Projects

This project is funded by the World Health Organisation.

The gender difference in dementia risks with women having higher risks of dementia than men has been well-documented. The neuroprotective effects of female gonadal hormones (i.e. oestrogen and progesterone) on cognitive functioning has been highlighted in various research, however, findings regarding the impacts of hormone therapy on cognitive decline and dementia risk have been inconclusive. The menopause transition, which involves substantial fluctuation in hormonal levels, is one critical research target for the gender difference in dementia risks.

Director of the Menopause Mind Lab, Professor Aimee Spector, leads an evidence synthesis project for the update of World Health Organisation’s (WHO) guidelines on risk reduction of cognitive decline and dementia, focusing on the impacts of HT on cognition.

The research question from is: For women during the menopause transition and beyond with normal cognition or mild cognitive impairment, is the use of hormone therapy more effective than usual care or no intervention in reducing the risk of cognitive decline and/or dementia?

This project will synthesise evidence from existing literature, address the research question, and assist in WHO’s recommendations development.

This project is funded by the UCL Global Engagement Partner Funds.

This is a collaborative project between UCL and Shanghai Jiao Tong University, funded by the UCL Global Engagement Partner Funds. 

Brain fog-related cognitive problems, including forgetfulness and difficulty in concentration, are one of the most common issues in the menopause transition. However, our understanding of women’s cognitive experiences has been limited by the lack of measuring instruments. Furthermore, most studies have been conducted with Western populations despite the cultural differences found in menopausal experiences. This project will adapt and validate a newly developed UK self-reported cognitive measure, known as the Menopause-specific Cognitive Scale (Meno-Cog), developed in the lab within the PhD project of Lexi He. This project will involve a focus group study to explore Chinese women’s MT-related cognitive experience and revise the subjective cognitive measure according to the cultural context, and a pilot study to validate the Chinese version of Meno-Cog.

We aim to 1) explore Chinese women’s cognitive experiences during the menopause transition and consider findings across the two countries; 2) culturally adapt and validate the UK-version measure in the Chinese context; 3) identify unmet needs regarding brain health in a healthcare settings; and 4) enhance cross-cultural communication between the two institutions via college visit.

There are currently no viable, evidence-based treatment options for people in menopause transition experiencing cognitive problems, or ‘brain fog’. This study involves the development and testing of CST-Meno, consisting of four, 2-hour online group sessions. The programme was developed through the existing research evidence and using findings from our recent survey, which asked women with self-reported cognitive problems what support they felt they needed. The key components of CST-Meno are a) education about menopause and the brain, b) Cognitive Behavioural strategies; c) specific memory and cognitive strategies / skills and d) peer support / normalisation. 

We are about to conduct a feasibility study to test CST-Meno with 40 people, where we will compare 20 people attending CST-Meno groups and 20 will receive treatment as usual. If results are promising, we hope to expand to a larger trial looking at the effectiveness and cost-effectiveness of CST-Meno (for example, whether it leads to any changes in working days or use of medication).

This work follows from the highly successful Cognitive Stimulation Therapy (CST) for dementia programme. CST for dementia is now used in 40 countries and is the only non-pharmacological intervention recommended to support cognition in the UK NICE dementia guidelines.

This project is conducted by Paige Williams, for Doctoral thesis.

On average, women report experiencing symptoms of the menopausal transition for over seven years during their forties and fifties. However, around a third of women experience long term symptoms. Women experiencing the menopausal transition are the fastest growing demographic in the workplace, bringing high levels of skill and experience and often being at the peak of their career. Despite this, women continue to feel forced into leaving the workplace or stalling their career progression due to symptoms of the menopausal transition. Stigma regarding the menopause continues to impact women in the workplace, with women reporting distress at perceived reactions to symptoms and identifying difficulties in discussing the menopause at work.   Cognitive symptoms, such as difficulties with concentration and memory, have been identified as particularly disruptive at work, however, research into the impact of these cognitive symptoms on women, and the relationship between the workplace and cognitive symptoms, is limited. This research will use qualitative methods to explore cognitive symptoms of the menopausal transition and the impact on women in the workplace, in order to harness rich data and enhance our understanding of the experiences of women in this stage of their lives.

