Menopause preparedness for patient, provider, and policymaker

Consideration of policy solutions to address regulatory barriers of care is also proposed by a working group of 13 experts convened by the Society for Women's Health Research. In addition, providers need to factor in the diverse needs of individuals experiencing menopause in the development of their personalized care.

The experts encompass patient advocates and policy leaders, as well as clinical specialists and researchers in gynecology, reproductive endocrinology, psychiatry, and epidemiology.

“Menopause is often stigmatized and framed as if it were a disease, as opposed to a natural part of a woman's life cycle,” wrote the authors. “A holistic patient care model that emphasizes earlier and more robust education about the menopause transition for patients and providers would aid in the normalization of this life transition and improve quality of life for patients.”

The menopause transition can span up to 20 years. Some postmenopausal women are also at increased risk for serious health conditions like cardiovascular disease, osteoporosis, and diabetes. With increases in life expectancy, a woman's postmenopause phase may represent up to 40% of her life.

But without adequate preparation and/or symptoms not well-managed, the menopause transition might exacerbate conditions that impair quality of life and life expectancy; therefore, the authors advise providers to prepare women as young as age 35 for better overall health during the menopause transition and postmenopause.

A personalized approach to care is recommended because menopausal symptoms and experiences vary widely, based on age of onset, overall patient health and the patient’s specific type of menopause.

Providers should consider which symptoms an individual is experiencing that impede quality of life, along with available interventions: medical, lifestyle and/or behavioral.

Structured physical activity and yoga are 2 lifestyle interventions that can improve perimenopausal and postmenopausal quality of life. However, while aerobic exercise is an effective approach to managing mood, its usefulness has not been proven for managing vasomotor symptoms (VMS). Meanwhile, cognitive behavioral therapy and mindfulness-based therapies are often efficacious in managing the bother and interference of VMS.

Furthermore, provider training might help curtail the use of custom-compounded hormone products that are not regulated by the FDA and that lack evidence of safety or efficacy.

Enhanced medical curriculum on menopause is also proposed, not only for ob-gyns, but for the spectrum of health care providers for women in midlife, including primary care and mental health professionals.

“Without menopause-specific education, providers can easily misunderstand or dismiss menopause symptoms related to irregular menstrual cycles or heavy bleeding, mood, vaginal symptoms, and disordered sleep,” wrote the authors.

Collecting data from diverse populations on the intersections of menopause and race, gender, culture, and socioeconomic status will better inform key stakeholders on developing personalized care, according to the authors.

Also needed is intentional accommodation of menopause in the workplace, such as flexible leave policies, which has gained momentum in countries like Australia and the United Kingdom.

Reference

1. Aninye IO, Laitner MH, Chinnappan S.Menopause preparedness: perspectives for patient, provider, and policymaker consideration. Menopause. 2021 Oct; 28(10):1186 – 1191. doi:10.1097/GME.0000000000001819