Asm. Rebecca Bauer-Kahan (D — San Mateo), a 45-year-old chair of California’s Select Committee on Reproductive Health, expressed during a recent meeting how women are told that menopause is inevitable and that they should just deal with it. At the same time, those in perimenopause and menopause experience brain fog, hot flashes, insomnia—all during the peak of their careers. The all-women committee met this week to discuss ways to incorporate menopause healthcare into the state’s policies.
The average age of menopause is 52 years, although anything that occurs after 40 years is considered normal, according to Dr. Stephanie Faubion, professor and chair of the department of medicine at the Mayo Clinic in Jacksonville, Florida.
“We refer to that time leading up to menopause, which is defined as no menstrual period for a year, as perimenopause,” Faubion told the committee.
She said many women don’t understand that all of the symptoms they experience during menopause are related.
“We have gaps … in the education of women. We also have gaps in terms of education of our medical providers at all levels, including clinicians out in practice today. And then we have treatment gaps, so women aren’t receiving therapies that we know are safe and effective.”
— Faubion
Addressing menopause in a public setting requires getting rid of stigma surrounding the natural reproductive health cycle. Jennifer Weiss-Wolf, attorney and executive director of the Birnbaum Women’s Leadership Center at the NYU School of Law, said hormone therapy is a key area where policies are needed.
Publicly and federally funded research is also at the heart of this issue, she said. She said there also needs to be a push for the modernization of communication mechanisms between federal agencies, including the National Health Institute and the Food and Drug Administration (FDA).
“There is an effort underway to request or demand that the FDA have proper warnings about estrogen treatments that are out of date,” Weiss-Wolf said.
She added that the state needs to fill in gaps left by the federal government, like medical education on how professionals are trained to work and communicate with patients, and educating the public through public service announcements.
“Among the workplace reforms that have been more interesting to me are the ability to leverage economic power to ensure that adequate resources are provided to people who are experiencing perimenopause and menopause.”
— Weiss-Wolf
Weiss-Wolf said there needs to be greater inclusion of telehealth services in women’s healthcare so they can meet menopause specialists, and cited Illinois—which has undertaken measures to ensure that perimenopause and surgical menopause treatments are covered in full by state and private insurances. She said there needs to be collaboration to ensure new research is being conducted, and that people are open to hearing new findings and trusting the government.
“It’s very affirming to hear that California’s PSAs or education around abortion has been fruitful,” Weiss-Wolf said. “Information is not only gate-kept in doctor’s offices. It’s also hard to know if you’re getting good information or not.”
Bauer-Kahan said health insurance carriers need to clarify the specific medical benefits that are medically necessary, the things that insurance covers. Women need to be treated like humans, and the notion that suffering and being in pain is noble needs to be eradicated, she added.
Faubion went over some menopause facts for the committee: the mean duration of symptoms is seven to nine years; symptoms may vary; hot flashes and night sweats will affect 75 to 80 percent of women; and those ages 50 to 59 are most affected by symptoms.
“The benefits of hormone therapy are relatively healthy … the benefits typically outweigh the risks, but we know the usage rates are down,” Faubion said, noting that four to six percent of menopausal women use hormone therapy.
For women of color, the average span of symptoms is ten years, and women of color are more likely than white women to experience menopause surgically. Dr. Alexis Reeves, postdoctoral scholar in the Department of Epidemiology and Population Health at the Stanford School of Medicine, said surgical menopause creates a stark and sudden reduction in hormones, worse menopause symptoms, and sometimes earlier or worse health complications.
Surgical menopause is frequently left out of menopause research, and Reeves sees importance in learning about the causes and consequences of this to further understand disparities.
“I think the research needs to include more women of color. It needs to include women of different gender identities, so that we can understand how they’re traversing this menopausal transition, and what leads to a rougher, or a little symptom transition, or whether they’re having reproductive surgeries.”
— Reeves
A main indicator of reproductive surgeries in women of color is excessive bleeding or fibroids, and Reeves wants women of color to be presented with a diversity of treatments that aren’t the most drastic measures, such as a hysterectomy. She said there’s a high prevalence of fibroids in Black women that occur earlier on and are more severe. That combined with racial bias can add to an increase in early surgeries, and a lack of information on menopause acts as a barrier for women to self-advocate.
Women interested in urinary health who experience frequent urinary tract infections, may discuss the use of vaginal estrogen cream. Dr. Elaine Waetjen, professor at UC Davis’s Department of Obstetrics and Gynecology, said this therapy is frequently covered for those on good health insurance plans.
“There’s a large number of women who do not have good insurance to cover medications, and in that case, a tube of vaginal estrogen cream, for example, can cost $300-400.”
— Waetjen
Faubion noted how vaginal estrogen cream is not used as a lifestyle drug, but rather to be able to more comfortably function in life, and prevent medical complications like UTIs. She said there are estrogen therapies available, although some may have allergies and need a different type of therapy, which can be financially prohibited. According to Faubion, a new drug called Veozah was launched last year to address menopausal hot flashes, but it’s still prohibitive: one must have experienced the failed use of an antidepressant, in addition to another requirement, and it’s expensive.
“It’s sad that we have therapies straight out of the gate that no one can use,” Faubion said.
The committee will meet again on March 4th to discuss menopause in the workplace.