Key Dates

Related Announcements

• September 6, 2024- State-based Healthcare Extension Cooperatives to Accelerate Implementation of Actionable Knowledge into Practice (U19). See NOFO RFA-HS-24-004.
• February 6, 2024 - AHRQ Health Services Research Demonstration and Dissemination Grants (R18). See NOFO PA-24-156.
• February 6, 2024 - AHRQ Small Health Services Research Grant Program (R03). See NOFO PA-24-155.
• February 6, 2024- AHRQ Health Services Research Projects (R01). See NOFO PA-24-154.
• May 3, 2023 - Services Research Dissertation Program (R36). See NOFO  PA-23-196.
• September 22, 2022 - AHRQ Mentored Research Scientist Career Development Award (K01). See NOFO PA-22-255.
• August 8, 2022 - AHRQ Mentored Clinical Scientist Research Career Development Award (K08). See NOFO  PA-22-232.
• December 8, 2021- AHRQ Mentored Career Enhancement Awards for Established Investigators in Patient-Centered Outcome Research (K18). See NOFO PA-22-051. 
• December 8, 2021- AHRQ Patient-Centered Outcomes Research (PCOR) Mentored Clinical Scientist Career Development Award (K08). See NOFO PA-22-050.
• December 8, 2021- AHRQ Patient-Centered Outcomes Research (PCOR) Mentored Research Scientist Career Development Award (K01). See NOFO PA-22-049. 

Issued by

AGENCY FOR HEALTHCARE RESEARCH & QUALITY (AHRQ)

Purpose

This Special Emphasis Notice (SEN) informs the research community of the Agency for Healthcare Research and Quality’s (AHRQ) strong and continued interest in receiving health services research grant applications which focus on improving the diagnosis, treatment, and management of perimenopause and menopausal symptoms (i.e., menopause-transition (MT) and menopause-related chronic conditions (such as, but not limited to: osteoporosis, cardiovascular disease, and diabetes)  to help improve women's health outcomes.

In the United States, it has been estimated that over 1.5 million women experience menopause each year. While menopause itself is a natural part of aging, many women experience disruptive symptoms. Up to 80% of women going through the menopause transition experience vasomotor symptoms (hot flashes and night sweats), which can last for more than 7 years. (Avis et al., 2015 & Santoro et al., 2015).  Other common symptoms include vaginal dryness, urinary incontinence, mood changes, sleep disturbances, joint aches, and cognitive difficulties, which collectively negatively impact the quality of life for millions of women (Peacock et al., 2021). The severity, duration, and type of symptoms a woman experiences vary based on a variety of factors, including, but not limited to, demographics such as socioeconomic status and age.

Although there are safe and effective evidence-based non-pharmacological and pharmacologic interventions to address menopausal symptoms, many are underutilized, as many women view symptoms as ‘expected trial to be endured’, or are concerned about treatment side effects of drugs and do not seek care. Treatments are also inequitably available, leading to disparities in menopause-related health outcomes and access to treatments (Zahn et al., 2024).

Additionally, the MT is a period of increased risk for the development of chronic conditions, including cardiovascular disease, osteoporosis, Type II diabetes, as well as impairments of function status. More research focusing on this time-period as a possible inflection point, or ‘teachable moment’ is needed to prevent poor health outcomes and optimize health and well-being as women age. Findings from the Study of Women’s Health Across the Nation offer insights for clinical care and disability research (El Khoudary et al., 2019).

The MT period is a significant health milestone for women, and its influence extends far beyond reproduction. In addition to the symptoms that accompany menopause; associated biological, psychological, behavioral, and social changes shape women's midlife and future health. Much of what we now know about the MT period characteristics and consequences is the product of a series of seminal cohorts that were established in the 1980s and 1990s (Kaufert, 1984; McKinlay et al., 1987; Matthews et al., 1989). These longitudinal studies broadened our understanding of the MT, which was formerly based on reports of women seeking clinical care and was not reflective of the more general MT experience. More research is needed to improve the management of perimenopausal and menopausal symptoms, including addressing barriers that prevent women accessing evidence-based interventions and ensuring that evidence-based therapies, including lifestyle interventions, are scalable and can be disseminated equitably across diverse healthcare systems, settings, and populations.

This SEN conveys AHRQ’s interest in supporting health services research that will address questions related to developing, implementing, evaluating, and scaling person-centered models of care to optimize women’s health during midlife and the menopausal transition. This SEN builds on AHRQ’s prior work, including:

1. Genitourinary Syndrome of Menopause(2024)  https://effectivehealthcare.ahrq.gov/products/genitourinary-syndrome/research

2. Long-Term Drug Therapy and Drug Holidays for Osteoporotic Fracture Prevention (2018) https://effectivehealthcare.ahrq.gov/products/osteoporosis-fracture-prevention/research

https://effectivehealthcare.ahrq.gov/products/osteoporosis-fracture-prevention/research3. Nonsurgical Treatments for Urinary Incontinence in Adult Women: A Systematic Review Update (2017) https://effectivehealthcare.ahrq.gov/products/urinary-incontinence-update/research-protocol 

4.  Menopausal Symptoms: Comparative Effectiveness Review of Therapies (2015) https://effectivehealthcare.ahrq.gov/products/menopause/research-protocol

