique needs, ultimately enhancing her healthspan.

The economic benefits of investing in women’s health presents a significant global economic opportunity, estimated as adding at least $1 trillion annually to the global economy by 2040 according to a World Economic Forum estimate (World Economic Forum & McKinsey Health Institute, 2024). This economic gain comes from several key areas: reducing productivity loss, increasing women’s participation in the workforce, and lowering healthcare costs.

Closing the gap between male and female healthspan has the potential to lead to a tremendous improvement in quality of life for women, together with huge economic gains, making this an essential area of focus for healthy humanity.