Why women aren't getting menopause help they need
Menopause is something every woman goes through, but doctors — even OB-GYNs — aren't required to learn much about it.
Why it matters: Millions of women don't get the care they need — and some are getting misinformation at the doctor's office.
Catch up quick: In 2002, research from the Women's Health Initiative found hormone therapy increased a woman's risk of heart disease and breast cancer, upending conventional medical recommendations about the treatment.
But in recent years, the research was put into context: the risks weren't as great as originally thought and the data was weighted toward women 60 and older. The average age of a menopausal woman is 51.
Since then, researchers and health professionals have tried to correct the messaging, noting the benefits of hormone therapy for women younger than the age of 60, including treating hot flashes and preventing bone loss.
Even some women over 65 can benefit from hormone therapy, new research suggests.
"It's such an uphill battle to not just teach people about it, but to undo all the damage of the last 20+ years," Deborah Gomez Kwolek of Mass General Women's Health and Sex and Gender Medicine Program tells Axios.
Stunning stat: Only about 7% of OB-GYN residents reported feeling adequately prepared to manage menopause, according to a 2019 survey published in Mayo Clinic Proceedings.
More than one in five OB-GYN residents (about 20%) reported receiving no menopause lectures during residency.
About a third said they wouldn't offer hormone therapy to a symptomatic, newly menopausal woman without contraindications (or warnings).
Symptoms vary widely. Perimenopause, the phase leading up to menopause, can begin 6-10 years earlier and trigger all sorts of hormonal chaos. Menopause is officially marked after a woman has gone one year without a period.
Primary care physician and Elektra's chief medical officer, Nora Lansen, has a message for perimenopausal patients: "You're not crazy."
"There are so many different symptoms and they manifest in different ways and at different times of life. So it could be: 'I can't remember my kid's teacher's name' this year but then, two years from now, it's, 'My libido's tanking.'"
Recent research from UVA Health and the women's health app Flo suggests these symptoms could show up as early as age 30.
Between the lines: Required medical school curriculum dedicated to menopause and hormone therapy is limited and, when it is offered, it is often folded into broader courses.
"Most continuing education courses have an hour on menopause, like in a weeklong course, or even some of the OB-GYN and the women's health courses have one hour on menopause hormone therapy," Kwolek said. "That's really not enough."
What they're saying: "There is no room in the medical school curriculum for menopause," says Stephanie Faubion, medical director for The Menopause Society and a longtime advocate for better education on the topic. Her daughter, a fourth-year medical student at Mayo, is seeing this gap firsthand.
The Menopause Society has worked to fill this void, offering educational resources and establishing a competency exam in 2002 for health care professionals to earn a Menopause Society Certified Practitioner credential.
What's next: Businesses are stepping in where doctors aren't. Millennials, the generation that currently includes the most women in America, are heading into the menopause years. Celebrities are launching telehealth companies and saying " women deserve better." Influencers are pushing products, which may or may not have scientific backing.
And even that's not meeting demand.
Case in point: Kwolek's menopause clinic has a yearlong waiting list.
To meet demand, she's working to equip more physicians with necessary training.
This month, Kwolek is directing a five-day menopausal treatment course organized by Mass General Brigham and designed by national and Harvard Medical School experts.
The bottom line: "Women don't have to suffer," Faubion said, but they have to find a physician who knows enough to help.
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Los Angeles Times
12-06-2025
- Los Angeles Times
Why REM Sleep Behavior Disorder Is a Warning Sign for Parkinson's and Other Brain Diseases
REM Sleep Behavior Disorder (RBD) might sound like something out of a sleepwalker's nightmare, but it's a very real—and increasingly important—sleep disorder. RBD occurs when the normal muscle paralysis, known as muscle atonia, during REM (rapid eye movement) sleep disappears, allowing individuals to physically act out their dreams during dream sleep. REM sleep is one of several sleep stages, also referred to as paradoxical sleep or active sleep, and is characterized by rapid eye movements and vivid dreaming. This loss of muscle atonia can involve anything from flailing limbs to more aggressive or even violent behaviors, potentially resulting in injury to the sleeper or their bed partner. Once seen as a rare curiosity, RBD is now recognized as both a disruptive parasomnia and a warning sign of more serious neurological conditions—especially neurodegenerative disorders known as synucleinopathies, such as Parkinson's disease, Lewy body dementia, and multiple system atrophy (MSA). This dual significance places RBD at a unique crossroads between sleep medicine and neurology. Pinpointing RBD isn't just about noticing odd behavior at night. While many patients (or more often, their partners) report vivid, sometimes violent dream enactment, true diagnosis requires polysomnography—an overnight sleep study that records brain activity, muscle tone, and eye movements. RBD diagnosis relies on identifying abnormal behaviors during the REM stage of the sleep cycle. Specifically, clinicians look at the REM stage as a specific sleep stage for the presence or absence of muscle atonia—REM sleep without atonia indicates a loss of the muscle paralysis that should naturally occur during this phase. According to a 2017 review in Mayo Clinic Proceedings [1], this diagnostic confirmation is vital—not just to guide treatment, but also to identify those at heightened risk for developing a neurodegenerative disorder. And that risk is real. A 2025 study titled The Many Faces of REM Sleep Behavior Disorder [4] found that individuals with idiopathic RBD (i.e., RBD not linked to medications or other causes) have a significant chance of developing Parkinson's or DLB within a decade. This makes RBD one of the most robust prodromal biomarkers in neurology today. First and foremost, in managing RBD, we need to keep patients and partners safe. That often means adapting the sleep environment—removing sharp objects, padding furniture, or even sleeping separately if necessary. RBD often coexists with other sleep disorders which can complicate management and require a comprehensive approach. But pharmacological treatment can also be very effective. Two drugs are front runners: The 2025 International RBD Study Group consensus [2] also explores new territory, finding potential benefit from cholinesterase inhibitors like rivastigmine and dopamine agonists such as pramipexole. 