When Congress held its first hearing ever last month devoted entirely to menopause, that fact drew almost as much attention as the testimony itself.
And while the Senate Special Committee on Aging hearing didn’t quite break new ground on the long-overlooked topic of menopause, it highlighted how far behind the medical and research establishment has fallen in researching and treating a life stage that affects roughly half the population. It also pointed the way to some underreported stories health care journalists should consider.
The testimony repeated statistics that journalists covering women’s health have cited for years but seemed new to senators in attendance. For example:
- More than a million women in the U.S. enter menopause annually.
- The population of postmenopausal women is currently 64 million and projected to top 90 million by 2060, according to a report from FP Analytics.
- The annual economic toll is $1.8 billion in lost work time and $26.6 billion when medical expenses are factored in, according to a Mayo Clinic analysis.
“Women are not simply smaller versions of men,” said Jean Wactawski-Wende, PhD., dean of the University at Buffalo’s School of Public Health and longtime investigator with the Women’s Health Initiative. “Biologic differences matter, and understanding those differences is essential for developing effective prevention treatment strategies.”
Several speakers cited a National Academies analysis finding that just 8.8% of NIH grant spending between 2013 and 2023 went to women’s health research at all. Women’s health advocate Jennifer Weiss-Wolf JD, executive director, Birnbaum Women’s Leadership Center at NYU Law, noted that less than 1% of federal research dollars specifically target menopause and midlife women’s health.
Wactawski-Wende pointed out that an NIH-commissioned 1985 report led by Ruth Kirschstein flagged the same shortfall. “I’d argue we are now 35 years later,” she said, “and we have not come all that far.”
The September 16 hearing, “Half the Country, Zero Hearings: Meeting the Moment to End the Menopause Care Gap in America,” was led by ranking member Kirsten Gillibrand (D-NY) and chairman Rick Scott (R-FL).
Why this matters
For reporters covering health, aging, or policy beats:
- Three active bills are pending that reporters can track for votes/movement, including the Advancing Menopause Care and Midlife Women’s Health Act, the Service Women and Veterans Menopause Research Act, and the Hormone Health Data and Research Act, plus a House bill on menopause education for medical students. Find out where your local reps and senators stand on these pieces of legislation.
- State-level coverage: Louisiana’s Medicaid/insurance mandate and the other states that have followed suit — Illinois, Oregon, New Jersey and Washington — along with pending legislation in Massachusetts, New York, Pennsylvania and Virginia are an opportunity for reporters in those states to follow enactment and implementation and for journalists in other states to ask lawmakers whether they plan to propose similar legislation.
- Workplace benefits: Which states or corporations have workplace benefits for menopause-related needs? Which are still fighting to gain coverage?
- Data gaps: As some at the hearing noted repeatedly, basic data doesn’t exist on women who started HRT in perimenopause and stayed on it, on breast cancer survivors and HRT, or economic/divorce impacts. Why is there no data? Track the funding, or lack of it.
- Oher possible story angles that can be localized with individual state medical boards, insurers, or medical schools include insurance reimbursement rates, prior-authorization burdens on OB-GYN practices, care deserts in the South and Midwest, and graduate residency training requirements.
One reason for increased focus on post-menopause care may be the the disease risk statistics. Women’s chronic disease risk typically runs lower than men’s before menopause, then rises sharply afterward for heart disease, hip fracture and Alzheimer’s, Suzanne Silverman Fenske, MD, a board-certified gynecologist, and HHS Office on Women’s Health ambassador, said at the hearing.
Women account for about two-thirds of U.S. Alzheimer’s cases, yet only 12% of NIH Alzheimer’s funding focuses on women, she said. Silverman Fenske, cited data showing women suffer hip fractures at nearly three times the rate of men, with 1 in 2 women fracturing a hip by age 90 and a fifth of those dying within a year. She also pointed to a study of more than 5,600 women with recurrent urinary tract infections, which found that starting vaginal estrogen cut UTI recurrence by more than 50%.
Hormone therapy’s changing evidence base
A recurring theme was how badly outdated hormone therapy research is. Fenske and Wactawski-Wende both noted that the foundational trials — the Women’s Health Initiative and the earlier HERS study — used older hormone formulations and higher doses than are common today, so their findings on cardiovascular risk don’t necessarily apply to modern transdermal or lower-dose options. Wactawski-Wende was careful to note that no clinical trials exist on women who began hormone therapy during perimenopause or who stayed on it continuously into their 60s, leaving physicians and patients guessing.
