PBS News Hour

JOHN YANG: The transition into menopause is an inevitable part of life.

For many it's accompanied by a range of symptoms including hot flashes, insomnia, and weight gain.

Yet it continues to be under studied and undertreated.

Ali Rogin has more -- as part of our ongoing series unequal treatment.

ALI ROGIN: Menopause is the period when menstruation ends, someone officially enters this phase of life 12 months after their last period, but symptoms often begin during perimenopause, which is a transition period that can last years.

It's something many people go through but just one in five OBGYN residents have any training in it.

And studies show that many menopausal women aren't getting any treatment, and often don't even talk about it with their doctors.

We wanted to find out more about why this stage of life is frequently ignored, especially in the United States, and why getting treatment for its symptoms is often such an afterthought.

I'm joined by Stephanie Faubion.

She's the director of the Mayo Clinic Center for Women's Health and the medical director for the North American Menopause Society, which promotes women's health during midlife and beyond.

Dr. Faubion, thank you so much for joining us.

For something is so ubiquitous as menopause, why is it so stigmatized?

STEPHANIE FAUBION, Mayo Clinic, Center for Women's Health: Well, I think it has been stigmatized in the past because it's so tied to aging.

You know, the mean age of menopause in the United States is 52.

So I think that's part of it.

It's also a mysterious women's event and just like menstrual cycles, and puberty and all of that sort of thing.

You know, pregnancy, childbirth, lactation, it's been one of those things.

It's not as talked about, but I think it's doubly so for menopause because it's tied to aging as well.

Menopause does have that that stigma.

If you look up Google images of menopause, you see harried hot, sweaty, angry women.

And you know, that's not the reality for most of us, but it does have a negative stigma.

ALI ROGIN: And you mentioned angry, hot, sweaty, but let's talk about what the symptoms tend to be and also what sorts of treatments are available for these symptoms?

STEPHANIE FAUBION: So the typical symptoms of menopause and let's just say that some women have none, the lucky few that have none.

But most women will have some symptoms and the most common symptoms are vasomotor symptoms, which are hot flashes and night sweats.

A lot of women have sleep disturbances and mood disturbances like irritability and anxiety.

But there's also some ones that many people don't necessarily associated with menopause like joint aches, palpitations, that sort of thing.

ALI ROGIN: And even still, we found 120 21 study that said 73 percent of women aren't getting the treatment for their menopause symptoms.

Why is that?

STEPHANIE FAUBION: Well, let's be clear, not everyone needs treatment for their menopause symptoms.

But for those women who do have symptoms, women end up in a bunch of different doctor's offices for some of the symptoms and aren't necessarily putting it together that this is menopause related, when they do end up in a physician's office.

They are sometimes dismissed as their, you know, they're told that their symptoms aren't important or not bothersome enough to be managed.

ALI ROGIN: And a related element of this seems to be that there isn't a lot of training happening in menopause management.

Why is it so understudied?

STEPHANIE FAUBION: I think that's a great question.

We published a study a few years ago on how much training medical residents were getting and those were residents and internal medicine, family medicine and OBGYN and the bottom line is that none of those residency programs were receiving much in the way of education on menopause about one to two hours at most, and the majority of those residents felt uncomfortable managing menopause when they graduated their training programs, but also I think, many physicians feel that there isn't anything to do about the symptoms.

So, I think the Women's Health Initiative has contributed to this, that there's a big fear of hormone therapy out there.

ALI ROGIN: You mentioned the Women's Health Initiative.

Can you explain briefly what that was and the impact it had on the treatment of menopause?

STEPHANIE FAUBION: Well, the Women's Health Initiative study looked at women between the ages of 50 and 79 years of age, and their goal was really to see if hormone therapy was good for disease -- chronic disease prevention, that's the way it was designed.

So the women entering the trial were not necessarily and for the most part did not have menopausal symptoms at the time.

They carried on the study for several years.

And after five years, in 2002, the combination therapy arm was stopped due to increased risk of cardiovascular disease and breast cancer.

So there were a number of concerns raised about it.

But the problem with the study was that the mean age of the women in the study was 63 years of age, which is not the age of the women that we commonly see in our offices who are having trouble with menopause symptoms.

And the results were analyzed by the entire group at one time and not by decade of life.

And so the key findings were a little bit misleading initially.

ALI ROGIN: And what was the result once those findings were released?

STEPHANIE FAUBION: When the findings were released, there was a dramatic drop off in the hormone therapy use rates in the United States such that we went from roughly 40 percent of women using hormone therapy postmenopausal up to roughly 4 percent and that really hasn't rebounded much since then.

ALI ROGIN: And Dr. Faubion how does the medical field need to change in order to better serve patients going through menopause?

STEPHANIE FAUBION: We need to educate providers on what can be done about menopause symptoms.

Not everyone needs hormone therapy, but providers should be definitely comfortable with understanding the risks and benefits of hormone therapy and who would be a good candidate for it, as well as the non-hormonal options that we have out there for management of menopause symptoms.

ALI ROGIN: Stephanie Faubion with the Mayo Clinic and the North American Menopause Society.

Thank you so much for your time.

STEPHANIE FAUBION: Thank you.