Experts discuss trending priorities within women’s health.
By Jenna Hughes
As research and understanding of women’s health continues to advance, providers are taking a closer look at female health across the lifespan. Each life stage for women – especially the menopause transition – can influence long-term health outcomes, such as lifelong reproductive health, cardiovascular risk and healthy aging.
Historically, however, menopause treatment has remained a significant gap in women’s healthcare because of ongoing stigma, provider training gaps and lack of research.
“Many healthcare professionals receive limited or no formal training in menopause management, which can leave patients without consistent guidance grounded in the latest research,” said Dr. Chrisandra Shufelt, Professor and Chair, Division of General Internal Medicine & Associate Director, Women’s Health Research Center at Mayo Clinic. “Widespread misinformation, particularly around hormone therapy, can add to the confusion. That makes clinician education and clear, individualized patient counseling even more important.”
At the same time, the approach to women’s health has been evolving – driven by greater public awareness, expanding research and a growing recognition of women’s specialized health needs.
Understanding menopause
Menopause represents a significant stage of life when women may experience a range of changing health considerations. During the menopause transition, cardiovascular health can begin to decline more rapidly for women in comparison to premenopausal years, according to the American Heart Association (AHA). Perimenopause is defined as the transitional period from the reproductive to the non-reproductive phase and is marked by hormonal and metabolic changes.
“There’s not one syndrome that every person with menopause gets,” said Dr. Monica Christmas, Associate Professor & Section Chief in Obstetrics and Gynecology at the University of Chicago, & Associate Medical Director for the Menopause Society. “It is very variable – like the wide variety of ages that early life menstrual symptoms begin for individual women. At the opposite end of the reproductive spectrum, this is very similar, where there can be a variation in the age it begins.”
Dr. Christmas, who has been focused on researching menopause for the last 20 years, says most people experience their final menstrual period (defined as not having a period for a full year) at about age 51 to 52. Although, the range that 95% of people fall into is between the ages of 45 and 55.
During perimenopause, estrogen and progesterone levels fluctuate, menstrual periods may become irregular, and women often experience symptoms such as mood changes, sleep problems and hot flashes. These symptoms of the menopause transition may also begin much earlier than when a woman stops having her period.
“Menopause-related symptoms such as hot flashes, sleep disturbance, brain fog, mood changes, sexual dysfunction and genitourinary syndrome of menopause are still frequently underrecognized and undertreated,” said Dr. Shufelt. “Too often, women are told these symptoms are simply part of aging rather than being offered a thorough evaluation and treatment options that can meaningfully improve their quality of life.”
Healthcare across the lifespan
To address gaps in women’s healthcare, providers manage midlife health concerns with a focus on the factors that influence health such as age, reproductive history, family history, lifestyle and personal risk factors rather than a one-size-fits-all approach.
“Women start having symptoms related to these natural shifts in hormones up to about seven years before the final menstrual period, so it’s quite normal for people in their early 40s and certainly in their mid-40s, even their late 30s, to start to experiencing symptoms,” said Dr. Christmas. “Cardiovascular health risks increase with age, and it doesn’t just start in late life.”
The widespread public attention on the topic of menopause has brought with it both opportunities and challenges, according to Dr. Shufelt. “Women are coming to us more informed and empowered to discuss their symptoms, which is a very positive change, but there is still significant misinformation out there. Our role is to help put that information into context so each woman can make an informed treatment decisions based on her symptoms, health history and individual risks.”
Dr. Christmas notes that there has also been an increasing trend where the risks of birth control are blown out of proportion to the benefit of birth control, and then the opposite, where the benefits of hormone therapy are being blown out of proportion in a way that minimizes its associated risk.
“One important misconception with hormone therapy is that changes to the U.S. Food and Drug Administration’s (FDA) black boxed warnings means that it is now appropriate for every woman or can be started at any age,” said Dr. Shufelt. “The balance of benefits and risks still depends on a woman’s age, time since menopause, medical history, formulation and route of therapy.”
Current FDA labeling specifically emphasizes considering initiation before age 60 or within ten years of menopause for systemic therapy.
“The labeling change is important because it helps correct decades of overly broad fear around hormone therapy,” said Dr. Shufelt. “But we do not want the pendulum to swing all the way in the opposite directions, creating the impression that hormone therapy is universally beneficial or risk-free. The decision still needs to be individualized.”
“From my perspective as a provider, there must be checks and balances in regard to how information is disseminated,” said Dr. Christmas. “This also applies to the widespread communication of modifiable risk factors for cancer but also for cardiovascular risk. For instance, more women die from cardiovascular-related diseases than they do from all other cancers added up together,” said Dr. Christmas. “We as providers must address the risk factors for cardiovascular disease early and often.”
Regarding the prevention and treatment of women’s health issues, Dr. Christmas says that women should be asked annually about any family history of cardiovascular disease, have their lipid profile assessed and ensure that blood pressure is well-managed.
“Physicians should also be asking about a woman’s pregnancy outcomes, including elevated or gestational blood pressure or preeclampsia, as those conditions increase cardiovascular risk later in life as well. This information helps us to assess and understand a woman’s cardiovascular risk,” said Dr. Christmas. “Modifiable risk factors for all women include regular exercise, quitting smoking, reducing alcohol intake and adhering to a heart healthy diet.”
Finding accessible care
Dr. Christmas says that getting proper midlife care starts with identifying a healthcare provider familiar with menopause symptoms and its treatment. The Menopause Society has a resource where women can enter their zip code and find menopause experts in their vicinity.
Primary care providers themselves can also gain greater familiarity with identifying and managing midlife health and menopause-related concerns.
“The Menopause Society’s membership has doubled in just two years, alongside record applications for its menopause certification exam, and by 2025 the Society reported more than 12,500 members, 57% of whom were physicians,” said Dr. Shufelt. “That growing interest is encouraging. Ultimately, improving menopause care comes down to education through CME, clinical courses, podcasts, annual meetings and other high-quality learning opportunities that help clinicians build confidence in menopause care.”
Understanding menopause within the broader process of aging can help shape a more comprehensive approach to women’s health.
“Menopause is inextricably tied to the aging process, and there’s a stigma around aging and menstrual cycles. Patients don’t need to feel alone, embarrassed or ashamed about anything,” said Dr. Christmas. “Menopause is a natural process that can be associated with many bothersome symptoms, and physicians have lots of different ways of helping manage and mitigate those symptoms.”
Key Takeaways
- For women, each stage of the lifespan has specific health considerations.
- During the menopause transition, cardiovascular health can begin to decline more rapidly for women.
- Proper care is especially important for women during the menopause transition; care and treatment during this normal biological process can influence long-term health outcomes.
- Providers should consider a woman’s complete health history when assessing cardiovascular and overall health risks.