FEMTECH REPORT: Innovations for Perimenopausal Health and Cardiovascular Risk in Women

 Written by: Lennard Goetze, Ed.D 

Cardiovascular disease (CVD) is the leading cause of death among women, next only to breast cancer in terms of public health awareness and research focus. Despite the increased visibility of breast cancer campaigns, heart disease remains under-recognized in the female population, particularly during the perimenopausal transition. The hormonal fluctuations in this stage are linked to increased risks of hypertension, dyslipidemia, metabolic syndrome, and other cardiovascular complications. These risks are compounded by the relative lack of early diagnostic interventions that are sex-specific, leading to a growing interest in the development of health technologies aimed at women in midlife (Mosca et al., 2011).

"FEMTECH FOR MENO-CARE"

The emerging field of FemTech—a sector dedicated to technology-based solutions for women’s health—is rapidly addressing the gap in perimenopausal and menopausal care. Innovations include wearable devices such as the BELLABEAT WELLNESS TRACKER and AVA FERTILITY BRACELET, which monitor physiological changes in heart rate, temperature, and sleep patterns. These devices provide data that can signal perimenopausal onset or changes in cardiovascular risk factors.

In addition, digital health platforms like CLUE and MYMOJO track hormonal symptoms and cycles, while more clinically integrated devices, such as IHEART INTERNAL AGE and FEMBEAT, offer non-invasive assessments of vascular and metabolic health in real time. These advancements not only promote self-monitoring but also facilitate earlier engagement with healthcare providers (Labrie et al., 2017).

Medical devices have further expanded into diagnostic and preventive technologies specifically tailored for women. One such innovation is the application of portable and advanced ultrasound systems to screen and monitor cardiovascular and endocrine changes. For instance, carotid artery ultrasound imaging can detect early atherosclerotic changes in perimenopausal women, offering a non-invasive method for risk stratification (Wildman et al., 2008). Point-of-care ultrasound (POCUS) is increasingly utilized to monitor visceral fat accumulation, cardiac function, and vascular compliance—all of which correlate with heightened cardiovascular risk in this demographic. These imaging tools provide accessible and radiation-free options for clinicians seeking to intervene early in the disease continuum.

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CIMT and Longevity

Written by: Dr. Robert L. Bard

Carotid (artery) Intimal Thickness is a vital marker for evaluating peri-menopause related illness. The paired carotid vessel system is the main channel for brain oxygenation and is the main target for hypertension, autoimmune disease (Hashimoto’s thyroiditis, lupus, psoriasis, rheumatoid arthritis) and cardiovascular hemodynamic disorders. 

The intimal thickness of 6-8mm in middle age is considered physiologic while a measurement over 1 mm is strongly associated with increased cardiovascular risk. Some studies have shown that estradiol may reduce systolic blood pressure in older women.  The arterial wall has 3 layers; an outer layer-the adventitia-the strong support structure to maintain the vessel shape; the muscular media that cause the artery to constrict as a response to high blood pressure; and the inner lining of a thin layer of cells called the intima

A closer look at the inner lining of any artery is the single cell layer called the “endothelium” which, like the ovary, has many functions. The skin is considered the largest organ in the human body but the endothelial lining is 14,000 square feet (or 6.5 tennis courts) when measured. It is a protective barrier and a hormone producing entity that is vital to the maintenance of every system in our body.  Hypertension increases pressure in the arterial wall and the endothelium reacts with a hormonal shield to reduce the structural damage to the heart, brain, eyes and kidneys. 

Reducing damage to the arterial system is improved due to better evaluation of the abnormal pressures in each organs blood supply. Hemodynamic assessment is now improved by tracking flow abnormalities using spectral Doppler ultrasound that pinpoints the weakest link in the body's vascular defense mechanism. Advance warning of the “at risk” area is key to targeting focal therapy-is it the retina, the heart, the brain, the liver or the kidney separately or in combination? New pressure dynamic imaging highlights vulnerable structures so damage may be mitigated or repaired before permanent issues occur.

Note that the thyroid gland sits adjacent to the carotid system and tumors of the thyroid or parathyroid may be discovered at the same time.  More importantly, high blood flow of inflammation or hyperthyroid disease and low blood flow associated with autoimmune disorders such as Hashimoto’s or lupus may reveal themselves in similar scan sections. The reverse is true where clinically significant plaque is detected during a neck scan for abnormal lab results. Similarly, the recent application of Elastography for thyroid fibrosis also differentiates friable and dangerous soft carotid plaque that may embolize causing stroke.

