Hot flashes. Night sweats. Brain fog. For 85% of women, menopause symptoms derail sleep, work, and relationships. Yet less than 5% are treated with hormone replacement therapy (HRT), the most effective way to relieve these symptoms.
This is despite research showing HRT is safe for healthy women under 60 or within 10 years of menopause. The reasons? Doctors often aren’t trained to recognize or treat menopause, and many still cling to outdated fears, Hone Health reports.
A national survey published in the journal “Menopause” revealed that just 30% of residency programs offer a dedicated menopause curriculum. In a 2019 Mayo Clinic survey, only 7% of OB-GYN residents felt “adequately prepared” to manage patients in menopause. About one-third said they wouldn’t offer hormone replacement therapy to a symptomatic, newly menopausal woman, despite evidence that it could dramatically improve her quality of life.
This lack of training leaves women searching for answers in exam rooms where doctors aren’t equipped to treat them. Preliminary results from a large, ongoing survey—presented at the Menopause Society’s 2024 annual meeting—suggest that when women report symptoms like hot flashes, sleep issues, and fatigue, their doctor may not identify them as being associated with perimenopause or menopause.
A study published in “Menopause” in 2024 suggests that less than 14% of women with moderate or severe hot flashes received any treatment in primary healthcare visits. Only 25% of women were identified by their providers as being in perimenopause or menopause during their first visit; 35% had to see their providers four or more times before their symptoms were linked to hormone changes.
The problem is compounded by fallout from the 2002 Women’s Health Initiative (WHI), a landmark study that seemed to suggest that hormone therapy significantly increased risks for breast cancer and heart disease.
The data was later reanalyzed and found to be misleading, but the damage was done. Research shows the share of U.S. women who were on estrogen dropped from a peak of around 42% in 2001 to 4.7% by 2017–2020, and it hasn’t rebounded.
“The way the findings were publicized by the media led to widespread fear around hormone therapy, both among patients and physicians,” says Tina Zhang, M.D., director of the Academic Women’s Health Fellowship in General Internal Medicine at Johns Hopkins.
Education on menopause was cut from residency programs, leaving younger doctors without mentors who knew how to prescribe hormone therapy confidently, says physician Heather Hirsch, M.D.
“In the short term, untreated menopause symptoms like hot flashes, brain fog, sleep disturbance, and low libido can drastically reduce quality of life and affect work, relationships, and mental health,” says Zhang. “Long term, the menopausal transition is associated with decreased bone density, increased cardiovascular risk, and increased risk of UTIs.”
It’s also going to affect how symptomatic your perimenopause and menopause experience will be, says Mache Seibel, M.D., a women’s health and menopause expert. “Your list of symptoms is going to be a lot shorter if you’re on hormone therapy,” he says. “Your quality of life and the impact on your work life will be noticeably improved.”
Women deserve informed, compassionate care in perimenopause and menopause. While physicians and educators continue to improve provider education, here are seven things every woman can do to get better menopause care right now.
Improving menopause education and patient care isn’t about prescribing one solution for all women—it’s about developing and providing science-backed, evidence-based guidance and treatment options, listening to women, and helping them understand which options might be most helpful to them.
This story was produced by Hone Health and reviewed and distributed by Stacker.
