Despite the health risks that affect half of the world’s population for a third of their lives or longer, many health providers are unprepared and/or lack knowledge to fully treat post-menopausal women. 

It’s a problem not only in the U.S., but in many societies around the world. And, while it’s heartening to see more physicians beginning to specialize in menopause, they are still few and far between. The Menopause Society (formerly the North American Menopause Society) certifies menopause practitioners who have undergone advanced training. There are still only about 1,300 NAMS-certified practitioners in the world.

This lack of education and training means older women are often not getting the information or treatment they need — from availability of vaginal creams to bone density scans. It also perpetuates misconceptions about menopause hormonal therapy (MHT),  supplements and other non-hormonal therapies. 

Why? It’s a question reporters should be asking medical schools, hospitals, clinics and professional organizations. 

A challenging time of life

Menopause is defined as the time in a woman’s life when menstruation has ceased for 12 consecutive months. The average age at which women reach menopause in the U.S. is 51, although the timing can vary widely. 

The effects of changes in levels of estrogen, progesterone and other hormones go beyond the stereotypical hot flashes and night sweats. Once a woman is in the postmenopausal phase of life, the risks of serious health problems increase, sometimes significantly. 

Studies show that many physicians — including OB/GYNs — are not well versed in many aspects of women’s postmenopausal health. Few medical schools have courses that focus on these issues, and residents don’t receive much hands-on training either, according to Joan Naidorf, D.O., a osteopathic physician in Alexandria, Va. “There was no emphasis or education regarding menopause or peri-menopause,” Naidorf wrote in Medium.

This lack of training may mean providers are unprepared when it comes to older women’s health, according to the federal Office on Women’s Health. Yet as women transition, changes in estrogen levels raises a woman’s risk for many serious conditions:

• Heart disease: Before age 55, women have a lower risk of heart disease than men. Estrogen helps keep blood vessels relaxed and open and helps the body maintain a healthy balance of good and bad cholesterol. Without estrogen, cholesterol may start building up on artery walls leading to the heart. By age 70, women have about the same risk for heart disease as men of the same age.
• Stroke: A woman’s risk of stroke doubles every decade after 55. The lower levels of estrogen in a woman’s body may play a role in cholesterol build-up on artery walls leading to the brain. 
• Osteoporosis: Loss of estrogen causes faster loss of bone mass, increasing risk of osteoporosis. Women lose bone mass much more quickly than they did before menopause, which puts them at risk for osteoporosis, a bone disease characterized by progressive loss of bone density and thinning of bone tissue, causing bones to break easily. Women who have severe hot flashes and night sweats during the years around menopause usually have more bone loss and are at higher risk for hip fractures than women who do not have severe symptoms, research shows.
• Incontinence: About half of postmenopausal women have trouble with incontinence and other urinary tract issues. Although these issues can significantly affect quality of life and mental health, many women do not seek treatment.
• Oral health issues: There’s an increased likelihood of dental issues after menopause. Lower levels of estrogen decrease the amount of saliva, leading to sore and sensitive gums, cavities, ulcers, infections and tooth decay.
• Weight gain: Many women gain an average of 1.5 pounds each year as they go through their 50s. Lower estrogen levels may play a role, but weight gain may also be caused by age-related slowing of the metabolism. Weight gain increases the risk of high blood pressure, cholesterol, diabetes, heart attacks and strokes. The risk is greater in women who are already overweight, are inactive, or who don’t already eat a healthy diet. Women also lose muscle mass as they age and calorie burning slows. 
• Sexual health changes: Many women experience changes in their sex life as they go through menopause. Not only can menopause impact sexual desire, but women may experience physical problems during sex due to vaginal dryness and loss of elasticity. This can lead to pain or bleeding as well as more urinary tract infections and genitourinary syndrome of menopause (GSM), also known as atrophic vaginitis or vaginal atrophy, according to University of Utah Health.

Resources

• Menopausal women often turn to doctors who know little about the symptoms — here’s what needs to change — Megan Arnot for The Conversation.
• The Menopause Society (formerly North American Menopause Society) — Media contact: Eileen Petridis.
• Office of Women’s Health Menopause Resources.
• What to know about Menopause — from Weill-Cornell (infographic).
• Menopause Preparedness toolkit — from The Society for Women’s Health Research.
• What Happens During Menopause? Science is finally piecing it together — Meryl Davids Landau for National Geographic.

Experts

• Jen Gunter, M.D., OB/GYN and author of “The Vagina Bible”.
• Rebecca Levy-Gantt, M.D., private practice, Napa, Calif.
• Susan Reed, M.D., University of Washington.
• Monica Christmas, M.D., University of Chicago.
• Stephanie Faubion, M.D. M.B.A., Mayo Clinic and Medical Director, The Menopause Society.