This project is conducted by Alisha Mehta, for Doctoral Thesis.

This project aims to investigate the impact of ethnicity on women’s experiences of menopause at work. It has been found that in UK workplaces, women from ethnic minority backgrounds, compared to White counterparts, are less likely to report menopause symptoms at work and are more likely to view the menopause as having a negative impact on their career progression. However, there is no research on how different minority ethnic groups compare with one another in terms of how they experience menopause symptoms at work. The research questions are:

• Is ethnicity a predictor of menopause symptom severity in the workplace? 
• In the workplace, are there differences between ethnic groups in: 1) Reporting of symptoms at work and barriers to reprting symptoms? 2) Perceived support from colleagues, managers and their organisation? 3) Perceived support and perceived stigma?

These questions will be addressed through the development and dissemination of a short survey, which will be shared with women working in UK-based organisations, who are currently experiencing perimenopause or have recently reached menopause.

This is the first study in the UK that aims to obtain an ethnically diverse sample of menopausal women to directly explore how ethnicity may intersect with menopause experiences at work.

This project is conducted by Simone Saidel and Kate Robinson, for Doctoral thesis.

This study aims to determine whether group-based compassion focussed therapy (CFT) can be feasibly used with adults experiencing menopause, to treat anxiety and depressive symptoms. Considering the existing literature, there is scope to investigate high intensity CFT as an intervention for treating psychological difficulties in menopausal adults. This project is intended as a preliminary exploration to establish whether intervention modifications are necessary and provide direction for further evaluation of intervention efficacy. This study will be a feasibility randomised controlled trial of online, group CFT plus treatment as usual compared to treatment as usual. A combination of quantitative and qualitative methods will explore the feasibility of recruitment and eligibility, participant willingness to be randomised, retention rates in both the intervention and overall trial, suitability of outcome measures and acceptability of group CFT for this population. Preliminary effects on a range of clinical outcomes will also be explored.

This project is conducted by Nora Bahhar, for Doctoral thesis.

Menopause is a complex phenomenon that manifests in different ways. Understanding the psychological mechanisms during this transitional period can help healthcare professionals to provide appropriate, individualised care for those who are struggling. Using data from a longitudinal, population-based study, the current research project aims to determine if mental health varies by menopausal status (i.e. pre-menopause, perimenopause and post-menopause). Secondly, given conflicting evidence regarding the nature of psychological symptoms during the menopausal transition, this research project will aim to determine if psychological poor health is more likely to be associated with concurrent life experiences (such as work stress, family stress, or physical health difficulties), or to menopausal status itself. Finally, the current project will aim to explore if early-life adverse experiences (such as history of mental health difficulties), predict poor psychological symptomology during the menopausal transition. Until now, studies that have attempted to answer these questions had methodological limitations or results that have not been replicated. The current research project will aim to address these gaps and will aim to make a valuable contribution to the current biopsychosocial understanding of mental health in menopause and the menopausal transition. 

This project is conducted by Lexi He, for Doctoral thesis.

People might experience diverse symptoms during their menopause transition. Brain-fog related symptoms, such as forgetfulness, poor memory and difficulty in concentration, are frequently reported by people during the menopause transition. The menopause research conducted in various cultures have challenged the notion of a universal menopausal experience, and emphasised the need to understand people's cognitive health and menopausal experiences with a cross-ethnic perspective. However, the majority of the current menopause research was conducted with Western populations from the White ethnic communities. Furthermore, a critical issue in the menopause literature is the lack of subjective cognition measures developed specifically for people transitioning into menopause and are validated in different ethnic groups. This study aims to review people's cognitive experiences during their menopause transition across ethnic groups, to critically look into the existing measures used in menopause research, and to develop and evaluate a subjective cognition measure for people from multi-ethnic groups in the United Kingdom.

