Menopause is having a moment, and medicine is finally catching up

At the turn of the millennium, 1 in 3 women in midlife took hormone therapy for menopause symptoms like hot flashes, insomnia and brain fog. But that changed with the release of a study in 2002 that found links between hormone therapy - medicines replacing the estrogen and progesterone women's bodies stop making at the end of their reproductive years - and chronic disease.

The study would later come under serious scrutiny, but not before pitching menopause care and research into a sort of nuclear winter, says UCLA Health OB-GYN Dr. Rajita Patil.

"Progress in this field ground to a halt for 20 years," Dr. Patil says. "It made people fearful to where doctors basically stopped writing prescriptions." By 2020, fewer than 1 in 20 women in midlife used hormone therapy.

That long freeze may finally be thawing. These days menopause is the focus of celebrity memoirs and buzzy novels, and it's blowing up on TikTok. "I definitely think menopause is having a moment," Dr. Patil says. "More women have realized that they don't have to stay silent and they don't have to suffer. That increased awareness has driven a huge increase in demand for care."

That's why Dr. Patil launched the Comprehensive Menopause Care program at UCLA, forging a new model to provide evidence-based, multidisciplinary care for women throughout the years-long transition through menopause. We caught up with her to talk about what's changing for patients and doctors and how the University of California is helping women navigate menopause.

Q: Why is menopause having a moment now? What's changed?

Dr. Rajita Patil: It's not one specific thing, but there have been a few catalysts. One was a 2023 New York Times article, "Women Have Been Misled About Menopause," summing up the debate around the landmark Women's Health I Initiative study from 2002. It found increased risk of cardiovascular disease, stroke, breast disease and blood clots among women taking hormone therapy.

Q: What were some of the issues with the Women's Health Initiative study?

A: For one thing, it wasn't really studying the population of people who used hormone therapy to treat menopause symptoms - people in their 40s and 50s, mainly. The average age of study participants was 65. At that age, for many women, their bodies haven't seen estrogen in over 10 years. Their blood vessels have changed in that time to where reintroducing estrogen can do more harm than good.

Even so, the absolute increased risk of heart attack, stroke, blood clot and breast disease was less than 10 per 10,000 women. We classify that as a very low increased risk. And when they later stratified the data to look at the women in their early 50s, they didn't see any increased risk of chronic disease from hormone therapy.

It's not like it wasn't a rigorous study and we didn't get good data from it, but it wasn't the right type of study to address the ways and reasons people were actually using these medicines. Still, it has continued to influence the science, and shape what data we do and don't have about menopause and health today. Now, finally, the pressure is on for science to add better data to this field and stop ignoring the half of the population that's going to go through menopause.

Q: What's it been like for the generation of women who haven't had much access to treatment for their symptoms?

A: Menopause happens at this time in life when people are juggling enormous responsibilities. At home they may be taking care of both their kids and their parents, and at work they're usually at the peak of their careers. And just at an age when people feel like they have themselves figured out, suddenly there's this hormone shift that can totally rock that equilibrium.

They're dealing with hot flashes and genitourinary symptoms, which can be very uncomfortable and even painful. They have mood symptoms they've never had before, or brain fog, and on top of that they're struggling to sleep, all of which disrupt executive function right when you're at the busiest time of your life.

Q: It's no wonder people would seek relief and treatment. How hard is it to find care?

A: We have knowledgeable providers who are practicing evidence-based medicine, but not nearly enough of us. So, patients are turning to other sources. There's been a rise in direct-to-consumer platforms that sell compounded medicines, celebrity doctors with big social media presences who pushing their own products, or doctors who don't have the necessary expertise and who may be providing non-evidence-based care. So, women might be receiving care that's unsafe and misguided. The lack of access to competent providers has created a space for major confusion, misinformation and misconception.