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These findings support a holistic approach to RBD care—one that considers sleep hygiene, lifestyle and even dietary factors as part of the treatment. REM Sleep Behavior Disorder is no longer just a sleep curiosity—it's a diagnostic warning sign that may sound years before neurodegenerative disease sets in. While traditional treatments like clonazepam and melatonin work for symptom control, newer research points to the possibility of disease interception. As we learn more about sleep, neurobiology and behavior, RBD may become a key entry point for early intervention in Parkinson's, DLB and related conditions. The future of sleep medicine will shape the future of neurology—and for those with RBD that's good news. [1] St Louis, E. K., & Boeve, B. F. (2017). REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions. Mayo Clinic proceedings, 92(11), 1723–1736. [2] During, E. H., Malkani, R., Arnulf, I., Kunz, D., Bes, F., De Cock, V. C., Ratti, P. 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[6] Coelho, J., Samalin, L., Yrondi, A., Iftimovici, A., Philip, P., & Micoulaud-Franchi, J. A. (2025). La santé du sommeil comme marqueur et cible d'intervention dans les troubles psychiatriques [Sleep health as a marker and target for health interventions in psychiatric disorders]. Medicine sciences : M/S, 41(5), 477–489. [7] Wang, P., Chen, X., Na, M., Flores-Torres, M. H., Bjornevik, K., Zhang, X., Chen, X., Khandpur, N., Rossato, S. L., Zhang, F. F., Ascherio, A., & Gao, X. (2025). Long-Term Consumption of Ultraprocessed Foods and Prodromal Features of Parkinson Disease. Neurology, 104(11), e213562. [8] Mondino, A., Jadidian, A., Toth, B. A., Hambrecht-Wiedbusch, V. S., Floran-Garduno, L., Li, D., York, A. K., Torterolo, P., Pal, D., Burgess, C. R., Mashour, G. A., & Vanini, G. (2025). Regulation of REM and NREM Sleep by Preoptic Glutamatergic Neurons. Sleep, zsaf141. Advance online publication.
Medscape
11-06-2025
- Medscape
Supplements Boost Postmenopausal Serum Biomarkers
Postmenopausal women who took vitamin B 12 , fish oil, or flaxseed oil as dietary supplements had significantly higher levels of accompanying serum biomarkers than those who did not use these supplements, based on new data presented at American Society for Nutrition (ASN) 2025 Annual Meeting. Dietary supplement use in the US is common among older adults, but data on the health effects of dietary supplements remain relatively mixed, said presenting author Hannah T. Baillie, MS, RD, in an interview. Hannah T. Baillie, MS, RD 'One way to measure whether or not supplements could be getting to the intended targets in the body is to measure the amount of the supplement's nutrients in the blood. This could inform whether the supplements have their intended health effects in an objective manner,' said Baillie, a PhD student at the University of Washington, Seattle. To examine the associations between dietary supplements and higher serum concentrations of corresponding biomarkers, Baillie and colleagues enrolled 153 participants in the Women's Health Initiative in a 2-week controlled feeding study. The participants consumed an individualized menu, including a habitual diet, and continued use of their usual dietary supplements. After 2 weeks, the researchers measured serum vitamin B 12 , lutein plus zeaxanthin, and phospholipid fatty acids. In a multiple linear regression analysis, the geometric mean serum concentration of vitamin B 12 was 58% higher among women who used any type of vitamin B 12 dietary supplement than among nonusers ( P < .001). In addition, the geometric mean serum concentrations of phospholipid docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) ranged from 38% to 46% higher among users of fish oil or flaxseed oil supplements than among nonusers ( P < .0001). 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The unreliable and inadequate labeling of nutrient content on dietary supplement packaging was a main study limitation, Baillie told Medscape Medical News . 'Although the contents from labels of each dietary supplement were recorded into our database, prior research has shown there may be discrepancies in what is reported on labels and what each supplement contains,' she said. 'Additionally, labels are not consistent in how nutrient information is reported; for example, for fish oil supplements, omega-3 fatty acids are sometimes displayed as total omega-3 fatty acids, sometimes as EPA and DHA, and on other labels as total EPA + DHA,' Baillie said. This discrepancy makes consistent assessment of total nutrient intake a challenge and limits what conclusions that can be drawn from the data, she noted. Raising Awareness, Examining Intake 'Additional research investigating best practices for assessing nutrient intake from dietary supplements is needed, and this may require changes in the requirements around dietary supplement labeling,' Baillie told Medscape Medical News . Future research also should address assessing serum response among a more heterogeneous population, she added. Older women often take supplements without knowing their full effect, and the current study is important to help alert clinicians to ask patients about type, timing, and dose, said Christine M. Sager, MD, an assistant professor in the Department of Obstetrics and Gynecology at East Tennessee State University, Johnson City, Tennessee, in an interview. The findings were not unexpected, said Sager, who was not involved in the study. 'In clinical practice, we see similar elevations in B 12 when patients are taking B vitamins,' she said. The current study is too short and too small to make global recommendations on supplement intake, but the results suggest that the type, dose, and time of day matter for many supplements, just as with medications, although research on this topic is limited, Sager said. 'Also, serum levels do not always correlate with goals of therapy,' she noted. Looking ahead, the safety and efficacy of intravenous vitamins and supplements is an important question for additional research, Sager added.
Tom's Guide
01-06-2025
- Tom's Guide
Japanese walking vs running — which is best for you?
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