• Experts called for more research and standardized training in menopause care.
• Proposed legislation, including the Menopause Education for Medical Students Act, could help fill gaps.

The United States Special Senate Committee on Aging recently held the first-ever congressional hearing on menopause, discussing barriers to care and potential solutions.

Lynne Coslett-Charlton, MD, FACOG, MSCP, a board-certified gynecologist, told Healio she was proud to testify during the hearing “on behalf of my patients and women across the country to advocate for increased federal investment in research and expanded access to menopause care.”

“Too many women suffer needlessly with burdensome symptoms of menopause due to substantial barriers to care such as physician shortages in rural areas and inadequate insurance coverage,” she said.

During the hearing, Coslett-Charlton; Jean Wactawski-Wende, PhD, SUNY Distinguished Professor at the School of Public Health and Health Professions at the University at Buffalo; Jennifer Weiss-Wolf, JD, executive director of the Birnbaum Women’s Leadership Center at NYU Law; and Suzanne Silverman Fenske, MD, FACOG, ABOIM, MSCP, women’s health ambassador at the HHS Office on Women’s Health, spoke on critical gaps in research and clinical care.

According to Wactawski-Wende, 1 million women in the U.S. enter menopause yearly while 64 million women aged 50 years or older are postmenopausal.

“These women represent one of the fastest growing segments of the population, yet many of their health needs remain inadequately studied,” she said.

Wactawski-Wende underlined the need for further investment in research on lifetime women’s health, especially investigations “that examine how hormonal changes across the lifespan influence healthy longevity.”

She also called for more understanding into chronic diseases, including cancer, frailty, dementia and CVD, among aging women, as well as better training and education in menopause, as many women “report difficulty obtaining accurate information and evidence-based care.”

A major limitation in current evidence on women’s health is that the data often come from observational studies, Wactawski-Wende said.

“Clinical trials are the gold standard evidence, and we do not have enough of those trials in women, especially in postmenopausal women,” she said. “The Women’s Health Initiative (WHI) was such a trial, and it helped us to understand the long-term benefits and risks of hormone therapy, specifically conjugated equine estrogen and medroxyprogesterone acetate.”

Although hormone therapy formulations and doses have changed since WHI findings, Wactawski-Wende said “we’ve not done the clinical trials to look at the health outcomes of those changes. Women deserve to have that done.”

Less than 1% of federal funding is invested in midlife women’s health, Weiss-Wolf said. Research on millennial and Gen X women and women across diverse populations, including symptom collection, data tracking, and the effects of initiating hormone therapy during perimenopause, is “sorely needed,” she added.

Rachel Gandell Tetlow, ACOG’s vice president of government and political affairs, told Healio that the medical society “will continue advocating for increased federal investment in closing research gaps in women’s healthcare, as well as passage of the Advancing Menopause Care and Mid-Life Women’s Health Act (H.R. 9090).”

Many witnesses during the hearing voiced their support for HHS’ changes to estrogen hormone therapy black box labeling, in which warnings for stroke, breast cancer, CVD and probable dementia were removed.

Coslett-Charlton said this move was “a huge step in the right direction for improving access to care.”

“For years, that box warning did not reflect the accumulating scientific evidence and discouraged patients and clinicians from using an effective treatment,” she said, adding that estrogen therapy has a strong safety profile, but menopause care “is not a one-size-fits-all” approach.

“For some patients, systemic hormone therapy may come with an increased risk,” Coslett-Charlton said, emphasizing “the importance of access to an individualized, thoughtful approach to menopause management, based on each patient’s unique risk factors.”

Committee chairman Rick Scott, R-Fl., and ranking member Kirsten Gillibrand, D-Ny., requested a Government Accountability Office report assessing federal funding and treatment access within menopause care. Scott said that many menopause gaps stem from a severe workforce shortage and burnout.

“Congress should look at what we can do to eliminate unnecessary regulatory barriers and administrative burdens that take doctors away from the patients and contribute to burnout,” he said.

Insufficient medical education and standardized training also play a role in improper management of menopause, Gillibrand said, as some studies showed 80% of OB/GYN residents “say they’re unprepared to talk about menopause.”

Weiss-Wolf encouraged Congress to address these gaps by supporting the Menopause Education for Medical Students Act (H.R. 9273), which would direct HHS to require institutions receive grants to include menopause training in their curriculums, and push “Medicare and the Departments of Defense and Veterans Affairs, which have control over funding for graduate medical education, to ensure that menopause education is part of the accreditation standard.”

She added that some states have already taken steps to implement this strategy by “incentivizing through their state medical boards to include menopause in continuing professional education for clinicians.”

Lynne Coslett-Charlton, MD, FACOG, MSCP, and Rachel Gandell Tetlow can be reached through Rachel Kingery at rkingery@acog.org.