Why menopause care is still a challenge in California
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 in California and around the world lack access to 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 that hormone therapy, which is used to alleviate menopause symptoms, increased a woman's risk of heart disease and breast cancer, upending conventional medical recommendations about the treatment.
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 60, including treating hot flashes and preventing bone loss.
What they're saying: "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 20% of OB-GYN residents reported receiving no menopause lectures during residency.
How it works: Perimenopause, the phase leading up to menopause, can begin six to 10 years earlier and trigger all sorts of hormonal chaos. Menopause is officially marked after a woman has gone one year without a menstrual cycle.
"There are so many different symptoms and they manifest in different ways and at different times of life," said Nora Lansen, primary care physician and Elektra's chief medical officer. "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.'"
Zoom in: One way health professionals can signal they've undergone additional training is by obtaining a certified credential through Menopause Society training.
In California, fewer than 340 people have this credential (about 20 in San Francisco and around 30 in San Diego County) even though the state is home to 5 million women ages 40-64.
Hospitals in San Francisco and San Diego also offer specific menopause health programs with specialists, hormone therapies and a clinical trial.
What to watch: Assemblymember Rebecca Bauer-Kahan (D-San Ramon) introduced legislation last month that would require physicians to complete menopause-specific training if women compose more than 25% of their patient population.
The bill would also mandate comprehensive insurance coverage for menopause and perimenopause treatments.
She authored a similar bill during the 2024 legislative session, but Gov. Gavin Newsom vetoed it in September, calling it "too far-reaching."
Also moving through the Legislature is Assemblymember Diane Papan's (D-San Mateo) AB360, which would require state medical boards to develop and administer menopause training surveys as part of the license renewal process.
The big picture: Businesses are stepping in where doctors aren't. Older millennials, the generation that currently includes the most women in America, are on the early cusp of menopause years.
The Bay Area has seen a surge in femtech companies, which focus on technological products and services aimed at improving women's health.
Many of these companies, from Midi Health to Evernow, have zeroed in on menopause care to meet increased need.
But even that's not meeting demand.
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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