To whom it may concern,

I am writing to express deep concern regarding the persistent gaps in healthcare access, diagnosis, and treatment for women experiencing perimenopause and menopause in the United States. Despite the fact that over 75 million American women are currently in or beyond the menopausal transition, the medical system continues to overlook their needs, resulting in diminished quality of life, lost productivity, and preventable health complications.

The Scope of the Problem

Underdiagnosis and Mismanagement: A recent analysis of nearly 29 million women aged 45–51 revealed that only 7% had a documented perimenopause or menopause diagnosis, despite widespread symptoms such as sleep disturbances, mood changes, and anxiety.
Disparities in Care: Women with commercial insurance were 60% more likely to be diagnosed than those on Medicaid, and white women were 38% more likely to be diagnosed than Black women.
Lack of Provider Education: Only 30% of OB/GYN residency programs include menopause instruction, and nearly two-thirds of residents failed a basic menopause treatment question.
Documentation Failures: In a study of 229 women reporting moderate to severe hot flashes, fewer than 23% had their symptoms documented in their electronic health records. Only 6.1% received hormone therapy, despite its proven efficacy and safety for many women.
Health Consequences of Untreated Menopause

Untreated menopause is not merely uncomfortable—it can have serious long-term health implications:

Cardiovascular Disease: Estrogen decline increases the risk of heart disease, the leading cause of death among women.
Osteoporosis and Fractures: Women can lose up to 20% of their bone density in the first five to seven years post-menopause.
Cognitive Decline: Sleep disturbances and hormonal shifts are linked to memory issues and cognitive impairment.
Mental Health Strain: Depression, anxiety, and irritability are common during the menopausal transition, often misdiagnosed or dismissed.
Economic Costs of Inaction

Lost Productivity: The U.S. economy loses an estimated $1.8 billion annually due to absenteeism, reduced productivity, and premature workforce exit among menopausal women.
Earnings Penalty: Women who seek care for menopause-related symptoms earn 10% less four years later—often due to reduced hours or leaving the workforce entirely.
Workplace Burnout: With 60% of U.S. women aged 55–64 in the workforce, untreated symptoms contribute to burnout and leadership attrition.
Recommendation: Age-Based Insurance Benefits

Current insurance models often prioritize reproductive care for women across all age groups, yet this fails to reflect the shifting health needs of women in midlife. Women in their 50s and beyond typically do not require routine OB/GYN services such as fertility or prenatal care—but they do need access to:

Menopause specialists and hormone therapy
Bone density screenings and cardiovascular monitoring
Mental health support tailored to hormonal transitions
I strongly recommend that corporate insurance benefits be age-adjusted, not solely coverage-tiered. This would ensure that women receive care aligned with their life stage, rather than outdated assumptions about reproductive health. Companies like Fertifa and Maven Clinic are already leading the way by offering menopause-specific benefits that include clinical support, flexible work policies, and targeted treatment options.

What Needs to Change

Expand Coverage: Ensure that insurance plans cover both hormonal and non-hormonal treatments for menopause-related symptoms, including counseling and lifestyle interventions.
Improve Provider Training: Mandate menopause education in medical curricula and continuing education for primary care providers.
Support Research and Coding Reform: Advocate for a dedicated ICD-10-CM code for perimenopause to improve data tracking and treatment access.
Promote Public Awareness: Fund campaigns to destigmatize menopause and encourage women to seek care without shame or dismissal.
Modernize Corporate Benefits: Shift insurance design to reflect age-specific needs, especially for women in midlife and beyond.
Conclusion

Women spend over one-third of their lives in perimenopause or post-menopause. It is unacceptable that this phase continues to be treated as invisible. We must act now to ensure that every woman receives the care, dignity, and support she deserves.

I welcome the opportunity to discuss this further and collaborate on solutions that prioritize women's health across the lifespan.

Sincerely,
Julia E. Pavlick