Oct. 18 is designated as World Menopause Day by the International Menopause Society. The purpose of the day is to raise awareness of menopause and the support options available for improving health and well-being. So it’s the right moment to examine how the U.S. and Utah perform on menopause care.
Fewer than 5% of American women use hormone replacement therapy (HRT), according to JAMA, to help manage symptoms they experience during the menopause transition. Compare that with an HRT usage rate closer to 15% in the U.K. and Australia, where prescribing is steadily rising.
American health care practitioners are not well prepared: only 6.8% of family medicine, internal medicine and obstetrics and gynecology residents reported feeling adequately prepared to manage women experiencing menopause transition symptoms, according to a 2019 Mayo Clinic survey. Six years later, that has undoubtedly risen with the increasing general awareness of menopause, but it’s still shockingly low.
Utahns face some additional challenges. The state does fairly well on the ratio of obstetricians and gynecologists (OB-GYNs) to women, ranking 18th in the country. However, as a state with one of the highest birth rates, Utah OB-GYNs are busy with maternal care rather than menopause care. While women often think to turn first to their OB-GYNs for help with menopause, they might not be the best equipped. Primary care physicians (PCPs) can provide menopause care, but Utah has one of the worst ratios of PCPs to residents in the entire United States.
Medication options are also more limited in the U.S. There are no approved testosterone treatments for menopausal women despite the fact that in appropriate dosages, testosterone can increase energy, improve sexual function, and preserve muscle mass and bone health. American doctors only prescribe testosterone to women “off label,” whereas Australia offers a cream approved specifically for postmenopausal women.
The shadow of old data
So why is the U.S. so different in our approach to menopause care?
Much of the hesitation originates with a Women’s Health Initiative study published in 2002. The data from that study was presented in black-and-white terms that overstated risks. But those headlines stuck, and two decades later, many women are still paying the price. It takes 17 years on average for medical research updates to translate into day-to-day medical practice. This is far too long for women to wait for effective and appropriate menopause care.
Despite the need to close the gap between current medical practice and new research, the U.S. still lacks adequate medical training around menopause. Only 31.3% of obstetrics and gynecology residency program directors report they have any type of menopause curriculum as part of their residents’ training. For most, this curriculum consists of one to two lectures per year.
The human cost of delay
When menopause symptoms go untreated, the costs are high. Sleep suffers. Cognitive function declines. Emotional well-being takes a hit. Productivity at work drops. And over time, without hormone replacement intervention, health risks can mount — most specifically, increases in osteoporosis, cardiovascular disease and the likelihood of Alzheimer’s.
So better menopause care isn’t just a women’s health issue. It’s a public health issue.
Moving forward
While we don’t know everything about hormones, in large part because of a significant gap in research on women’s health specifically, the overwhelming consensus today is that HRT is both safe for most women and the most effective solution to treat menopause-related symptoms. And it should be readily available. This requires better education for health care providers, more specialized and holistic care, and less stigma. It also means giving women space to track their own symptoms, understand what’s changing and decide what “forward” looks like for them.
That’s why I founded Inflexxion Health — so that together, we can ensure that women in Utah no longer have to wait for the care they deserve.
This World Menopause Day, awareness must translate into action.