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HEART RATE VARIABILITY (HRV) AND CARDIOVASCULAR RISK IN PERIMENOPAUSE
By: Dr. Lesie Valle-Montoya

HRV has become one of my GO-TO tools for understanding how the body is handling oxidative stress and regulating itself—especially in women going through perimenopause. During this transitional phase, estrogen levels begin to fluctuate and eventually decline, which can impact the cardiovascular system in subtle but important ways. We often think of heart disease as something that happens later in life, but changes in autonomic nervous system balance—reflected in a drop in HRV—can actually show up much earlier. Lower HRV is often a sign that the body is under strain, leaning more heavily on the sympathetic (“fight or flight”) system rather than maintaining a healthy parasympathetic (“rest and repair”) tone. 

For perimenopausal women, tracking HRV can be incredibly helpful in identifying early shifts in cardiovascular regulation—long before anything shows up on labs or imaging. It gives us a window into how hormonal changes, stress, and lifestyle are all interacting in real time. That kind of insight allows us to be proactive with lifestyle interventions, stress management, and support for the nervous system. I see HRV not just as a data point—but as a guide for more personalized, preventative care.

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TOP 10 MEDICAL DIAGNOSTIC SOLUTIONS FOR CARDIOVASCULAR DISORDERS IN PERIMENOPAUSAL WOMEN

* AMBULATORY BLOOD PRESSURE MONITORS (ABPM) Tracks blood pressure over 24 hours. Essential for detecting masked or nocturnal hypertension, which is more prevalent during hormonal shifts.

* WEARABLE ECG MONITORS (e.g., KardiaMobile, Apple Watch ECG) Detect arrhythmias like atrial fibrillation. Useful for tracking palpitations and cardiovascular symptoms related to hormonal fluctuations.

* CARDIAC CT SCANNER (Coronary Artery Calcium Scoring) Measures coronary artery calcium buildup.  A preventive tool to assess atherosclerosis risk in asymptomatic women with risk factors.

* ECHOCARDIOGRAPHY SYSTEMS (e.g., GE Vivid, Philips EPIQ) Evaluates heart structure and function. Detects diastolic dysfunction, which is more common post-menopause. 

* STRESS TESTING SYSTEMS (Treadmill or Nuclear) Assesses how the heart handles physical stress. Helps identify ischemia in women with atypical symptoms.

* CARDIAC MRI - Non-invasive, detailed imaging of heart tissues. Useful in diagnosing myocarditis, cardiomyopathy, or scarring not seen in other imaging.

* IMPLANTABLE LOOP RECORDERS (e.g., Medtronic Reveal LINQ) Long-term monitoring of unexplained fainting or arrhythmias. Beneficial when symptoms are infrequent.

* LIPID PROFILE TESTING KITS (e.g., Everlywell Heart Health Test) Monitors cholesterol, triglycerides, and other lipid markers. Home-use options support early detection and tracking of dyslipidemia.

* CARDIAC TELEMETRY MONITORS - Used in hospitals or remote care for continuous ECG monitoring. Helps manage patients during acute phases or high-risk periods.

* VASCULAR ULTRASOUND DEVICES - Evaluates carotid intima-media thickness and arterial stiffness. Non-invasive marker of early atherosclerosis in perimenopausal women.

WHERE TO GO NEXT?

The current state of heart health in women reflects a critical need for gender-specific diagnostics and therapeutic approaches. Historically, female cardiac symptoms have been underdiagnosed due to a male-centric model of cardiology, but advances in both digital and imaging technologies are beginning to reverse this trend. With ongoing development in AI-integrated diagnostic platforms, wearable biosensors, and imaging-based risk assessments, the future of cardiovascular care in women promises to be more personalized, predictive, and preventive. As awareness of perimenopausal health risks continues to grow, so too does the potential for early intervention through comprehensive, tech-enabled care strategies (Maas & Rosano, 2010).

References

Mosca, L., Benjamin, E. J., Berra, K., Bezanson, J. L., Dolor, R. J., Lloyd-Jones, D. M., ... & Zhao, D. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. Circulation, 123(11), 1243-1262. https://doi.org/10.1161/CIR.0b013e31820faaf8

Labrie, F., Archer, D. F., Bouchard, C., Fortier, M., Cusan, L., Gomez, J. L., ... & Martel, C. (2017). Serum steroid levels during the perimenopause: changes and significance. Climacteric, 20(3), 241-246. https://doi.org/10.1080/13697137.2017.1301928

Wildman, R. P., Colvin, A. B., Powell, L. H., Sowers, M. R., Johnston, J., Mancuso, P., & Karvonen-Gutierrez, C. A. (2008). Associations of testosterone and sex hormone–binding globulin with carotid artery intima-media thickness in midlife women. Arteriosclerosis, Thrombosis, and Vascular Biology, 28(3), 575-581. https://doi.org/10.1161/ATVBAHA.107.157545