5. Tool and Resources to Help Improve Urinary Incontinence Care for Women (2023) page https://www.ahrq.gov/evidencenow/projects/urinary/resources.html

AHRQ encourages applications that:

• Study the effectiveness of dissemination and implementation research methods to examine how existing evidence-based interventions that improve the diagnosis, management, and treatment of menopausal symptoms (or help to prevent menopause related chronic conditions) can be adopted, adapted, implemented, and sustained at a broader scale, including in primary care settings or in new settings in healthcare delivery systems (such as telehealth) and for different populations of women.
• Develop and evaluate novel models of healthcare delivery that integrate the voices of diverse women, including co-designing interventions and generation of evidence of what works in different contexts.
• Identify and address gaps in provider/clinician and patient education and develop and test tools and training that enable healthcare providers to support their patients’ preferences in managing menopause symptoms or prevention of menopause-related chronic conditions.
• Evaluate the impact of shared decision-making approaches on the management of menopausal symptoms or prevention of menopause-related chronic conditions.
• Use a person-centered, whole-person approach to managing menopausal symptoms and prevention and management of menopause-related chronic conditions and co-existing illness in perimenopausal and menopausal women.

The Agency encourages research teams to submit applications in response to this SEN using AHRQ’s current research grant announcements – See  Notice of Funding Opportunities | Agency for Healthcare Research and Quality

Specifically, the Agency encourages research teams to submit applications in response to this emphasis using AHRQ’s standing R13, R18, R03, and R01 funding mechanisms (PA-22-238, PA-24-156, PA-24-155, PA-24-154) or any reissue of these NOFOs through the expiration date of this SEN. AHRQ is also interested in receiving career development awards using AHRQ’s K01, K08, and K18 funding mechanisms (PA-22-255, PA-22-232, PA-22-051, PA-22-050 and PA-22-049) that propose developing generalizable health service research skills through projects related to menopause  research. Additionally, AHRQ is interested in receiving dissertation grant proposals addressing menopause research using AHRQ’s R36 funding mechanism (PA-23-196).

Applicants should clearly state in their grant application’s project summary/abstract that their application is responsive to this SEN by including the title and number of this SEN NOT-HS-25-009. Applicants should also enter the number of this SEN in box 4b (Agency Routing Identifier) of the SF 424 (R&R) Form.

Applications responding to this SEN should be submitted following regular application receipt dates identified in the respective NOFO and will be reviewed by AHRQ standing study sections.

Applicants should Consider this SEN active until December 20, 2027.

References

Avis, N. E., Crawford, S. L., Greendale, G., Bromberger, J. T., Everson-Rose, S. A., Gold, E. B., Hess, R., Joffe, H., Kravitz, H. M., Tepper, P. G., Thurston, R. C., & Study of Women's Health Across the Nation (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA internal medicine, 175(4), 531–539. https://doi.org/10.1001/jamainternmed.2014.8063

El Khoudary, S. R., Greendale, G., Crawford, S. L., Avis, N. E., Brooks, M. M., Thurston, R. C., Karvonen-Gutierrez, C., Waetjen, L. E., & Matthews, K. (2019). The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN). Menopause (New York, N.Y.), 26(10), 1213–1227. https://doi.org/10.1097/GME.0000000000001424

Guthrie JR, Dennerstein L, Taffe JR, Lehert P, Burger HG. The menopausal transition: a 9-year prospective population-based study. The Melbourne Women's Midlife Health Project. Climacteric 2004; 7:375–389.

Kaufert PA. Women and their health in the middle years: a Manitoba project. Soc Sci Med 1984; 18:279–281.

Matthews KA, Meilahn E, Kuller LH, Kelsey SF, Caggiula AW, Wing RR. Menopause and risk factors for coronary heart disease. N Engl J Med 1989; 321:641–646.

McKinlay JB, McKinlay SM, Brambilla DJ. Health status and utilization behavior associated with menopause. Am J Epidemiol 1987; 125:110–121.

Peacock, K., Ketvertis, K. M., & Doerr, C. (2021). Menopause (Nursing). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568694/

Santoro, N., Epperson, C. N., & Mathews, S. B. (2015). Menopausal Symptoms and Their Management. Endocrinology and metabolism clinics of North America, 44(3), 497–515. https://doi.org/10.1016/j.ecl.2015.05.001

Sowers M, Crawford S, Sternfeld B, et al. SWAN: a multi-center, multi-ethnic, community-based cohort study of women and the menopausal transition. In: Lobo RA, Kelsey J, Marcus R, editors. Menopause: Biology and Pathobiology. San Diego, CA: Academic press, 2000:175–188.

Woods NF, Mitchell ES. The Seattle Midlife Women's Health Study: a longitudinal prospective study of women during the menopausal transition and early postmenopause. Womens Midlife Health 2016; 2:6.

Zahn, K., Pittman, A., Conklin, J., Knittel, A., Neal-Perry, G. (2024). Disparities in menopause care in the United States: a systematic review. Maturitas, 186. https://doi.org/10.1016/j.maturitas.2024.108021  

Inquiries

Please direct all inquiries to: 

Agency for Healthcare Research and Quality

Emily Chew [email protected] or Kisha Coa [email protected]