New research from Oregon Health & Science University spotlights the high unmet need for menopause care among women in Oregon.
The study, published this week in the journal Menopause, found that even with comprehensive health insurance, most patients with moderate and severe symptoms of menopause are not receiving treatment. Additionally, people who are publicly insured are even more likely to go untreated than those who are privately insured.
Menopause may significantly impact a woman's health in the short- and long-term through disruptive symptoms — hot flashes, mood swings, changes in vaginal comfort and sleep disturbances. The hormonal changes of menopause can also be associated with development or progression of chronic diseases, including cardiovascular disease, osteoporosis and Type 2 diabetes.
An estimated 1.1 billion women will be menopausal by 2025, but limited attention has been paid to menopause compared with other areas of sexual and reproductive health, making access to evidence-based menopause care an urgent public health concern, said Maria Rodriguez, M.D., M.P.H., professor of obstetrics and gynecology in the OHSU School of Medicine and director of the OHSU Center for Reproductive Health Equity.
"Menopause has been an area that's been almost completely ignored, and that's significant because we know this change can cause major disruptions in health and quality of life," Rodriguez said. "The knowledge gap within our community is concerning and a disservice to women everywhere.
"There's a need for more basic research on how this transition affects health overall," she added, "and we also need to address this issue with better training of providers and improved education among patients."
Treatment gap in rural areas
Leveraging a cross-sectional survey of Oregon patients, researchers evaluated treatment for moderate or severe menopause symptoms among more than 800 perimenopausal or postmenopausal individuals. Researchers also looked at demographic and clinical information, including age, geography, race, ethnicity, primary language and insurance type.
Their analysis shows that more than 60% of individuals with moderate and severe symptoms of menopause were not receiving any form of treatment. Additionally, public insurance was associated with an average 47% increase in nontreatment, meaning people who are publicly insured are more likely to go untreated than those who are privately insured.
Researchers note significant geographic and economic barriers that may widen gaps in care.
"Rural areas experience disparities in most areas of health, but especially women's health," Rodriguez said. "Publicly insured individuals are more likely to reside in rural areas, so it's crucial there is additional outreach in rural communities that can improve education about options for safe, effective treatment."
The primary reason for a lack of treatment identified in the study was the clinician not recommending treatment, underscoring the importance of education among health care teams on the availability, safety and efficacy of available options. Participants also noted significant fears of side effects or safety of treatments, suggesting outreach and education at the patient level is necessary, Rodriguez said.
To help close the gaps in menopause care in Oregon, the OHSU Center for Women's Health launched a menopause-focused ECHO, or Extension for Community Healthcare Outcomes, virtual program that allows health care professionals throughout the state to gain expanded training and knowledge from clinical specialty experts. The ECHO program educates clinicians about how to identify and counsel patients on a wide variety of menopause symptoms and what treatments can be offered to manage the physical, emotional and sexual changes of menopause.
OHSU's Center for Women's Health includes a specialized menopause clinic with clinicians who have advanced training in managing menopause. The clinic also offers telehealth appointments, recognizing the various barriers patients may face to in-person care.
"The symptoms brought on by menopause may profoundly impact quality of life, and we've learned that those symptoms may go untreated for years, leaving many patients to suffer in silence," said Sara Cichowski, M.D., assistant professor of obstetrics and gynecology in the OHSU School of Medicine and co-author of the study. "We need to develop care pathways that provide space for open discussion around this transition and empower patients to advocate for their needs."
This work was conducted with the support of the Yarg Foundation.