Maas, A. H., & Rosano, G. M. (2010). Cardiovascular disease in women: a clinical perspective. Nature Reviews Cardiology, 7(11), 606-615. https://doi.org/10.1038/nrcardio.2010.162

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Thursday, April 10, 2025

SEXUAL AND PSYCHOLOGICAL ISSUES WITH MENOPAUSE

By: Dr. Barbara Bartlik

The onset of menopause, typically in a woman’s early 50s, is a time of major physiological transition, due mainly to plummeting estrogen levels. The hormone estrogen, primarily produced in the ovaries, controls the female reproductive cycle and sexual response and affects all of female biology. Estrogen is anti-inflammatory and protects the bones, brain, gut, heart, joints, nervous system, and skin, so when a woman enters menopause, her whole system undergoes major changes. These changes lead to unwanted sexual changes, such as vaginal dryness, reduced lubrication, painful intercourse, orgasmic difficulties, and low libido. Estrogen is to women as testosterone is to men: with low levels of estrogen, women can lose interest in sex and have difficulty performing. If they become anxious or depressed, this, too, can impact their sexuality.  

The extent and severity of menopausal changes can vary significantly from woman to woman. Some may experience no mood changes, while others may experience low mood and even depression. Unhappiness and dissatisfaction can arise from physical changes and loss of fertility that accompany aging. Weight gain, graying hair, and wrinkles can negatively affect a woman's self-esteem.

Menopause is no longer synonymous with old age, but rather a time of transition and potential growth. With women now living at least one-third of their lives past menopause, many are prompted to make positive changes - increasing exercise, improving diet, giving up unhealthy habits, and making  psychological adjustments. Many women find themselves feeling empowered and better than ever, a state that anthropologist Margaret Mead referred to as “menopausal zest.” 

However, many women do experience deep depression that may require psychiatric medication; some require hospitalization for the first time in their lives. Rates of depression increase two-fold (Freeman, 2006). The reduction in estrogen decreases the feel-good neurochemicals dopamine and serotonin. For most women, there is a period when hot flashes interfere with the workday and also with sleep, which contributes to depression. Again, duration and severity vary widely. Many women experience a reduction in sexual feeling and interest related to hormonal changes, vaginal discomfort, disturbed sleep, and low energy. For some, this persists, but not for all. At the same time, their partner may be experiencing problems related to sexual functioning or midlife issues. These experiences are normal and shared by many women going through menopause. You are not alone in this new normal.

What can a woman do to minimize the psychological and sexual changes that accompany menopause? First and foremost, maintain a healthy lifestyle. Reducing alcohol intake, quitting smoking, regular exercise, and consuming a balanced diet can all offer benefits - these changes alone can often stop hot flashes and insomnia. Secondly, engage in stress-relieving practices, such as meditation, yoga, exercise, spending time in nature, enjoying music, and engaging in pleasurable hobbies. Seek support and guidance from specialists who can provide solutions. And finally, do not neglect your sex life and go into sexual retirement. Keeping it active can improve your psychological health, relationship, vaginal health, sexual competence, and vitality.  

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FEMTECH REPORT (Part2) : Modern Modalities to Mitigate Perimenopausal Symptoms 

Written by: Women's Health Digest editorial team

The transition into perimenopause brings a variety of physiological and emotional changes, including hot flashes, vaginal dryness, mood swings, and sleep disturbances. As awareness of these symptoms grows and the demand for holistic, patient-centered care increases, medical technologies and therapeutic devices have emerged to meet this evolving need. These devices are designed to support women through non-invasive or minimally invasive approaches that either complement or substitute traditional hormone replacement therapies. The development of such tools responds to the growing desire for personalized, safer alternatives that align with individual health goals and risk profiles, especially for women who are not candidates for hormonal therapies due to underlying medical conditions.

Among the notable innovations are vaginal laser therapy and radiofrequency vaginal rejuvenation devices. These modalities are used to treat vaginal atrophy, dryness, and urinary incontinence by stimulating collagen production and improving tissue elasticity. Administered in clinics by gynecologists or women's health specialists, these procedures are becoming increasingly popular due to their short recovery times and long-lasting effects. 

Meanwhile, neurofeedback devices offer cognitive and mood-related benefits by helping to regulate brainwave patterns, proving helpful for women dealing with anxiety, depression, or sleep disruptions associated with hormonal changes. Hormone replacement therapy (HRT) continues to be a mainstay, but its use is increasingly supported by wearable technology and digital monitoring platforms that help tailor dosage and monitor physiological responses more precisely.

