Quick look
Iowa State researchers are studying whether menopause sets off small but important changes in the brain and blood vessels that could help explain why women face higher risks of stroke and Alzheimer's disease as they age. Their goal is to identify these shifts early enough to intervene.
AMES, Iowa - For decades, much of the medical focus on menopause centered on hot flashes, sleep problems and bone density. Now a growing body of research is zeroing in on a different organ altogether: the brain.
At Iowa State University, researchers have launched a new study to examine whether the menopause transition may quietly accelerate brain and blood-vessel aging - potentially helping explain why women face higher risks of stroke and Alzheimer's disease later in life.
The cross-sectional project known as the BRAVA study - short for BRAain & VAscular Aging across the menopause transition - includes plans for long-term follow-up that will allow researchers to track how vascular and cognitive changes unfold over time.
"We know men's and women's brains age differently," said Wesley Lefferts, the BRAVA study's principal investigator and an assistant professor of kinesiology and health at Iowa State. "Data shows women have a greater risk of cognitive diseases like Alzheimer's and dementia, and also tend to experience worse outcomes after cerebrovascular events like a stroke."
But the "why" behind these disparities is not well understood.
"Over the decades, brain-aging research has primarily focused on men," Lefferts said. "The BRAVA study is part of a growing movement to correct that imbalance and to recognize that women's health can't be fully understood without studying the menopause transition."
The BRAVA study is funded by grants from the American Heart Association and the National Institutes of Health, with each grant supporting a subset of participants who have different health histories and conditions, Lefferts said.
A midlife shift
Women have a longer life expectancy than men, which might explain part of the imbalance in brain and blood-vessel aging, Lefferts said - but doesn't tell the whole story.
"Our data from prior research suggests that women may have less inherent protection against damaging blood-flow patterns and that the menopause transition may accelerate increases in cerebral blood flow pulsatility, which is associated with cerebrovascular disease risk and brain health," Lefferts said.
If confirmed, Lefferts said this could help explain why the decades following menopause carry an elevated neurological and cerebrovascular risk for women and why traditional cardiovascular risk models may miss important sex-specific factors.
"Our goal isn't just to understand what's happening, but to understand it early enough to intervene," said Lefferts, who serves as co-director of the Clinical Vascular Research Lab at Iowa State.
"If we can give researchers a possible target for drug and behavioral interventions to improve brain blood flow patterns, we might be able to reduce disease risks for women later in life."
Inside the study
Enrollment for the BRAVA study is currently underway, with a goal of enrolling of approximately 370 women over the next three years.
To be eligible, women must be between the ages of 40 to 64; in the premenopausal (regular menstrual cycles), perimenopausal (irregular menstrual cycles) or early post-menopausal (within five years of their last menstrual cycle) stages; and have specific health characteristics, which will be assessed through online screening surveys and an in-person screen visit on the Iowa State campus. Women who do not experience a menstrual cycle because their uterus has been removed are also eligible.
"Perimenopause, in particular, can be highly variable from person to person, and it's been often overlooked in past research for that reason," Lefferts said. "But perimenopause is also a turning point for so many aspects of women's health, and we can't and shouldn't ignore it."
Once approved for the study, participants will complete a comprehensive series of clinical assessments, ranging from heart and artery function to brain blood-flow measurements, cognitive testing and blood biomarker analysis. This will include online questionnaires, two in-person visits and eight days of at-home ovulation tracking for women who currently experience a menstrual cycle.
"All assessments are non-invasive and focus on measuring vascular health, cognitive function and lifestyle behaviors, including physical activity/exercise, strength and diet," Lefferts said.
In turn, study participants will receive complimentary comprehensive health reports, monetary compensation for participating and the option to return annually for repeated annual assessments for five years.
"For many women, this is a unique and valuable opportunity to see detailed information about their brain and vascular health while also contributing to research that could reshape how future generations of women age," Lefferts said.
Lefferts is leading the BRAVA study with ongoing support from Iowa State students, who gain valuable research expertise by helping with assessments, data management and more.
"Research plays a critical role in how well we understand so many things related to our health, including the aging process, and the opportunity to help manage the BRAVA study is an incredible learning experience," said Brooke Roberts, a sophomore in the integrated health sciences program at ISU. "I know I will be a stronger and more prepared professional as a result."
Learn more
To learn more about the BRAVA study, click here, or you can take a brief online survey to see if you are eligible to participate.
