We Can Do Better: Educating on Perimenopause and Menopause Is a Good Thing

This content was independently produced by Pharmacy Times in partnership with Bayer Healthcare.

Perimenopause and Menopause Were Relatively Rare Not So Long Ago

Yes, you read that correctly. Historically speaking, the biological trajectory toward the slowing and eventual ending of menses have been reserved only for those with early onset or for those who survived long enough to experience it. It is always important to remind ourselves that living past 45 years of age was rare for the majority of human history. It wasn’t until 1900 that the world’s life expectancy cracked 30 years, and even industrialized Europe only achieved an average age of death of 43 years at the turn of that century.¹

Certainly, there were women who lived to experience menopause prior to 1900, but not the 98% of women globally who have reached 50 years of age this year.² The modern practice of medicine and subsequent emergence of modern pharmaceuticals for men and women over the age of 50 is a blink in the historical eye of humankind. While management of the challenges associated with perimenopause may certainly include the option to “do nothing,” perhaps taking the nonintervention approach should not be considered normal. There is nothing “normal” about living past the age of 50 for our species—we simply do not have the historical runway to say that either men or women are well designed to age in the modern world without intervention.

Undervaluing the Consequences of Doing Nothing

Over 15% of the population aged 65 or greater has hypothyroidism or subclinical hypothyroidism.^3,4 We think nothing of providing hormone replacement therapy (HRT), such as levothyroxine, as an intervention for this most often age-related condition and maintain an HRT rate of greater than 90% for persons over the age of 60.⁴ Absent treatment, hypothyroidism can cause progressive weakness, cognitive impairment, and failure to thrive. Yet the deleterious effects of perimenopause and menopause are often unspoken or dismissed as an unavoidable consequence of aging. However, the effects of perimenopause and menopause, which include short- and long-term cognitive decline, adverse cardiovascular effects, increased risk of osteoporosis, and a host of other declines in function, result in a dramatic reduction in the quality of life for large portions of the world’s population.

A 2022 survey found some sobering results that put into question why we don’t provide more education, support, and treatment—among the survey results⁷:

• 77% found at least 1 menopause symptom “very difficult”
• 84% experienced trouble sleeping
• 73% experienced brain fog
• 69% of women experienced difficulties with anxiety and depression due to menopause
• 44% of women experienced 3 or more severe symptoms

Graduates, Like Prior Graduates, Are Ill-Equipped to Manage Perimenopause and Menopause

A recent survey of medical residents reported that 93.8% believed it was important or very important to be trained to manage menopause, yet only 6.8% felt adequately prepared to do so.⁷ Unlike hypothyroidism, where 1 hormone can be managed to treat a host of symptoms, perimenopause and menopause are far more complex, requiring careful evaluation of symptoms and a combination of hormone levels to bring about improvements. There is no 1-size-fits-all approach.

The initial findings of the Women’s Health Initiative (WHI) compound the lack of education and exacerbate the tendency to “do no harm at the expense of allowing greater harm.” This 2002 study suggested there were risks of HRT and resulted in a 4-fold drop in HRT to less than 5% of women over the age of 40.8 Since then, 2 camps have emerged: those who practice generally, who tend to shy away from intervention; and those who practice with a more focused approach on menopause as a condition, often requiring especially individualized assessments and treatment, with complex intersecting effects. In short: those who practice menopause management.

Importantly, a recent article in JAMA this fall attempted to “clear the air” on the findings of the WHI study. It encouraged practitioners to stay up to date on evolving interpretations, assess each patient on the risks and benefits of HRT, and to generally do a better job of assessing the effects of perimenopause and menopause and to become much more open to intervention.

A New(er) and Emerging Arm of Women’s Health-Certified Practitioners

The Menopause Society is a charitable nonprofit organization with a more than 3-decade history of promoting better education, awareness, and evidence-based practice for the management of perimenopause and menopause.⁹ With leadership, governance, and members grounded in well-established arms of medicine, members also include nursing, pharmacy, and other care team members. The Society provides practice certifications, publications, meetings, and resources for menopause management. A quick search of providers online will reveal a modest but growing number of practitioners, though sadly a quick search of the 15-mile radius for my own zip code (27516) returns a grand total of 13 practitioners and no pharmacists. This area includes Duke (Durham) and the University of North Carolina Hospitals (Chapel Hill) catchment areas.

Beyond Compounding Pharmacies, All Pharmacists Should Be Conversant in Menopause Management

There are many hundreds of pharmacies that provide customized, compounded HRT for management of perimenopause and menopause. Perhaps there should be thousands alongside many more medical practitioners who actually practice management of menopause. At least, we should all consider more continuing education and lifelong learning for this area of practice and push schools of pharmacy to increase their didactic and experiential learning. It’s long past due now that we’ve achieved a life expectancy approaching 80 years of age in developed countries, with nearly half of a woman’s life now experienced beyond childbearing years.

REFERENCES

1. National Center for Family & Marriage Research. Bowling Green State University. Accessed November 4, 2025. https://www.bgsu.edu/ncfmr.html

2. Murphy SL, Kochanek KD, Xu JQ, Arias E. Mortality in the United States, 2023. NCHS data brief No 521. CDC. December 2024. Accessed November 4, 2025. https://www.cdc.gov/nchs/data/databriefs/db521.pdf

3. Dedon J. Thyroid disease in aging. Mo Med. 2022 Jul-Aug;119(4):351-353. Accessed November 4, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC9462896/

4. Tessnow AH, Gigliotti BJ, Perkins JM, et al. Treatment of Hypothyroidism by Age and Sex in the United States: A NHANES and Optum Claims Data Analysis. Endocr Pract. Published 2024. Accessed November 4, 2025. doi:10.1016/j.eprac.2024.12.004

5. Trujillo L. Welcome to the ‘menodivorce’. Why women aren’t sweating marriage in a sea of hot flashes. USA Today. August 14, 2025. Accessed November 4, 2025. https://www.usatoday.com/story/life/health-wellness/2025/08/14/divorce-women-perimenopause-menopause/85622804007/

6. Shahzady F. The Family Law Menopause Project & Newson Health Research and Education partner to launch survey uncovering women’s experience of menopause & divorce. LinkedIn. Accessed November 4, 2025. https://www.linkedin.com/pulse/family-law-menopause-project-newson-health-research-partner-shahzady/

7. Kling JM, MacLaughlinn KL, Schnatz PF. Et al. Menopause Management Knowledge in Postgraduate Family Medicine, Internal Medicine, and Obstetrics and Gynecology Residents: A Cross-Sectional Survey. Mayo Clin Proc. Published 2018. 2019;94(2):242–253. doi:10.1016/j.mayocp.2018.08.033

8. Schweitzer K. New Analysis of Women’s Health Initiative Data Aims to “Clear the Air” Over Menopausal Hormone Therapy. JAMA. 2025;334;(15):1318-1320. doi:10.1001/jama.2025.14187

9. The North American Menopause Society. Accessed November 4, 2025. https://menopause.org/