epocrates

The empowerment approach to menopause

March 21, 2024

Menopause has recently been gaining a lot of attention. Just a few days ago, President Biden called on Congress to make an investment of $12 billion in new funding for women’s health research. Under this plan, Biden directed the HHS to launch a research agenda that would guide future menopause-related research and develop resources to provide women with unbiased, evidence-based options for menopause-related symptom prevention and management. (White House, 2024) A recent McKinsey report found that menopause is among the female health conditions with the highest unmet need and has enormous potential for innovative treatments. In fact, the menopause market size today is estimated at $16.9 billion and expected to grow to $24 billion by 2030. (Weiss-Wolf, 2024) And on March 8, The Lancet kicked off a new series on the ubiquitous but highly individual experience of menopause, focusing on the sociocultural, environmental, behavioral, and biological factors that influence health disparities and inequities.

Women, particularly those in disadvantaged areas and those of color, have suffered from a paucity of information and education on menopause and a lack of access to health care resources. In one of the Lancet’s papers in its menopause series, first author Andrea LaCroix, Ph.D., M.P.H., distinguished professor at the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego, and her colleagues argue that an empowerment approach to menopause can better support women in managing their symptoms. In particular, the authors see the workplace and the doctor’s office as two key areas that could be improved upon to facilitate empowerment. (Hickey, 2024)

Workplace assistance and protection from inequities in the workplace

LaCroix writes that women aged 45 to 55 years represent a large percentage of the workforce and that women older than 40 are the fastest growing sector of the paid workforce. That means that many women are working during the menopause transition, and symptoms at work can be problematic due to embarrassment and concerns about reactions from others. (Hickey, 2024)

Governments are paying attention to these needs. By passing the 2010 Equality Act, the U.K. attempted to make menopause, like pregnancy, a protected characteristic. The measure largely failed. But, under new guidance issued in late February by the Equality and Human Rights Commission (EHRC), employers could be sued for disability discrimination if they fail to make “reasonable adjustments” for women going through menopause. The organization explained that the move was prompted by concern over the growing number of women leaving their jobs due to symptoms. Recent research cited in The Guardian indicates that one in 10 women left their job due to menopausal symptoms that had a negative impact on their work life. (Badshah, 2024; Weiss-Wolf, 2024)

Jennifer Weiss-Wolf, executive director of the Birnbaum Women’s Leadership Center at NYU Law and dubbed the “architect of the U.S. campaign to squash the tampon tax,” sees possible avenues to protect women experiencing menopause in the U.S. workplace. A combination of landmark civil rights laws like the Protecting Older Workers Against Discrimination Act, Pregnant Workers Fairness Act, Family and Medical Leave Act, and Americans with Disabilities Act, could provide pre-existing frameworks for employee protection. Workplace benefits like flexible time, access to human resources support, and access to menopause resources can also assist women during this time in their lives, although they are less likely to impact women in low-wage jobs. (Weiss-Wolf, 2024)

Unbiased information from empathetic clinicians

While not all women feel the need for medical intervention or support, some do experience symptoms that affect quality of life and seek out medical care. However, according to a recent survey by Contemporary OB/GYN, only 20 percent of U.S. residency programs offer a formal menopause curriculum. (Krewson, 2024) The result is a generation of doctors unable to identify menopause symptoms, let alone offer expert guidance or treatment. Fortunately, steps are underway to address this gap. A new bill introduced in Congress in 2023, titled We’re Addressing the Realities of Menopause (WARM) Act of 2023, would incentivize robust instruction and national accreditation standards. (Weiss-Wolf, 2024)

To be empowered, LaCroix explains that women must be listened to and validated, a simple act that is not afforded equally to all. The largest U.S. study of menopause, The Study of Women’s Health Across the Nation (SWAN), enrolled a multi-racial/ethnic cohort of women across the country and followed participants for over 25 years as they transitioned from pre-menopause through menopause and into early old age. Investigators found some key differences in the menopause experience across races and socioeconomic groups. For example, Hispanic and Black women reported more frequently than White women that their concerns about menopausal symptoms were dismissed by clinicians. Women need access to a supportive clinician who listens with empathy and offers treatment if needed by using a shared decision-making model. (Hickey, 2024; Harlow, 2022)

To validate experiences and listen with empathy, clinicians need to be aware of social and cultural differences that underlie the menopause experience and be cognizant of their own internal biases. For women seeking treatment and support, clinicians can offer evidence-based information about the range of effective interventions and invite shared decision making. (Hickey, 2024)

Sources:

(2024, March 18). The White House. Executive Order on Advancing Women’s Health Research and Innovation. https://www.whitehouse.gov/briefing-room/presidential-actions/2024/03/18/executive-order-on-advancing-womens-health-research-and-innovation/

Badshah, N. (2024, February 21). The Guardian. Employers must make ‘reasonable adjustments’ for women going through menopause. https://www.theguardian.com/society/2024/feb/22/employers-must-make-reasonable-adjustments-for-women-going-through-menopause/

Harlow, S et al. (2022, October 21). Womens Midlife Health. Correction: Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women's Health Across the Nation (SWAN). https://pubmed.ncbi.nlm.nih.gov/35130984/

Hickey M, et al. (2024, March 9). Lancet. An empowerment model for managing menopause. https://pubmed.ncbi.nlm.nih.gov/38458214/

Krewson, C. (2023, August 11). Contemporary OB/GYN. Survey shows menopause curriculums lacking in residency programs. https://www.contemporaryobgyn.net/view/survey-shows-menopause-curriculums-lacking-in-residency-programs

Weiss-Wolf, J. (2024, March 2). Ms. Women deserve our ‘menopause moonshot.’ U.S. policy can help. https://msmagazine.com/2024/03/07/us-law-policy-menopause-congress/