Prescription of hormone therapy may vary based on the type of healthcare provider consulted

CLEVELAND, Ohio – As the medical community continues to grapple with the complexities of menopause management, a groundbreaking new study unveils significant disparities in treatment approaches rooted in healthcare provider education and specialty. Menopause, characterized by profound physiological and psychosocial shifts, affects an estimated 80% of women, often manifesting through symptoms that severely impact quality of life. Despite the proven efficacy of hormone therapy in ameliorating these symptoms, its utilization has declined precipitously in recent years, with only a fraction of women aged 45 to 59 engaging in such treatments.

This latest research provides critical insights into how variations in provider type—ranging from obstetrician/gynecologists (OB/Gyns) to endocrinologists, internal medicine, and family medicine practitioners—influence the likelihood of women receiving menopause-related prescription therapies. The study, drawing from electronic health records of nearly 5,500 women coded for menopause-related consultations, reveals that just 17.1% of patients were prescribed any treatment for their symptoms. Among those treated, systemic estrogen was prescribed to 34%, vaginal estrogen to 47%, and selective serotonin reuptake inhibitors (SSRIs) to 16%.

Intriguingly, OB/Gyn providers exhibited the highest propensity to prescribe systemic estrogen, aligning with their specialized training in female reproductive health. Conversely, internal medicine and family medicine providers more frequently favored SSRIs, which, while beneficial for some menopausal symptoms, do not address the underlying hormonal changes as directly as estrogen therapy. When analyzing provider types beyond specialty, midwives and nurse practitioners were more inclined than physicians to prescribe systemic estrogen, whereas physician assistants more commonly prescribed SSRIs. These differential prescribing patterns underscore inconsistencies in menopause care that may arise from heterogeneous educational backgrounds and training exposures.

The core hypothesis driving this investigation suggests that the decline in hormone therapy utilization may stem largely from a lack of standardized, comprehensive menopause education across medical disciplines. Supporting this, surveys fail to show adequate preparation among residents in internal medicine, family medicine, and even OB/Gyn specialties, with fewer than 10% feeling confident managing menopausal care after training. This educational gap likely contributes to fragmented care pathways and may leave many women underserved during this pivotal stage.

Dr. Anna Caroline Cochrane of Wake Forest University School of Medicine, lead author of the study, emphasizes the pressing need for curricular reforms. “Menopause encompasses complex symptomatology that requires nuanced understanding and tailored interventions. Unfortunately, our current training paradigms fall short, which likely explains the wide variability seen in care delivery and treatment decisions,” she explains. Dr. Cochrane advocates for integrating evidence-based menopause education into all levels of medical training to harmonize and improve patient outcomes.

The repercussions of this variability extend beyond individual treatment preferences and resonate through broader public health implications. Hormone therapy, when appropriately administered, not only mitigates vasomotor and genitourinary symptoms but can also confer long-term benefits in bone health and cardiovascular risk modulation. The underutilization of such therapies may thus represent missed opportunities for optimizing women’s health during and after the menopause transition.

Furthermore, the study sheds light on the role of non-physician providers in menopause management. Increased reliance on midwives and nurse practitioners prescribing systemic estrogen suggests these groups might receive more focused education or adopt differing clinical guidelines. Conversely, the preference of physician assistants for SSRIs—as opposed to hormone therapy—raises questions about their training scope and comfort levels with prescribing hormonal treatments.

In response to these findings, The Menopause Society has intensified efforts to develop accessible, evidence-based educational resources that can be disseminated widely across specialties. Dr. Stephanie Faubion, medical director of The Menopause Society, stresses the importance of leveraging advanced educational technologies and standardized curricula to bridge current knowledge gaps. “We are poised at a transformative juncture where improving clinician education will positively influence the quality and consistency of menopause care provided globally,” she asserts.

The presentation of these study results at The Menopause Society’s 2025 Annual Meeting signifies a pivotal moment for elevating awareness within the medical community. The poster, titled “Provider-Level Factors Related to Receiving Treatment for Menopause Symptoms,” promises to spark critical conversations about training reforms and collaborative care models necessary for enhancing women’s health.

As menopause emerges from the shadows of medical education into mainstream discourse, empowered patients are increasingly seeking comprehensive symptom relief. Aligning provider education with patient needs stands as an ethical imperative to ensure equitable and effective care. This study’s revelations beckon a concerted effort among educators, clinicians, and healthcare organizations to unify menopause management protocols and harness the full therapeutic potential of available treatments.

Looking forward, integrative strategies embracing interdisciplinary training, patient-centered communication, and robust, real-world data collection may serve as cornerstones for advancing menopause care. This research not only highlights existing gaps but also illuminates pathways toward a future where women receive consistent, informed, and evidence-based treatment options during one of life’s most significant biological transitions.