Menopause Care Gaps Exist in Primary Care

While 60% of women had vasomotor symptoms documented in their clinic notes, only 23% had their menopause symptoms recorded in their electronic health record during their primary care visits, according to a study published today in Menopause. In addition, just 6% of women reported taking hormone therapy treatment to address the symptoms. Nonhormonal hormone therapy use, which includes only two FDA-approved options, low-dose paroxetine and fezolinetant, was also low at 14.8%.

To find out the reasons behind the lack of symptom reporting, a team of researchers led by author Mackenzie L. Bevry, Pharm.D., a hospital pharmacist in Froedtert South in Pleasant Prairie, Wisconsin, studied the Mayo Clinic survey responses of 229 women with self-reported moderate-to-severe menopause symptoms. Women reported menopause symptoms using the Menopause Rating Scale, which consists of 11 questions evaluating current menopause symptoms on a 5-point Likert scale. Survey answers were collected from March 1, 2021, through June 30, 2021. Bevry and her team then studied the EHRs of participants from May 1, 2019, through May 1, 2021.

Bevry and her associates conclude that this absence of menopause symptoms in EHRs may be due to a few things.

“We hypothesize that women may not be inclined to report menopause symptoms to primary health care providers during clinic visits because conversations regarding these issues may be uncomfortable for both patients and clinicians or there may be a perceived

lack of time for discussion during primary care visits,” the study reads.

Women may also not want to bring up their menopause symptoms if they were previously dismissed by a primary care physician.

Past safety concerns about hormone therapy may also be to blame. A controversial 2002 study on hormone therapy safety said that hormone therapy increased the risk of coronary artery disease, breast cancer, stroke and venous thromboembolism. This has caused lasting concern even though recent research shows that not only is hormone therapy safe, but it is also the most effective treatment for vasomotor symptoms.

About 75% of all menopausal experience unpleasant vasomotor symptoms such as hot flashes, which can affect physical and emotional wellbeing. If work is missed because of hot flashes, financial consequences may also be felt.

“We need better methods for identifying midlife women with bothersome menopause symptoms in primary care clinics so that appropriate treatment options, including hormone therapy, can be discussed and offered,” Bevry and her team write in the study. “Efforts in this direction could improve the quality of life of midlife women.”