Why women aren't getting menopause help they need

Catch up quick: In 2002, research from the Women's Health Initiative found hormone therapy increased a woman's risk of heart disease and breast cancer, upending conventional medical recommendations about the treatment.

• But in recent years, the research was put into context: the risks weren't as great as originally thought and the data was weighted toward women 60 and older. The average age of a menopausal woman is 51.
• Since then, researchers and health professionals have tried to correct the messaging, noting the benefits of hormone therapy for women younger than the age of 60, including treating hot flashes and preventing bone loss.
• Even some women over 65 can benefit from hormone therapy, new research suggests.

"It's such an uphill battle to not just teach people about it, but to undo all the damage of the last 20+ years," Deborah Gomez Kwolek of Mass General Women's Health and Sex and Gender Medicine Program tells Axios.

Stunning stat: Only about 7% of OB-GYN residents reported feeling adequately prepared to manage menopause, according to a 2019 survey published in Mayo Clinic Proceedings.

• More than one in five OB-GYN residents (about 20%) reported receiving no menopause lectures during residency.
• About a third said they wouldn't offer hormone therapy to a symptomatic, newly menopausal woman without contraindications (or warnings).

Symptoms vary widely. Perimenopause, the phase leading up to menopause, can begin 6-10 years earlier and trigger all sorts of hormonal chaos. Menopause is officially marked after a woman has gone one year without a period.

• Primary care physician and Elektra's chief medical officer, Nora Lansen, has a message for perimenopausal patients: "You're not crazy."
• "There are so many different symptoms and they manifest in different ways and at different times of life. So it could be: 'I can't remember my kid's teacher's name' this year but then, two years from now, it's, 'My libido's tanking.'"
• Recent research from UVA Health and the women's health app Flo suggests these symptoms could show up as early as age 30.

Between the lines: Required medical school curriculum dedicated to menopause and hormone therapy is limited and, when it is offered, it is often folded into broader courses.

• "Most continuing education courses have an hour on menopause, like in a weeklong course, or even some of the OB-GYN and the women's health courses have one hour on menopause hormone therapy," Kwolek said. "That's really not enough."

What they're saying: "There is no room in the medical school curriculum for menopause," says Stephanie Faubion, medical director for The Menopause Society and a longtime advocate for better education on the topic. Her daughter, a fourth-year medical student at Mayo, is seeing this gap firsthand.

• The Menopause Society has worked to fill this void, offering educational resources and establishing a competency exam in 2002 for health care professionals to earn a Menopause Society Certified Practitioner credential.

What's next: Businesses are stepping in where doctors aren't. Millennials, the generation that currently includes the most women in America, are heading into the menopause years. Celebrities are launching telehealth companies and saying "women deserve better." Influencers are pushing products, which may or may not have scientific backing.

• And even that's not meeting demand.

Case in point: Kwolek's menopause clinic has a yearlong waiting list.

• To meet demand, she's working to equip more physicians with necessary training.
• This month, Kwolek is directing a five-day menopausal treatment course organized by Mass General Brigham and designed by national and Harvard Medical School experts.

The bottom line: "Women don't have to suffer," Faubion said, but they have to find a physician who knows enough to help.