This year’s annual meeting of The Menopause Society (TMS), held from Oct. 21–25, 2025, in Orlando, centered on the theme “Optimizing Health and Longevity at Menopause and Beyond.”
The meeting synthesized current research across diverse specialties, underscoring perimenopause as a crucial period for influencing long-term female health outcomes, including cardiometabolic and bone health.
Here are some key takeaways from our science team who attended the meeting.
Presented by a stellar lineup of speakers, the meeting’s Open Symposium focused on perimenopause.
“The hallmark criteria for perimenopause are cycle changes accompanied by fluctuations in reproductive hormones as outlined in the Stages of Reproductive Aging Workshop (STRAW)+10,” said Dr. Cynthia Stuenkel, past president of TMS. Clinicians should rely on menstrual history, age, and symptoms for diagnosis rather than laboratory test results. Vasomotor symptoms (VMS), altered mood and sleep, and sexual and cognitive issues are common during this period.
Yet, Dr. Marcie Richardson presented work from the Women Living Better study showing that symptoms can start earlier, in the late reproductive phase, challenging our view of when perimenopause starts.
Dr. Jill Liss spoke about the management of abnormal uterine bleeding and outlined that during perimenopause, cycle control, symptom relief, and contraception are the main goals, referring to The 2023 Practitioner’s Toolkit for Managing Menopause for more details. Meanwhile, Dr. Claudio Soares, outgoing president of TMS, emphasized the strong links between vasomotor symptoms, sleep, and mood, outlining evidence-based pharmacological and nonpharmacological treatment options.
On the topic of contraception, Dr. Andrew Kaunitz explained that healthy, nonsmoking women without additional cardiovascular risk factors (like smoking or diabetes) can safely continue combination hormonal contraceptives until age 50 to 55. He noted several noncontraceptive benefits, including relief from vasomotor symptoms, increased bone mineral density, and reduced endometrial and ovarian cancer risk. He also noted that for perimenopausal women receiving estrogen, the 52 mg levonorgestrel intrauterine device was highly effective for contraception while simultaneously providing endometrial suppression and cycle control.
Finally, Dr. Jen Gunter rounded off the Opening Symposium with insights into misinformation about bioidentical and compounded hormones, hormone pellets, hormone testing, and supplements.
During the Presidential Symposium, Dr. Pauline Maki, past president of TMS, underscored that cognitive challenges, often described as brain fog, are common, with more than 40% of women reporting forgetfulness during perimenopause.
She cautioned that while hormone therapy maintains memory in surgically menopausal women, there is currently no evidence of cognitive benefits for women who went through menopause naturally and is therefore not recommended for the prevention or treatment of cognitive decline or dementia.
However, she did point out that treating hot flashes, whether with pharmacological or nonpharmacological options, may offer cognitive benefits as hot flashes are associated with adverse effects on the brain including memory decline.
Dr. Rebecca Thurston highlighted that trauma, including childhood abuse and adult trauma, is a prevalent female health issue, with 52% of women in the Study of Women’s Health Across the Nation cohort scoring positive for abuse or neglect. Trauma history is associated with a greater symptom burden through midlife, including VMS, sleep, mood, and sexual function, as well as increased CVD risk and poorer brain health.
Dr. Jennifer Gordon detailed how perimenopause is a period of heightened vulnerability, increasing the odds for depressive symptoms and the risk for relapse in women with a history of depression. She highlighted that different estrogen sensitivity profiles exist among women. Those sensitive to estrogen decreases may be at greatest risk during the late transition and early postmenopause, while those sensitive to estrogen increases appear most at risk during the early transition. Meanwhile, those sensitive to estrogen changes may be at risk throughout perimenopause and early postmenopause, while women who are insensitive to estrogen have no increased risk beyond their premenopausal levels.
A number of symposia highlighted midlife as a metabolic vulnerability window. The decline in estrogen contributes to adverse metabolic changes, increasing the risk for dyslipidemia, insulin resistance, and hypertension.
In postmenopause, body composition worsens, characterized by increased visceral/central fat accumulation. Visceral fat percentage increases significantly from 5% to 8% of total body fat in the premenopausal state to 15% to 20% postmenopause. Poor sleep quality is associated with increased energy intake and lower diet quality, contributing to increased risk of cardiovascular disease (CVD). Furthermore, curtailing sleep by as little as 90 minutes per night for six weeks increased insulin resistance by nearly 20% in postmenopausal women, independent of body fat changes.
Speakers discussed several strategies including the Mediterranean diet, consistent eating and sleeping patterns, exercise, and calorie restriction.
Dr. Daniela Hurtado gave an overview of GLP-1 receptor agonists as highly effective agents for weight loss. Critically, these effects extend beyond weight reduction. Semaglutide, for instance, reduced major cardiovascular events by 20% in at-risk individuals. These agents have also shown benefit in improving steatotic liver disease and obstructive sleep apnea. In postmenopausal women who were using menopausal hormone therapy (MHT), GLP-1s led to greater weight loss than in those not on hormone therapy.
Dr. Garima Sharma kicked off the session with a reality check by explaining that awareness of CVD as a leading cause of death in women is decreasing. She highlighted midlife as a crucial window for early prevention strategies with a focus on lifestyle modification and called for greater awareness of female-specific risk factors and a focus on addressing health disparities.
