Menopause care is a necessity, not a nice-to-have. Yet the prevailing narrative too often presents it as a privilege, accessible only to those who can afford it.
Menopause is in the zeitgeist, in American culture—the focus of an executive order by the president, topping the New York Times’ most popular articles list, gracing the cover of Ms. magazine and even making its way into a Super Bowl commercial two years running. Normalizing this topic in the public discourse is progress.
However, the public conversation is often steered by influencers and celebrities who are also cashing in, selling products and supplements that may not be science-backed, affordable nor recommended by The Menopause Society—widely considered the preeminent clinical resource on menopause. This kind of commercial popularity should not be confused with progress in healthcare access, equity and outcomes.
Women at the margins often face distinct challenges during the decades of their lives spent in perimenopause and postmenopause. For those living in poverty or affected by systemic racism, access to high quality healthcare is historically and abysmally low. With clinical menopause expertise in short supply (about 2,000 certified providers in the U.S.), access to quality care is further exacerbated. This is particularly true for those who rely on Medicaid, approximately 20 percent of all U.S. patients.
Digital healthcare provides one opportunity to break through barriers in the traditional healthcare system. It is crucial to make high-quality menopause care accessible to members across a variety of insurance plans, including Medicaid. But the problem also comes from within the system: Medicaid health plans often express a shocking sentiment to us: “We don’t think this population will be interested.”
This assumption is not only misguided, but dangerous. By virtue of the demographics of the Medicaid population—approximately 50 percent Black and Hispanic—women with Medicaid benefits are even more impacted by symptoms of menopause than non-Black, non-Hispanic women. Black and brown women experience menopause symptoms that start earlier, and last longer. Moreover, Black and brown women are less likely to be offered gold-standard treatments for symptoms.
Menopause care is a necessity, not a nice-to-have. Yet the prevailing narrative too often presents it as a privilege, accessible only to those who can afford it. This must change. To address this dissonance, we need widespread reform:
More clinicians trained in menopause participating in Medicaid
For this to happen, we need more clinicians trained in menopause, period. Currently, less than 20 percent of OB/GYN residency programs offer menopause training. Expanding provider education will ensure that more healthcare professionals are equipped to address the unique needs of menopause patients, including those in underserved communities.
Policy alignment to incentivize broader access to high-quality menopause care
One avenue is to incorporate midlife care standards into health plan quality measures (Healthcare Effectiveness Data and Information Set or “HEDIS”) by which clinicians and health plans are assessed. HEDIS did in fact once include a requirement for menopause counseling but abandoned it decades ago. Adding it back in is possible and something that policymakers and patients should demand.
HEDIS measures directly affect how healthcare is reimbursed in the U.S. Including menopause in that equation will be the most powerful way to ensure the majority of women, no matter their income level, have access to comprehensive care both for menopause symptoms and to manage their health in this pivotal inflection point in which women experience accelerated rates of chronic disease and cancer risk.
Expanded use of digital health platforms to overcome geographical barriers to care
Leveraging telehealth services that focus on menopause care can provide critical support to women in rural or otherwise underserved areas.
Increased focus on community engagement through outreach and education
Increasing awareness about menopause and available care options is crucial. Community-based programs can empower women with information about their health, destigmatizing menopause and encouraging proactive health management.
Around 2 million women reach menopause every year in the United States, spending 8-10 years in perimenopause followed by 40 percent or more of their lives post-menopause. All in, that equates to well over three decades. Menopause is not optional. It doesn’t discriminate, and the healthcare system shouldn’t either. We cannot be picking and choosing who “deserves” to live well during these years.
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