This project is conducted by Danielle Proctor, for Doctoral thesis.

The aims of the study are to better understand: 1) What are the key cognitive difficulties experienced by perimenopausal and postmenopausal women? Are there differences between groups on subjective memory measures?; 2) What strategies might women already be using to help manage their cognitive difficulties, and what support do they receive?; 3) What could a novel intervention look like? Can we identify key intervention components based on the needs of this population?

Data will be collected through an online survey. Additional qualitative data will also be collected through qualitative interviews with perimenopausal or postmenopausal women experiencing cognitive difficulties. There is a distinct lack of research within this area, despite it being a research priority (Department of Health and Social Care, 2022), and available non-pharmacological interventions are limited. It is important that women are able to access interventions to support them with menopausal symptoms, particularly cognitive difficulties, which can be highly distressing and greatly impact their lives. By the end of this project, we will have produced and evidence-based intervention for the cognitive symptoms of menopause. The next step will involve testing its feasibility.

This project is conducted by Shahara Aziz Ellahi, for Doctoral thesis.

The UK is a multi-ethnic, multi-racial country and, in 2018, 13.8% of the UK population had an ethnic minority background. There is however limited research evidence of menopause experiences in British ethnic minority women. British Menopause Society (BMS) reported several variations in the symptomatic experience and prevalence of menopause in minoritized groups. It is reported that South Asian women tend to experience less typical symptoms such as hot flushes and sweats; instead, reporting more fluctuations in mood, heightened anxiety and musculoskeletal pain including bone and joint aches. A substantial portion of the information available is from overseas research, articles and blogs.

This study therefore aims to explore British South Asian women's experiences, beliefs, and attitudes towards menopause. The research questions are:

• What are British South Asian Women’s attitudes and beliefs towards menopause?
• How do British South Asian women identify and label the symptoms and experiences associated with menopause within their cultural context?
• What are the experiences of British South Asian Women of emotional wellbeing and mental health throughout menopause?

This study aims to fill a gap in current research by using a culturally sensitive qualitative approach to gather in-depth insights from this demographic.

This project is conducted by Nadia Lohawala, for Doctoral thesis.

Most studies on the experience of menopause have been conducted on majority Caucasian and middle-class populations. Cultural differences have been found to have a large impact on menopausal symptoms (Wray (2007). For example, a study comparing experiences of menopause between a sample of UK South Asian women, women living in Delhi, India and UK Caucasian women had found that both Asian groups reported poor health, and more physical and emotional symptoms than the Caucasian group, and, further, the UK South Asian sample had a significantly higher prevalence of vasomotor symptoms (hot flushes and night sweats) than both Delhi and UK Caucasian women (Gupta et al., 2006).

People from different cultural backgrounds may have different beliefs and attitudes regarding the menopause, which can impact on their ability to seek help (Pandey, 2021). For example, South Asian women present a unique set of cultural beliefs and values which may influence their awareness, understanding and perception of menopause as well as healthcare provision. These views need to be better understood to help clinicians and service providers better understand how to improve health promotion and provide adequate support for this group of women. Thus, due to the lack of inclusion of South Asian Women in most literature on menopausal experiences, it is particularly important to explore this further and update the limited research in this population.

This study aims to further explore and understand, through a quantitative analysis of responses from a cross-sectional survey, UK South Asian women’s experiences of menopause. It seeks to explore and identify the prevalence of menopausal symptoms in South Asian women in the UK, their knowledge and understanding of menopause, the demographic and lifestyle factors that influence their quality of life, and the behaviours and perceptions towards healthcare provision.

The Effectiveness of Psychosocial Interventions on Non-physiological Symptoms of Menopause: A Systematic Review and Meta-analysis (Aimee Spector, Zishi Li, Lexi He, Yasmeen Badawy, Roopal Desai). Published in the Journal of Affective Disorders.

