The Menopause Knowledge Gap

I was 47 when Covid hit in 2020. As I transitioned to working from home, I slowly found that I didn't feel like myself anymore. I had experienced erratic periods for a few years already, but around that same time I noticed almost overnight belly weight gain. I was frequently tired, and my thinking often felt foggy. I even remember telling a friend that I thought I might have ADD because I found it nearly impossible to concentrate on anything.

There were likely other symptoms of what I now know was perimenopause, but I wasn't paying attention to them. At the time, I attributed all of this to working from home and the anxiety of a global pandemic.

About a year went by. At my annual checkup, I brought up my concerns with my OB/GYN. I described what I was experiencing and asked about testing and what I could do, especially about the weight gain. Her response? "More than likely it's perimenopause. It's just the phase of life you're in now." She refused to order any blood work, telling me there was simply no point

I was shocked at her response. Before that time, she had taken time to listen to me. She understood that I enjoyed eating cleanly and loved working out. But when I talked about perimenopausal symptoms, she shut me down.

Looking back on it now, I understand that she, like most healthcare professionals, was never adequately trained to help me navigate the waters of perimenopause and menopause. This all started from a single, flawed study from over two decades ago.

Before 2002, hormones were widely prescribed and many studies demonstrated their safety. In fact, in 1975, estrogen was the fifth most prescribed medication in the USA. But then the Women’s Health Initiative (WHI) published findings from one of the largest studies ever conducted that focused on hormone therapy in women.

Before the results were published, some of the research team went public to say that the trial was stopped because of “an increased risk of breast cancer, some heart attacks, and increased stroke risk.”* Almost overnight, doctors stopped prescribing hormones and women stopped asking for them. The following year, the FDA placed a “black box” warning on all hormones.

Unfortunately, there were many flaws in the study, more than can be discussed in this post. I’d highly encourage you to read Dr. Kelly Casperson’s The Menopause Moment to learn more about the study, the issues with the study, and the overwhelming number of positive outcomes of hormone therapy that they did find.

The ripple effects that impacted medical education were profound and lasting. Residency programs reduced or eliminated substantive training on hormone therapy and menopause management. Physicians who trained in the years following the WHI, which includes a very large portion of the doctors practicing today, received little to no instruction on how to evaluate and treat the hormonal transitions of midlife.

A 2019 survey found that the majority of OB-GYN residents reported receiving fewer than four hours of menopause education in medical school. Primary care physicians often receive even less. The result is a generation of well-meaning, board-certified physicians who genuinely do not have the tools to recognize the full spectrum of perimenopausal symptoms, evaluate whether hormone therapy might be appropriate, or even have an informed conversation about the risks and benefits based on current science.

And so women are dismissed. Or misdiagnosed with depression or anxiety. Or told their labs are "normal" because conventional lab ranges for hormones are not calibrated to catch the fluctuating, erratic shifts of perimenopause. Or prescribed medications that treat the symptoms while ignoring the root cause entirely.

This is not a small problem. There are approximately 6,000 women entering menopause every single day in the United States. The average woman will spend more than a third of her life post menopausal. Yet the medical system has not kept pace with what women in this stage of life actually need.

The medical community's understanding of hormone therapy has evolved considerably since 2002. Major medical organizations, including The Menopause Society (formerly NAMS), have issued updated guidance making clear that for healthy women under 60 or within ten years of menopause onset, the benefits of hormone therapy generally outweigh the risks. The "timing hypothesis", the idea that earlier initiation of hormone therapy offers the greatest protective benefits for cardiovascular health and bone density, has substantial research support.

In November 2025, after significant advocacy efforts, the FDA’s black box warning was updated to reflect this evolution in science. However, there is so much more work to be done to educate healthcare providers and the public on the real science.

None of this means you should distrust your doctor. It means you deserve to understand why you may not be getting the support you need, and that you have options.

There is a growing community of physicians who have sought out specialized training in menopause medicine because the standard medical education system failed to provide it. These are the practitioners who have done the continuing education, stayed current with the literature, and made a commitment to being genuinely equipped to support women in midlife.

Finding one of them can be genuinely life-altering. The key is to educate yourself so that you feel confident to ask the important questions.

Where to Start

The Menopause Society (formerly NAMS) The Menopause Society maintains a searchable directory of certified menopause practitioners. These are providers who have completed specialized training and passed a rigorous certification exam in menopause care. This is one of the best places to begin your search.menopause.org/for-women/find-a-menopause-practitioner

The Menopause Society Patient Resources Their website also offers a wealth of evidence-based information for women navigating perimenopause and menopause — so you can walk into any appointment informed and prepared.menopause.org/for-women

The British Menopause Society For those outside the US or looking for additional perspectives and resources, the British Menopause Society also maintains provider directories and patient education materials.thebms.org.uk

Be Your Own Advocate

The dismissal you may have experienced in your doctor's office is not a reflection of the legitimacy of your symptoms. It is a reflection of a system that has historically under-invested in women's health and that has been slow to correct the damage done by a misapplied study more than twenty years ago.

You are allowed to ask questions. You are allowed to seek a second opinion. You are allowed to request a referral to a provider with specialized menopause training. You are allowed to say, this is not working for me, and I need something different.

This stage of life deserves real support, real information, and real care. And there are providers out there who are ready to give it to you. You just may have to seek them out.

The information in this post is for educational purposes and is not intended as medical advice. Please work with a qualified healthcare provider to make decisions that are right for your individual health history and needs.

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Footnotes

¹ Allen JT, et al. "Menopause education and resources in U.S. obstetrics and gynecology residency programs." Menopause. 2023. doi:10.1097/GME.0000000000002234

² Society for Women's Health Research. "Menopause." swhr.org. Accessed 2026.https://swhr.org/health_focus_area/menopause/