The best evidence-based care is still focused on managing and treating clinical symptoms, and on the constellation of factors that each patient brings in, from genetics to lifestyle to family history, Dr. Patil says. Credit: Getty Images/nortonrsx

Q: What are some misconceptions you talk about with your patients?

A: One is this idea of hormone testing and balancing hormones through individualized medication formulas. It sounds good as marketing, like, "Look, I'm checking all your lab levels and we're going to come up with this very specific concoction that's formulated just for you, to balance your hormones." But it's just not based in science.

There's no magic hormone level we're trying to achieve, and there's also no objective correlation between your hormone level and your symptoms. I could line up 10 people with the same levels of estrogen and progesterone and testosterone. And they all are going to have different symptoms, and they're all going to need different things. That's why the best evidence-based care is still focused on managing and treating clinical symptoms, and on the constellation of factors that each patient brings in, from genetics to lifestyle to family history.

Q: How'd you find your way to practicing as a menopause specialist?

A: Earlier in my career, I didn't want my patients to ask me questions about menopause because I didn't know how to answer them. So, I sought out menopause training, and I was blown away with how much I did not understand - both about how this transition affects your whole body and all of your organ systems and also about how much my patients were suffering because I couldn't help them.

Q: What does the Comprehensive Menopause Care program at UCLA do differently?

A: We created the UCLA Menopause Assessment and Pathways Support System (MAPSS©) to ensure that every patient - regardless of background, health literacy or prior access to care - receives the same high-quality, comprehensive menopause evaluation. I built the program by bringing together collaborators that specialize in the many body systems that are affected by menopause. I found a women's cardiologist, a sleep specialist, cognition specialist, mental health specialist, bone endocrine specialist, etc. Together, we designed 11 evidence-based clinical pathways that guide not only how we assess and treat the full range of menopause symptoms, but also how we use this life stage as a critical window of opportunity to identify health risks early and support long-term prevention and well-being.

Before their first appointment with us, patients fill out an in-depth digital questionnaire about their symptoms, medical and family history, lifestyle factors and risks across all these domains. This helps us identify where people are experiencing the most symptoms, be it sleep, hot flashes, mood or cognitive changes, sexual health or cardiometabolic concerns.

By the time I walk into the room for a 30-minute appointment, I already have a synthesized snapshot of the patient's health and priorities, along with pathway-guided considerations for treatment. Instead of spending the visit gathering history, we can focus almost entirely on shared decision-making, education and personalized recommendations. And because every patient moves through the same structured process, MAPSS© helps eliminate unwarranted variation in care, making the experience more equitable and consistent for everyone. By the end of the appointment, each patient leaves with a clear, individualized plan that reflects their symptoms, risks and goals.

Q: What are you and other UC experts doing to expand access to menopause care?

A: On the training side at the UCLA, we added menopause as one of the core components for OB-GYN residency, and within the medical school rotations for OB-GYN.

On the clinical side, we're now 14 menopause providers at UCLA, and we've cared for over 2,000 patients in the last two years using this model. A major reason we've been able to grow is our commitment to training the existing OB/GYN and primary care workforce. We've built dedicated continuing medical education opportunities in menopause and created multiple ways for clinicians to strengthen their skills. Through what we call "education percolation," every clinician we train goes on to train others, allowing expertise to spread organically across the system and raising the standard of care far beyond our own clinic walls.

There is now real momentum at the state level as well. Gov. Newsom has put a proposal in place to incentivize working physicians to get trained up. If this proposal goes through, anybody in California who is treating women over the age of 40 will get incentives for getting that training.

About a year ago, I brought together the five other UC academic health centers to create a systemwide consortium so we could help each campus build programs like ours. Nobody needs to reinvent the wheel and spend all this time to figure out how something might work, because we know our program works. Last year, California included dedicated menopause funding in the state budget, allocating three million dollars to expand perimenopause and menopause services across the UC system, which will further accelerate this work and broaden access statewide. Our shared goal across UC now is to reach as many Californians as possible.