Historically, menopause has been stigmatized and often not publicly discussed. Yet understanding how menopause is characterized, diagnosed, and treated in the U.S. healthcare system today is critical to supporting women’s health in midlife and beyond.
In the United States, approximately 1.3 million women enter menopause each year. Menopause is a natural aspect of reproductive biology in women, defined clinically as the permanent end of menstruation after 12 consecutive months without a menstrual period (menses). With increasing life expectancy, women may spend more than one-third of their lives in the postmenopausal stage.
The stigma with menopause intensified about 20 years ago, when interpretations of data from the Women's Health Initiative raised concerns about hormone replacement therapy (HRT), and the U.S. Food and Drug Administration (FDA) subsequently added a boxed warning to HRT products. In addition, many medical residency programs deprioritized menopause training, perpetuating limited communication by healthcare providers on the topic. In the last few years, public conversation and awareness have shifted due to growing scientific knowledge, social and traditional media attention, increased passage of menopause-related legislation, and a rise in menopause healthcare spending.
In this study, we investigated real-world evidence for menopausal diagnosis, treatment, and comorbidities among midlife women. Using the group commercial dataset within the Milliman Consolidated Healthcare Cost Guidelines Sources Database for calendar years 2022 to 2024, we examined whether pharmacologic treatment aligned with diagnosis status, and if HRT or a non-HRT alternative was used in treatment. We also compared comorbidity patterns between women with and without a clinical menopause diagnosis, and those who had received treatment versus those who did not.
Key findings:
- Menopause appears to be underdiagnosed in the commercially insured population, with only about 25% of women ages 40 to 64 receiving a diagnosis.
- Primary care providers are central to menopause diagnosis and documentation.
- Treatment patterns are not fully aligned with diagnosis status, as some women receive therapy without a formal menopause diagnosis.
- Women with a menopause diagnosis have higher observed rates of selected comorbid conditions.
- Opportunities exist to improve recognition, align treatment pathways, and support better health outcomes for women in midlife.