The FDA is currently considering changes to labels for hormone replacement therapy; celebrities from Oprah Winfrey to Michelle Obama are speaking up about their personal experiences with hot flashes; and searches for “menopause” are climbing on Google. However, one important group that would seemingly have a vested interest in the topic has remained uninvolved in the menopause buzz: medical schools.
Medical training is a journey that lasts more than a decade for most people: from undergraduate pre-medical courses in organic chemistry and biology, to four years of medical school education, to the three to seven year hands-on training of residency, there is a lot to learn. Over the course of my four years of medical school, I have received several thousands of hours of lecture from my educational institution. We learn about some diseases, like obesity, that affect nearly a third of Americans; we also learn about some “zebras,” or syndromes like Li-Fraumeni that affect approximately 0.02% of the population. However, in my four years, I have had exactly zero hours of lectures dedicated to menopause — a condition that will impact one in every two people.
In the U.S. alone, around 1.3 million women reach menopause annually. Symptoms of menopause include hot flashes, bladder irritation, frequent UTIs, depression, bone density loss, sleep difficulties, and more. The symptoms affect women’s quality of life and health status significantly, and yet, generations of doctors-in-training have received little to no education regarding its presentation or management.
In a recent study of almost one hundred U.S. ob/gyn residency programs, only one third reported having a menopause curriculum. That number is among training programs specifically dedicated to diagnosing and treating women’s health conditions; menopause education in medical school is even more sparse.
The explanation for our current state of menopause education is complex. Women’s health in general has been under-studied and under-researched; with medical schools’ prioritization of evidence-based medicine, it is difficult to teach something we don’t have enough data on. However, the problem goes beyond that. The focus in women’s health and ob/gyn on reproductive health, pregnancy, and childbirth means that problems of the post-reproductive period are often overlooked. The status of menopause in the medical community is thus still very tenuous: Is this a problem for an ob/gyn, who is supposed to specialize in women’s health and the reproductive system? Or an endocrinologist, who focuses on hormone systems? Or a primary care physician, who manages chronic conditions over a patient’s lifetime? While the answer is likely all of the above, the lack of consensus provides yet another avenue for menopause to slip through the cracks.
One nonprofit organization, the Menopause Society, is doing its best to change the face of menopause practice. In addition to advocacy and patient education, the Menopause Society offers accreditation to health care professionals from any field who complete a competency exam in menopause and midlife women’s health. However, this solution provides more of a bandage in some ways than a response to the root cause of the problem. Certifying clinicians who are passionate about menopause care and willing to seek out advanced training is important; however, the education needs to start much earlier, and much more broadly.
The same way that every student who graduates medical school in the U.S. comes out with a basic understanding of hypertension and how to manage it, every new physician should enter their respective fields with an elemental education on menopause and its treatment options. While most of these physicians may not go on to routinely manage menopause symptoms, the fact is that menopause affects every organ system. Falling estrogen levels in menopause increase the risk of cardiovascular disease, fractures associated with osteoporosis, and Type 2 diabetes. Thus, specialists like cardiologists and orthopaedists, as well as primary care doctors, should be well versed in identifying symptoms of perimenopause and menopause and counseling patients on their treatment options. The multitudes of women who feel their experiences with menopause were undertreated or overlooked suggests that this is not the current state of medical practice.
Medical schools have the power to change this. By integrating menopause into the core curriculum, we can ensure that every future physician has the tools to recognize, validate, and treat the symptoms that half of their patients will inevitably face. Ignoring menopause in medical education sends a message that this universal experience is medically insignificant or not worth addressing. But women deserve better. My call to my medical school, and to all medical schools, is simple: teach us about menopause. If we are truly committed to training doctors who care for the whole patient across the lifespan, we cannot continue to leave women behind at midlife.
Miriam is a fourth-year medical student in Philadelphia with a passion for women's health and advocacy. She is interested in menopause specifically, and increasing awareness in clinicians and patients about safe and effective management options.
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