Government Commitment to Menopause Research? It’s About Time
According to news headlines, menopause is “having a moment.” But we prefer to say that menopause has galvanized a full-throated movement—with advocates and influential women from all stripes and sectors demanding bold, systemic change. And now that commitment extends all the way to Capitol Hill.
In honor of World Menopause Day on October 18, we are thrilled that Congress will soon introduce legislation to prioritize menopause. Championed by Rep. Yvette Clarke (D-NY), a new bill will require the National Institutes of Health (NIH) to convene a multidisciplinary team of health professionals to evaluate the status of current menopause research and recommend new, needed studies toward advancing knowledge about perimenopause, menopause, and midlife women’s health. It would designate existing funds allocated to NIH to do so—which is significant because despite women representing just over half of the U.S. population, only about 10 percent of NIH’s 2020 budget of $45 billion went to conditions that primarily affect women; and an even tinier fraction was applied to menopause research. (Because NIH does not list menopause as a trackable entity, it is impossible to assess actual spending.) This legislation will elevate menopause to the federal research priority it deserves to be.
Equally important, the bill would also require NIH to issue updated, accurate guidance about the safety and effectiveness of menopause hormone treatment (MHT), as well as its overall long-term health benefits and potential risks. In effect, Congress is picking up where NIH dropped the ball some 20 years ago when it abruptly terminated the Women’s Health Initiative (WHI)—a sweeping research initiative intended to study whether the cardiovascular benefits of hormone therapy (seen in multiple observational studies) were applicable to older women at substantial risk. The WHI was not designed to assess hormone therapy’s effectiveness in alleviating the symptoms of menopause—hot flashes, painful sex, urinary tract infections, and the like—since this was already firmly established by decades of clinical experience. Chaos arose when the WHI results were misinterpreted and generalized to all women, not just to the (older) study population. Overnight, doctors stopped prescribing—and millions of women stopped using—MHT.
Thankfully, leading organizations like the Menopause Society, American College of Obstetricians and Gynecologists, and American Association of Clinical Endocrinologists have reset the record—and are emphatic that MHT is the safest and most effective treatment for the vast majority of healthy women with menopausal symptoms, and that the benefits outweigh the risks. (It is recommended that treatment start within 10 years of the last menstrual period or before the age of 60.) Yet too many women continue to avoid using MHT or are deterred from accessing it.
That millions have suffered needlessly without treatment is only part of the loss. As a nation, we have also squandered decades of opportunity to amass definitive data on the effects of MHT on things like cardiovascular disease and dementia. We have similarly failed to communicate the myriad positive effects of MHT—such as decreased risk of diabetes, colon cancer, and osteoporotic fractures. In the case of estrogen-only use, there is a 23 percent decrease in the incidence of new breast cancer, a 40 percent decrease in the risk of dying from breast cancer, and a 30 percent decrease in death from all causes.
Another key issue: Although menopause symptoms are often viewed as a private burden, they carry a costly public toll. Recent data from the Mayo Clinic shows a whopping $1.8 billion in lost earnings for menopausal women per year, with significant racial disparities: Among study participants, roughly 15 percent had either missed work or reduced their hours because of menopause, with Black women and Latinas reporting the worst symptoms and adverse work outcomes. A report issued by Bank of America this summer found that one in five women has considered leaving her job or retiring early because she doesn’t get adequate support for menopause symptoms. Earlier this month, a Deloitte study showed that working women in the U.S. pay $15 billion more out-of-pocket health expenses than men, with the costs of menopause care specifically called out.
Which is why before Congress ever stepped up, the private sector saw an opportunity. Menopause-friendly workplaces are an emerging trend as CEOs look for ways to fill the breach and retain talented women leaders. But here’s the thing: The interventions offered—cooling rooms, loose dress codes, flex time—hardly scratch the surface for what can be a decade of health disruptions. Nor do they meet the needs of most employees, especially those in blue- and pink-collar roles and low-wage and part-time service jobs, as well as those who have rigid or unpredictable schedules and circumstances.
Ultimately, these accommodations do not address the root of the problem: lack of science and systemic solutions. What we need is to chart a whole government approach that uncovers everything there is to know about menopause—so the rest of us can get busy reimagining and reshaping society around that knowledge. This includes how we work, how we access our healthcare, and how we create strong, supportive communities for the midlife and menopause journey.
We are a physician and a lawyer, respectively, and salute Rep. Clarke for her commitment to setting this change in motion. Congress rising to the moment is an acknowledgment that an entire generation of women has been let down.
Menopause policy is about research and equity—health, economic, education, age, race, gender. It enables people to make truly informed decisions and live their best lives. It requires firm political commitment to prioritizing women’s full and fair representation at all ages and life stages. Federal legislation is an excellent start.
Jennifer Weiss-Wolf is executive director of the Birnbaum Women’s Leadership Center at NYU Law. She serves on the board of the nonprofit Let’s Talk Menopause.
Dr. Sharon Malone is a board certified ob-gyn and a certified menopause practitioner. She is the chief medical advisor to Alloy Women’s Health and the author of the upcoming book Grown Woman Talk, due out in April 2024.
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