Menopausal symptoms of physiological changes, psychological difficulties and cognitive impairment are suffered by increasing number of women. Research shows that these concerns have been under-supported by standardized interventions. Some women are exposed to culturally stigmatized values around menopause and are reluctant to seek professional support, whereas others lack knowledge of where to access help. The conventional and most widely offered menopause intervention is hormonal therapy, but this does not suit all women. This systematic review and meta-analysis examines the effectiveness of psychosocial interventions on non-physiological symptoms of menopause, including mood, cognition, and quality of life. Thirty Randomized Controlled Trials (RCTs) that examined 3501 women were included. Findings based on pre- and post-intervention scores generally favored the effectiveness of Mindfulness-Based Interventions in improving menopausal symptoms. Other interventions including Cognitive Behavioral Therapy (CBT), Self-care Education, and Group Counselling also generated partially significant findings on certain outcomes. We identified menopausal cognitive functioning as an under-researched domain, and the high heterogeneity of findings point to a need for more research. In terms of implications for managing non-physiological menopausal symptoms, access to supportive social environments that promote an unbiased understanding of menopause may be helpful.

Read the publication here. 

The Risk of Depression in the Menopausal Stages: A Systematic Review and Meta-analysis. (Yasmeen Badawy, Aimee Spector, Zishi Li and Roopal Desai). Published in the Journal of Affective Disorders.

The menopause transition can be a period of emotional and physical changes that may be debilitating. The different menopausal stages have been associated with an increased risk for depressive symptoms and diagnosis. The purpose of this review was to conduct a literature review and meta-analyses to provide an estimate for the risk of developing clinical depression and depression symptoms in different menopausal stages. Sixteen prospective cohort studies on menopausal stage and depressive symptoms for diagnoses, as measured by standardized tests or structured interviews, were included. The meta-analyses included fourteen of the studies using seven random effects models, and the pooled odds ratios were reported for depressive symptoms and depression diagnoses. Perimenopausal women were found to be at a significantly higher risk for depressive symptoms but not clinical depression compared to premenopausal women. There was a trend that did not reach significance for a higher risk of depressive symptoms but not clinical depression in the post-menopausal stage compared to the premenopausal stage. Given that the menopausal transition is a period of increased vulnerability to depressive symptoms and disorders, early screening is necessary. It is important to note that more longitudinal research is needed in non-Western countries to be able to generalize these results.

Read the publication here. 

The Psychometric Properties and Applicability of Subjective Cognitive Measures Used in Menopause Research: A Systematic Review. (Lexi He, Nicole G. Jaff, Emily Kontaris, Aimee Spector). Published in the Journal of the Menopause Society

Cognitive issues can be problematic in menopause transition. However, the current understanding of women's cognitive experiences during the menopause transition has been limited by the lack of validated self-reported cognitive measures. This systematic review aimed to identify existing self-reported, or subjective, cognitive measures used in menopause research and evaluate their psychometric properties and applicability. Three databases, Medline, Embase, and PsycINFO, were searched in March 2024 with no restriction on publication year. Studies investigating women transitioning into postmenopause and with cognitive experiences measured using validated subjective cognitive measures were selected. The assessment of psychometric properties and applicability of included measures was conducted based on their development process and their performance in the menopause studies selected. Twenty-eight menopause studies involving 15 measures were included. Included measures showed adequate content validity, internal consistency, and construct validity when they were developed, yet other psychometric properties were either poor or not reported. Information relating to psychometric properties of included measures in menopause studies was also lacking, indicating doubtful applicability. This review recommends the use of subjective cognitive measures that assess more than one cognitive domain, as well as further assessment of the psychometric properties of these measures before their use in menopause research or clinical settings, particularly those measures initially developed for clinical practice. It also highlights the need for future development of a subjective cognitive measure for women transitioning through menopause to improve the current understanding of their cognitive challenges.

Read the publication here.