Supporting women beyond the reproductive years

About 1.3 million women reach menopause each year in the U.S., often undergoing profound shifts in their physical, emotional and cognitive well-being.¹ Approximately 85% of those going through the transition will experience some form of nearly 3 dozen menopausal symptoms that can last for as long as a decade. These symptoms range from hot flashes and difficulty sleeping to issues with memory and concentration.² Despite the far-reaching impacts of menopause, women often struggle to find the care and support they need. 

It’s increasingly clear that this lack of adequate information and expertise is harmful, not just to women’s day-to-day quality of life but also to their health outcomes throughout later decades. The onset of menopause may also increase the risk of serious health conditions, including osteoporosis, heart disease and Alzheimer’s.³ Studies have shown that women who experience frequent hot flashes are at a higher risk of heart attacks, strokes and heart failure, and that effective treatment may decrease these risks in addition to alleviating symptoms.⁴

Employers have a vested interest in improving menopausal support, as women over 55 make up the fastest-increasing age/gender working population category. This group will represent nearly 12% of the labor force by 2031.⁵ Nearly 2 out of every 5 women report experiencing menopause symptoms that interfere with their work performance or productivity each week, and almost 1 in 5 have quit a job or considered quitting because of their symptoms.⁶

Here are 3 ways health plans and employers can support improved menopause care.

Women may begin experiencing symptoms during perimenopause, which can start a full decade before menopause and impact women in their late 30s and early 40s.⁷ Moreover, because symptoms may begin earlier than women expect and can vary dramatically from individual to individual, subtle changes — including variances in menstrual cycles and disruptions to mood and sleep — run the risk of being ignored or attributed to other causes.

In fact, research shows that a limited understanding of menopause by both patients and clinicians contributes to delays in recognizing the transition and beginning symptom management.⁸ A review of insurance claims, meanwhile, indicates that half of women with menopausal symptoms delayed seeking care by more than 6 months, and nearly 40% had no prescribed treatment.⁹

This issue is compounded by the fact that few clinicians in the U.S. receive formal menopause training. Fewer than a third of ob/gyn residency programs offer such a curriculum, and nearly 85% of ob/gyn residents say they need more educational resources about menopause.¹⁰ And only about 1,100 providers currently have Certified Menopause Practitioner certification.

To combat this undertreatment, employers and insurers should embrace a holistic, personalized approach that emphasizes earlier, more robust menopause education. By addressing the growing reproductive health needs of the midlife workforce, employers and payers can enable proactive, informed choices that improve quality of life and health outcomes.

One major roadblock that prevents women from accessing menopause care is the widespread confusion and contradictory information about hormone replacement therapy (HRT). This treatment, which replaces estrogen and sometimes progesterone as the body stops producing it, can prevent and treat common menopause symptoms. But its use has been marked by controversy and evolving medical understanding.¹¹

After gaining widespread popularity through the second half of the 20th century, HRT use significantly declined after the Women’s Health Initiative (WHI) — a landmark clinical trial initiated by the National Institutes of Health that studied health outcomes for 160,000 postmenopausal women — raised concerns in 2002 about its safety, particularly in relation to an increased risk of breast cancer, heart disease and stroke among certain groups.¹¹

Today, medical experts acknowledge flaws in the WHI study,¹² and ensuing re-analysis and new studies have shown that the use of HRT earlier in menopause can have a beneficial effect on the cardiovascular system, reducing coronary disease and all-cause mortality.¹³

Despite revised guidelines and recommendations for HRT use, many women remain confused about the relative benefits and risk. Women also have additional options for effective medication support, as prescription drugs such as selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors have been shown to reduce the frequency and severity of hot flashes.¹⁴

The breadth of medication options, as well as the clinical importance of timing when it comes to starting, highlights the need for earlier access to comprehensive support services to help women navigate these complex issues. By providing access to trained specialists and dedicated care teams — both digitally and in person — employers and payers can enable women to seek answers and preemptively address symptoms before they impact their relationships, careers or health.

Beyond hormone therapy and other medications, lifestyle changes and cognitive behavioral therapy (CBT) have been shown to be helpful in managing a variety of menopause symptoms, including mood, memory, sleep and concentration-related symptoms.¹⁵ CBT focuses on the links between physical symptoms, thoughts, feelings and behaviors, and provides individuals with the tools to make positive changes.

Lifestyle changes related to diet and exercise can also help mitigate the risk of osteoporosis and cardiovascular disease that increase during menopause.¹⁶ Specifically, women should connect with providers who can help them plan to achieve the following:

• Adequate calcium intake and vitamin D supplementation, to counteract the risk of osteoporosis as estrogen declines
• A balanced diet rich in fruits, vegetables, whole grains and lean proteins
• A diet that limits or avoids alcohol, caffeine and spicy foods¹⁷
• A regular exercise program, including weight-bearing training, to help maintain a healthy weight, reduce stress and promote bone density
• A regular sleep schedule and plenty of rest

Beyond the physical changes associated with menopause, the transition can also affect women’s mental health. Research links menopause and an increased risk of depression, especially in women who have previously experienced depression, have sleep disrupted by hot flashes or endure a stressful life event during menopause.¹⁸

When hormone levels drop, serotonin levels also fall, contributing to increased irritability, anxiety and sadness.¹⁹ Declining estrogen and progesterone levels can also trigger mood swings. What’s more, the menopausal time frame often coincides with common midlife stressors, as responsibilities around child rearing, caring for aging parents and work collide.²⁰

Evidence suggests that many menopausal mood changes respond well to hormone replacement,²¹ but not everyone is a candidate for hormonal treatment. Antidepressants may be helpful in these cases, as studies show antidepressant treatment coupled with cognitive behavioral therapy is the most effective approach to managing depression.¹⁹ The complexity of mental health changes during menopause and considerations around effective treatment options once again underscore the need for comprehensive, holistic support from trained experts.

Demonstrating high-touch support for the growing number of menopausal employees creates clear benefits for workers and organizations alike. This is accomplished through improved access to virtual and in-person care, reputable educational resources, support groups and more. 

By delivering the right care at the right time, employers can help women battle debilitating symptoms that often strike at the height of their careers. The result? Lower employee absenteeism, turnover and healthcare costs, and a greater sense of what’s possible in midlife and beyond.²²