Cooling wearables and temperature-regulating clothing are another class of innovations aimed at alleviating hot flashes and night sweats, some of the most disruptive symptoms of perimenopause. These wearable solutions are being adopted by both healthcare providers and wellness-oriented consumers seeking discreet, non-pharmacological relief. The development of all these technologies reflects a broader shift in the healthcare landscape—one that acknowledges the complexity of the menopausal transition and prioritizes women’s quality of life, autonomy, and access to diverse therapeutic choices. These modalities are not only reshaping how perimenopausal care is delivered but also empowering women to take a proactive role in managing their health.

The following are the most recommended solutions to address perimenopausal symptoms:

1. VAGINAL LASER THERAPY DEVICES (e.g., MonaLisa Touch, CO2RE Intima) - Non-surgical CO₂ or erbium laser devices used to treat vaginal atrophy, dryness, and laxity by stimulating collagen production and improving mucosal health.

2. RADIOFREQUENCY VAGINAL REJUVENATION DEVICES (e.g., ThermiVa, Viveve) - Use controlled radiofrequency energy to promote collagen remodeling and improve vaginal tone, lubrication, and sexual function.

3. TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) UNITS - Portable devices delivering low-voltage electrical current to help manage joint pain, muscle tension, and some cases of hot flashes or mood swings through neuromodulation.

4. HORMONE REPLACEMENT THERAPY (HRT) Transdermal Patches (e.g., Climara, Vivelle-Dot) - Prescription patches applied to the skin that release estrogen (and sometimes progesterone) gradually, helping to relieve hot flashes, mood swings, and vaginal dryness.

5. NEUROFEEDBACK DEVICES (e.g., Muse Headband, NeuroSky) - Wearable EEG-based devices that help track brainwave activity to support cognitive clarity, sleep regulation, and stress reduction during hormone fluctuations.

6. INFRARED LIGHT THERAPY PANELS (e.g., Joovv, Mito Red Light) -  Red and near-infrared light therapy devices used to reduce inflammation, improve skin tone, support energy levels, and manage mild mood disorders linked to perimenopause.

7. COOLING WEARABLES (e.g., Embr Wave Bracelet) - Wrist-worn devices that regulate body temperature perception using thermal waves, helping women manage hot flashes and night sweats discreetly.

8. PELVIC FLOOR MUSCLE TRAINERS (e.g., Elvie Trainer, Perifit) - Biofeedback-based devices inserted into the vagina to guide and track pelvic floor exercises, improving incontinence, core strength, and sexual health.

9. SLEEP AND CIRCADIAN RHYTHM DEVICES (e.g., Hatch Restore, Philips SmartSleep) - Devices designed to optimize sleep hygiene by regulating circadian rhythms through light therapy, guided meditation, and soundscapes—important for hormonal balance and mood.

10. WEARABLE HEALTH TRACKERS (e.g., Oura Ring, Fitbit Sense) - Smart rings or watches that monitor heart rate variability, sleep patterns, skin temperature, and stress levels—useful for detecting hormonal changes and optimizing wellness strategies.

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SCIENCE NEWS

Understanding Thyroid Health: Key Insights on Hormones, Longevity, and Wellness

Thyroid health plays a critical role in nearly every physiological process of the body, influencing metabolism, brain function, heart health, and more. Yet, despite its significance, the nuances of thyroid function remain elusive for many. As we age, maintaining optimal thyroid function is an essential component of overall well-being, and understanding the balance of thyroid hormones can help prevent future health challenges.  See Dr. Angela Mazza's full report on Thyroid Health @ this season's MenoNews.

Inflammation, DHT, and the Biochemical Cascade of Hair Loss: A Scientific Overview: by Dr. Jordan Plews

Hair loss is a multifactorial condition influenced by genetic, hormonal, and inflammatory factors. Understanding the roles of DHT and inflammation provides insight into the pathogenesis of AGA and informs effective prevention and treatment strategies. Early intervention is crucial, as inflammation and follicular damage can progress unnoticed until significant hair loss has occurred, while genetic factors (such as expression of MMP genes) in some can lead to fibrosis and result in more difficult to treat hair loss. By focusing on inflammation as an early warning sign, treatment target, and significant factor to consider when diagnosing, tracking, and treating hair loss, existing methodologies can be greatly improved. Ongoing research continues to elucidate the complex mechanisms underlying hair loss, paving the way for more targeted and effective therapies. See Dr. Jordan Plews comprehensive overview on MENONEWS and the recent issue on the HOUSE OF HAIR