Menopause is clinically defined as the end of a female's menstrual cycle, but for many, this stage of life is marked by uncertainty and confusion. It is a period where information is vague, experience is poorly understood, and it leaves many women feeling isolated as they navigate the complex changes of aging. Each year, nearly two million women enter menopause, yet there is a significant knowledge gap among health care providers regarding its management. A 2019 study revealed that less than 7% of primary care providers felt adequately prepared to treat menopausal women. Even though 60% of women seek medical care for menopause-related issues, only 25% receive treatment.

Currently, there is no standardized approach for treating menopause. As a result, many women rely on self-care, lifestyle modifications, or over-the-counter remedies instead of clinical interventions, leading to a lack of documentation of these experiences in medical records. In addition, many symptoms associated with menopause, such as hot flashes, sleep disturbances, and mood changes, are coded under general health conditions rather than menopause-specific diagnoses. This fragmentation of care results in an underreporting of menopause-related data. Cultural stigma and limited provider-patient discussions around menopause have further compounded this issue, resulting in menopause being unrecognized as a medical need by the health care system.

Using HCCI's unique dataset of people with employer-sponsored insurance, this data brief assesses the frequency of menopause diagnosis codes, particularly natural or age-related menopause, from 2018 to 2022 and the types of providers that recorded these diagnoses. The underlying rate at which women experience menopause symptoms has likely not changed, but an increase in formally recorded diagnoses may reflect changing societal and medical attitudes towards the documentation of a critical component of women's health.This research aims to explore patterns in menopause diagnosis and identify opportunities for improved education, ensuring that providers are prepared to address this critical health issue.

From 2018 to 2022, we observe an increase in the percentage of women between the ages of 45 and 64 who have a menopause diagnosis. The percent of women with any diagnosis of menopause rose from 13.7% in 2018 to 14.7% in 2022 (Figure 1).

As shown in Figure 2, we observe a similar pattern when we look at the rate of menopause diagnosis per 100,000 women. In 2022, we observe a rate of 1,969 per 100,000 women aged 45-64, a nearly 10% increase from a rate of 1,793 in 2018. Most menopause diagnosis codes are for symptomatic menopause, and the increase in symptomatic menopause rates from 2018 to 2022 parallels the overall menopause diagnosis trend. The rate of symptomatic menopause diagnoses increased 11%; 840 per 100,000 women aged 45-64 in 2022, up from 757 per 100,000 in 2018.

As a share of all menopause diagnoses, symptomatic menopause remained flat over that period, contributing to approximately 42% of menopause encounter diagnoses. Postmenopausal symptoms and asymptomatic menopausal states have the next greatest share of encounters, at 27% and 24% respectively. 

Among women ages 45 to 54, symptomatic menopause was the dominant diagnosis (970 per 100,000 in 2022). Rates of encounters with this diagnosis in this age group was almost 38% higher than among women aged 55 to 64. In contrast, women between the ages of 55 to 64 had similar rates of diagnosis for asymptomatic menopausal state (692 per 100,000), postmenopausal symptoms (692 per 100,000) and symptomatic menopause (705 per 100,000). The rates of asymptomatic menopausal state and postmenopausal symptoms were much higher among the older age group than the younger age group.

Rates of menopause diagnosis are highest among people living in the "least vulnerable" areas, as categorized by the Minority Health Social Vulnerability Index (MH-SVI) and lowest within the most-vulnerable MH-SVI geographies. In 2022, the rate of menopause diagnosis encounters in the least vulnerable population was 30% higher than that in the most vulnerable population (2,193 per 100,000 compared to 1,688). This gap has widened over time, as the rates among the most vulnerable have marginally increased since 2018 (1623 to 1688, only 4%) compared to the least vulnerable (1935 to 2193, 13% higher).

In 2022, over 81% of menopause diagnoses were recorded by physician providers. From 2018 to 2022, the share of menopause diagnoses submitted by physician assistants and nurse practitioners has grown almost 50%, from 9.3% of diagnoses in 2018 to 13.8% in 2022.

Among physician providers, Obstetrician and Gynecologists most frequently recorded a menopause diagnosis. In 2022, 47% of menopause diagnoses from physicians were recorded by OBGYNs. Internal Medicine and Family Medicine doctors followed, representing 14% and 17% of menopause diagnoses respectively. 

This analysis highlights a notable rise in menopause diagnoses since 2018, which aligns with increased media coverage, venture capital investment in digital health tools for menopause, and concerted efforts to raise awareness by a range of stakeholders. Despite this progress, significant gaps remain among health care providers in symptom management, timely and accurate diagnosis, and effective treatment for menopausal women.

Some experts have suggested that every clinician treating women should begin screening for perimenopause by asking key questions starting at age 40 or earlier with the goal of discussing treatment options to alleviate current symptoms and setting expectations for what lies ahead. Tools, such as menopause symptom trackers, clinician discussion guides, and updated clinical guidelines could help both women and providers navigate the confusion and misinformation surrounding menopause. This analysis underscores the need for education on identifying menopause symptoms, not only for OB/GYNs but also for family and internal medicine practitioners.

At present, it often falls to women to initiate discussions about menopause with their providers. A stronger emphasis on women's health in medical research, better patient education on menopause management, and standardized coding systems that capture the full range of menopause-related health care services would help close those gaps. If fortunate, every woman will go through menopause, yet it has long been culturally overlooked. We need digital health, venture capital, employers, payers, providers and women at the table to be part of this dialogue. As a society, we must do more to ensure that women have the resources they need to thrive during this phase of life.