Transdermal estrogen doesn’t carry the stroke and blood clot risk associated with oral estrogen, and bioidentical progesterone has a different profile than the synthetic progestins used in most existing trials, according to Fenske. She described fielding insurance-company pushback that offered vaginal estrogen as a substitute for systemic therapy, an approach that doesn’t address symptoms elsewhere in the body. “So even at the level of insurance company,” she said, “we need to push for education.”
The FDA’s removal of the black-box warning on estrogen products, announced in November 2025, drew praise from nearly every witness. Gynecologist Lynne Coslett-Charlton, MD, testifying on behalf of the American College of Obstetricians and Gynecologists, called it “a huge step in the right direction for improving access to care,” particularly for low-dose vaginal estrogen products that had an especially strong safety record despite carrying the same label.
Weiss-Wolf traced the label back to the 2002 WHI announcement and the FDA’s 2018 denial of a petition to remove it, noting the agency finally acted on a renewed campaign led in part by Let’s Talk Menopause, which gathered momentum starting around 2024.
Roadblocks to care remain
The barriers-to-care discussion covered familiar ground. Coslett-Charlton described how much time her practice spends on prior authorizations for low-cost, FDA-approved hormone therapies; she said one nurse handles nothing else. “These are well-proven treatments, and any efforts that Congress can make to decrease the amount of administrative burden for physicians is greatly appreciated.”
Fenske traced much of the access problem back to reimbursement. Insurers pay so little for menopause-related visits that neither hospital systems nor private practices have much financial incentive to build out the specialty.
Training came up repeatedly. Fenske noted that OB-GYN residents face a required minimum of 200 vaginal deliveries but no parallel requirement for menopause education, a gap she attributed to accreditation standards set by the Accreditation Council for Graduate Medical Education. Coslett-Charlton, who trained before the WHI upended hormone therapy prescribing in the early 2000s, said her own residency happened to include strong menopause training. But the field’s move away from hormone therapy afterward left a generation of physicians undereducated and patients afraid of treatment even when their own doctors prescribed it.
Weiss-Wolf pushed the committee to think geographically. Care deserts are concentrated in the South and Midwest, but even in cities with plenty of specialists on paper, patients can wait six months to a year for an appointment. “One intervention that I think should be high on Congress’s list is telehealth,” she said, urging that connectivity and insurance barriers be overcome to allow access.
Many workplace challenges exist
Some of the hearing’s most moving moments came when experts connected menopause symptoms to career disruption. Fenske described fielding calls from CEOs “crying hysterically” in a bathroom before a meeting, unable to compose themselves enough to walk in.
Weiss-Wolf shared her own experience: “I bled so heavily that I couldn’t get up from a chair in a meeting because I didn’t want everyone to see that I’d ruined the chair and my dress.” She added that she’d also had “rage that was so severe, I couldn’t even explain it until it went away.”
Weiss-Wolf was notably skeptical of workplace accommodation policies as a fix, however. Without federal anti-discrimination protection, encouraging employees to use flex time or cooling rooms could backfire on workers who take employers up on the offer she said.
Illinois and Rhode Island have modeled state-level protections on pregnancy accommodation law, but most workplace reforms address only narrow circumstances and don’t touch the underlying long-term health consequences. “I would far rather see CEOs and business leaders investing in the research,” Weiss-Wolf said, “than putting a few band-aids in their workplace.”
Gillibrand pressed the panel on economic costs, citing a Mayo Clinic analysis that put the annual toll at $1.8 billion in lost work time and $26.6 billion when medical expenses are factored in. “What is the impact on America, because we refuse to study women’s health after the age of 40?” she asked the panel.
Weiss-Wolf called for reviving the Menopausal Hormone Replacement Therapies Act, first introduced by then-Rep. Barbara Lee back in 2011. She said current attention to menopause is “not a moment, it’s here to stay.”
Resources
- The Menopause Society
- Senate Select Committee on Aging hearing on menopause (Sept. 16, 2026)
- Menopause in the workplace, the National Menopause Foundation
- Menopause resources, ACOG
- Menopause: Let’s talk about it, the Endocrine Society
