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Lara Zibners and Adam Brown write that schools that do not integrate menopause training into their curricula are failing students, patients and society.
The medical community has a big problem: women’s health is treated as charity. The fact that investors bury it under impact fund” means they think it’s non-revenue generating.
The truth is actually the opposite. Women’s health is an increasingly profitable industry.
The gap in medical care for men and women is a well-documented phenomenon, stemming from systemic bias, a lack of women in scientific research, and a lack of women’s health training in medical schools.
That gap is most obvious when it comes to menopause. Even though menopause drives billions in direct and indirect costs each year, education remains limited or entirely absent from traditional medical school curricula and postgraduate speciality training. That includes training in specialities exclusive to women.
The moral imperative to improve care for over half the population is self-evident, but there is an economic argument to be made as well.
Not a niche clinical concern
We make it in a new white paper called The business case for integrating menopause education into a medical school curriculum: a central issue, not a peripheral one.
In the US, an estimated 1.3 million women enter menopause each year. Of these women, between 80% and 96% experience symptoms that can persist for years. The global menopause market is estimated at $17.8 billion (£13.3 billion) and projected to reach $24.4 billion by 2030.
Menopause is not a niche clinical concern limited to a few specialities. It is a biological inevitability that is driving billions in healthcare demand.
And yet physicians are not prepared to serve these women. For example, only 6.8% of physicians in internal medicine, family medicine and OBGYN feel prepared to treat menopause. Just over a third of OBGYN programme directors say they have a dedicated menopause curriculum, almost two-thirds of medical textbooks worldwide never mention menopause, and a fifth of resident physicians said they had no menopause lectures during their training. The medical education system is actively sending a message that a condition affecting half the population is irrelevant.
Nowhere is the effect of this lack of education better displayed than with the flawed Women’s Health Initiative (WHI) hormone replacement therapy (HRT) trial that was prematurely terminated due to misinterpreted results.
The ensuing media frenzy and fear by both patients and doctors led to a collapse in the use of HRT that resulted in a generation of women being denied oestrogen. It also resulted in soaring healthcare costs due to potentially preventable morbidity and mortality.
Menopause is a whole-body event that requires significant training to understand. Estrogen’s neuroprotective effects mean two out of three Alzheimer’s patients are women. The loss of oestrogen accelerates cardiovascular ageing, which is responsible for 35% of deaths in women. Oestrogen’s protective effects on bone mass mean 70% of hip fractures occur in post-menopausal women.
Menopause intersects with every medical discipline. Limiting education to only specific specialities is a critical, systemwide failure.
Not a theoretical cost
The cost of this failure is not theoretical. The fragmented diagnostic journey for patients whose menopausal symptoms are missed or misattributed to other conditions costs $4,600 dollars per patient per year. Symptom management creates an annual direct medical cost of $25 billion in the US alone.
Broadly, a lack of preventative care results in more than $200 billion in annual costs for cardiovascular disease in women and another $5.1 billion in hospitalisation costs for non-traumatic (osteoporotic) fractures. The lack of treatment for menopause clearly intersects.
Mismanaged patient care also drives women from the workforce, draining billions in global GDP. Roughly one in three women have considered leaving or have left the workforce due to unmanaged menopause symptoms, meaning businesses are at risk of losing institutional knowledge and essential leadership. For women who remain, the cost of lost productivity equates to $1.8 billion in the US and $2 billion in the UK.
Meanwhile, postmenopausal women prescribed oestrogen therapy saw a threefold reduction in overall costs and a 50-fold reduction in inpatient costs compared to untreated symptomatic women.
In other words: we could reduce costs if we improved training about HRT and about women’s health in general.
Addressing the training gap doesn’t have to be costly. Menopause physiology can be woven into existing modules using curricula like the 2022 European Menopause and Andropause Society position statement.
The US National Institutes of Health COMMIT Challenge is a national prize competition designed to identify and reward menopause-related curricula in both US-based health education and professional training programs. The contest brings with it a $2.5 million prize that should be a strong incentive to highlight programs already in existence and create new ones.
Schools that do not integrate menopause training into their curricula are failing students, patients and society.
As demand for menopause care grows, the consequences of poorly trained physicians will be felt across healthcare systems, the workplace and the wider economy.
