This World Menopause Day, Medicine is Still Failing Women
Before I started medical school, I spent more than two years working in a medical practice focused on urology, sexual medicine, and menopause care. I listened as women described being denied hormone therapy because they did not have picture-perfect menopause symptoms. I celebrated with women who were finally feeling better after seeing multiple specialists for symptoms that had seemed disconnected. And I empathized as I heard, again and again, from women who could only describe their experience as “not feeling like myself.”
The cases that stayed with me most, though, were the seemingly straightforward ones. Why were even these women struggling to find informed care?
That question sent me looking for answers in the published research. Driven by these patient stories, I assembled a team of colleagues from medicine, sociology, and public health who wanted to investigate the same question.
We found evidence of problems at nearly every level of the menopause care experience: women feeling dismissed or struggling to find the “correct wording” to describe their symptoms, clinicians reporting limited preparation to manage menopause, and racial, cultural, economic, and workplace factors shaping women’s experiences and access to care.
But these problems were usually studied separately, and I wanted to understand how they were connected. Just as menopause symptoms that seemed unrelated could sometimes be connected, the research contained scattered pieces that had not yet been brought together. What would happen if we connected the dots? I felt like a movie detective with red strings on a corkboard.
That question became the basis for our interdisciplinary framework. We examined how three parts of the menopause experience interact: what women feel and how they communicate it, what clinicians are taught and how they respond, and the larger systems that shape who receives informed care. Our framework proposed that we cannot understand what happens in the exam room by looking at any one of those pieces alone.
We submitted the paper to several academic journals, but it has not yet been accepted for publication. The bar for academic publication is high, and papers are rejected for many reasons. I cannot know what factors shaped those decisions. I did come to appreciate, however, that interdisciplinary work spanning medicine, sociology, and public health does not always fit neatly within publications organized around individual disciplines. In other words, real-world experiences do not fit neatly within academic disciplines.
That experience prompted a different question: What if these ideas also belong in a public conversation?
The need for that conversation is clear. Research has repeatedly identified gaps in clinicians’ preparation to provide menopause care, although the studies examine different groups and many focus on residency rather than medical school.
In a 2019 survey of residents from 20 U.S. internal medicine, family medicine, and obstetrics and gynecology programs, only 12 of the 177 who answered the question said they felt adequately prepared to manage menopause.
That finding is alarming, but it does not tell us exactly what every medical student in the country learns. I cannot draw that conclusion from my own experience as a first-year student, either. My formal reproductive-system coursework has barely begun.
We need better, more current information about what medical students and residents are being taught, how consistent that education is, and whether it prepares them to care for women across the lifespan, including through perimenopause, menopause, and the years that follow. Menopause does not belong to one specialty. Whatever fields my medical school colleagues enter, menopause concerns will almost certainly be in their exam rooms.
But the evidence we do have raises an urgent question: Are we adequately preparing the next generation of physicians to understand and provide care for a life transition that will affect roughly 50% of the population?
Rachel Rubin, MD, one of my mentors, is a board-certified urologist and sexual medicine specialist and an assistant clinical professor of urology at Georgetown University. She founded Rachel Rubin MD Urology and Sexual Medicine, a multidisciplinary practice that provides sexual medicine and menopause care to people of all ages and genders. Dr. Rubin believes that preparing future physicians requires changes far beyond adding an occasional lecture.
“There is no standardized menopause curriculum across medical schools, and no reliable way to know what each student learns,” she says. “Changing that will require leadership, including changes to test questions and board exams.”
Dr. Rubin also sees a problem with how responsibility for menopause care is divided. Primary care clinicians may assume it belongs in gynecology. Gynecologists must balance menopause care with obstetrics, surgery, and cancer care. Other specialists may not see menopause as part of their role. Women can be left stranded between clinicians, searching for someone prepared to connect their symptoms and explain their options.
This can happen even to women with extraordinary resources. Melinda French Gates has said that despite her privilege and access to excellent health care, she needed to see three doctors before someone identified what she was experiencing and helped her find the right perimenopause treatment. If a powerful, well-connected woman can struggle to access informed care, what happens to women who lack the time, money, insurance, or ability to keep searching?
Because I am “menopause-curious,” I used my gap years before medical school to seek out training from physician mentors deeply engaged in menopause care and education. Their mentorship changed how I understand women’s health and the kind of physician I hope to become.
But what about my colleagues who are not “menopause-curious”? Future doctors should not have to find the right mentor by chance to learn how menopause can affect health.
Women have already changed the public conversation. Menopause is being discussed more openly in group chats, on social media, in books and podcasts, in workplaces, and among friends. Rightly so, women are asking more questions and expecting informed, evidence-based answers.
Medical education must be ready to meet them there.
That goal is part of menopause justice: ensuring that every woman can access informed, evidence-based, and respectful care throughout perimenopause and menopause, and has the support she needs to make decisions that reflect her health, values, and preferences.
Menopause justice is more than raising awareness. It means improving medical education, supporting research, addressing disparities, and recognizing that menopause care is not confined to a single specialty. It also means looking beyond the exam room. Menopause symptoms can affect women’s work and quality of life, and social and economic forces can shape both their experience and their ability to receive care.
Menopause itself does not fit into a neat silo. Neither should menopause advocacy, education, or research.
I entered medical school with an unusual education already behind me. I had listened to women. I had worked alongside clinicians who took their concerns seriously. And I had examined the research across disciplines.
Now I commit to connecting those worlds. I refuse to let menopause care remain siloed or women’s experiences be silenced.
I cannot transform medical education by myself, but I can continue asking questions, connecting evidence across disciplines, and learning from both patients and mentors. Medical schools and testing organizations can reevaluate where menopause belongs in curricula and assessments. Clinicians in every specialty can consider how menopause intersects with the care they provide. And women can continue asking informed questions and insisting that their experiences be taken seriously.
Women have worked hard to bring menopause out of the shadows. My generation of physicians now has a responsibility to meet them there.
That is how I am working toward menopause justice. You have a role to play, too. Ask what your clinicians know about menopause. Share your experience when you feel able. Support better research and medical education. Expect health care institutions to treat menopause as an essential part of women’s health, not a niche concern. No woman should have to become her own medical expert simply to receive informed care. You have a seat at the table, too. Will you join us?
About the author
Grace Hauer is a first-year medical student at Rutgers Robert Wood Johnson Medical School. Before medical school, she spent more than two years working in a urology and sexual medicine practice, where she supported menopause care and began leading interdisciplinary research into gaps in menopause health care. She continues that work today.
We’d love to hear from you
Have you struggled to find a health care provider who understood what you were experiencing during perimenopause or menopause? What would “menopause justice” look like for you, your family, or the next generation? Share your thoughts and experiences in the comments below.
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