MIDLIFE CARE IS PRIMARY CARE – from someone who takes care of midlife woman, speaks to organizations about midlife care, and as a consultant to better menopause care.

This post details the current state of menopause education among clinicians, my views on why menopause is a primary care issue, and my latest consulting projects to have a further reaching impact on educating on menopause care.

I have been on a mission to educate my fellow peers about midlife and menopause care. By peers I mean fellow PAs, NPs, pharmacists, MDs, DOs, PTs, OTs, mental health counselors, sex therapists, and other allied health colleagues. As a medical professional, we do not get nearly enough education in menopause care. For me personally, I got a 45 minute lecture on menopause and my menopause pharmacology course was imbedded in the course on birth control. We can all guess what took precedence. Family medicine and OBGYN residences for MDs and DOs are along the same token; a study by Kling et al found that 20.3% of family medicine residencies did not contain any menopause lectures.1

In August of 2021 I gave a talk for the annual North Carolina Association for Physician Assistants (NCAPA) called “Menopause for the Primary Care Provider”, and I spent fifty minutes cramming in the pathophysiology of menopause, the disease states that result due to hormone deprivation, treatment options, and practice pearls. It certainly was not nearly enough time. In addition to this lecture, for the last 2 years I have given a 2-hour Reproductive Pharmacology talk to High Point University PA students. In that two hours we discuss birth control, PCOS, endometriosis, fertility, menopause, and STI treatments. Again, not nearly enough time but giving some exposure to menopause.

These efforts are all directed towards clinicians in primary care. Menopause care doesn’t need to be a “specialty”. Primary care is the backbone of the American medical system. We take care of all the things that specialists don’t want to deal with, that fall through the cracks otherwise, and we are the first line of access when our patients have a health concerns. We take care of patients across their lifespan – not just for a specific disease state or time period in their life. Which is why it is extremely important that primary care clinicians have an accurate, well-informed, up to date knowledge base when it comes to menopause care. I was upset to see the following results form a study published in The Menopause Journal in December 2024. This study by Bevry et al showed that among 229 female Mayo Clinic patients who reported vasomotor symptoms (the medical word for “hot flashes”), only 6% received hormone therapy for them and an additional 14% received prescription nonhormonal treatment options. This equates to only EIGHT women out of the 229 received first line treatment for hot flashes. Furthermore, of this 229 women who reported hot flashes, only 22% of them had it documented in their medical chart that they were having hot flashes.2 This is abysmal! Not only are we failing to adequately treat women, but we aren’t even appropriately documenting their symptoms and concerns.

Menopause care is not just about hormones. It’s about mental health (insomnia, anxiety, depression, ADHD oh my), bone health (hello bone density reduction and osteoporosis), cardiovascular disease risk reduction, metabolic health (rates of diabetes go up), sexual health (painful sex, recurrent UTIs, need I say more), and overall quality of life. Menopause is complex! It requires clinicians to be thorough in their evaluation and up to date on the highest quality of evidence and well read on latest guidelines from the major organizations such as The Menopause Society, International Menopause Society, British Menopause Society, International Society for Women’s Sexual Health, and American College of Gynecology.

In my mission to continue to educate my peers in a further reaching manner than speaking engagements, I have recently taken on two consulting projects. I was recently a subject matter expert for Planned Parenthood to update their Menopause Care Guidelines. I loved this project, because it also pushed me to review all the currently available data for menopause management and osteoporosis screening and management. The second project I have been working on is consulting with Mira fertility tracker for how their technology can be used for a perimenopausal woman and helping to develop a perimenopause course for clinicians.

If you are a woman seeking answers to some of your midlife concerns are located in North Carolina – we’d love to see you as a patient! If you are seeking someone to consult for midlife care for your organization, you can reach out to me through my website.

1. Kling, J.M. ∙ MacLaughlin, K.L. ∙ Schnatxz, P.F. et al. Menopause management knowledge in postgraduate family medicine, internal medicine and obstetrics and gynecology residents: a cross-sectional survey. Mayo Clin. Proc. 2019; 94:242-253.
2. Bevry ML, Stogdill ER, Lea CM, Taylor KR, Lovaas AM, Bailey KJ, Mara KC, Dierkhising RA, Chaudhry R, Faubion SS, Kapoor E. Addressing menopause symptoms in the primary care setting: opportunity to bridge care delivery gaps. Menopause. 2024 Dec 1;31(12):1044-1048. doi: 10.1097/GME.0000000000002439. Epub 2024 Oct 1. PMID: 39352126.