Primary prevention efforts should focus on the management of hypertension, dyslipidemia, and diabetes, according to Dr. Erin Donnelly Michos. While she called out lifestyle modifications as the foundation of prevention, she explained that high-risk patients benefit from additional pharmacotherapy. She also highlighted that white coat hypertension is not benign but linked with an increased risk of cardiovascular events and all-cause mortality if left untreated.
Both Dr. Sharma and Dr. Michos discussed the benefits of Lipoprotein(a) testing to assess CVD risk.
Dr. Puja Mehta rounded off the session with an overview of microvascular disease. She explained that ischemia with no obstructive coronaries, where two-thirds of women presenting with angina have nonobstructive disease, is a significant clinical challenge, citing coronary microvascular dysfunction as an underlying cause. Psychological factors and mental stress can act as triggers for coronary microvascular dysfunction, implicating the autonomic nervous system as a key mechanistic pathway through its interplay with endothelial function and vascular tone.
Accelerated bone loss begins in perimenopause, as Dr. Michael McClung explained. Rapid bone loss occurs from around two years before the final menstrual period and continues for several years afterward. This marks perimenopause and early postmenopause as a key time for prevention, as transmenopausal bone loss is a significant factor in the later development of osteoporosis.
Therapies approved for osteoporosis prevention in at-risk perimenopausal or early menopausal women should focus on maintaining bone mineral density and include estrogen (oral or transdermal), bisphosphonates (e.g., alendronate, zoledronate), raloxifene, and others.
To maintain the skeletal benefit obtained from estrogen therapy after discontinuation, transitioning to an antiresorptive agent is key. This loss prevention can be achieved through a short course (e.g., two years) of a bisphosphonate.
Dr. Risa Kagan kicked off the session about VMS management by explaining that hot flashes aren’t just heat waves but are associated with mood and sleep disturbances, brain fog, reduced quality of life, markers of subclinical CVD, and lower bone mineral density. Around 70% of women who experience VMS remain untreated.
She highlighted that without contraindications, MHT remains the gold-standard treatment for VMS, endorsed by all medical societies. She emphasized the need for better education for patients and shared individualized decision-making.
Dr. Laurie Jeffers provided an overview of nonhormonal pharmacological treatments for VMS, emphasizing compassion, collaboration, individualized care, and continuity of care. She discussed treatments with the strongest levels of evidence, including gabapentin, oxybutin, paroxetine, citalopram, escitalopram, venlafaxine, desvenlafaxine, fezolinetant, and the newly FDA-approved elinzanetant.
Among the nonpharmacological treatment options, the highest level of evidence (Level I) supports cognitive behavioral therapy (CBT) and clinical hypnosis, Dr. Janet Carpenter explained. Other recommended strategies (Level II–III evidence) include weight loss, which may achieve a 32% VMS reduction for every 5 kg weight loss or 5 cm decrease in abdominal circumference, and stellate ganglion block.
She also highlighted that there is currently not enough evidence to support the use of mindfulness, dietary changes, or electroacupuncture for the management of VMS. Further, she explained that for acupuncture, relaxation, and paced respiration, there was evidence of no effect, and for yoga and exercise, there was evidence of little or no effect. Finally, she pointed out that supplements are not recommended due to a combination of no evidence, conflicting evidence, and evidence of no effect.
The final symposium was dedicated to synthesizing the evidence surrounding testosterone. Dr. Susan Davies presented her recent research on testosterone levels in midlife women.
She explained that due to the very low levels of testosterone in women, precise measurement requires liquid chromatography with tandem mass spectrometry, as immunoassays are imprecise. Testosterone levels steadily decline between 40 and 60 years and then increase modestly with no effect of menopause on serum testosterone levels.
Beyond the treatment of low libido, Dr. Davies summarized that there is currently no evidence for the use of testosterone for the prevention or treatment of muscle loss, bone density changes, CVD, depressive symptoms, or cognitive decline during midlife. She called for more research in this field.
Finally, Dr. Jan Shifren discussed the evidence for the use of testosterone in the treatment of hypoactive sexual desire disorder (HSDD). In surgically and naturally postmenopausal women with HSDD, randomized controlled trials demonstrated that transdermal testosterone therapy increases total satisfying sexual activity versus placebo, leading to improvements across domains including desire, arousal, orgasm, and pleasure.
In addition to attending the talks and taking notes for you, our team copresented a series of posters, sharing early results from our latest perimenopause research study.
Based on results from a survey of 17,494 Flo app members, we explored levels of knowledge of potential symptoms common during perimenopause, highlighting a huge gap in knowledge, as well as reporting differences in symptom prevalence between women living in different countries.
In addition, we presented results focusing on the psychological burden of perimenopause, establishing international differences, and an analysis showing that social determinants of health including ethnicity, income sufficiency, level of education, and health care access, impact symptom burden.
Exploring perceptions of menopause, we highlighted that women are more uncomfortable discussing menopause at work than in their personal settings and that feelings of judgment, embarrassment, and stigma remain high.
Finally, we showed that women in perimenopause experience greater impairment in work productivity than premenopausal or postmenopausal women, estimating the cost to society in the United States at $2 billion annually.
We’ll be sharing more details about our perimenopause research program in the coming months. Flo supports clinical practice through evidence-based health education and tools that help patients navigate and self-manage their health across the reproductive lifespan. Learn more about us.