Albeit a bit late to the starting gate, this year, I approached my health care provider to finally discuss Hormone Replacement Therapy (HRT). My personal course through menopause was relatively mild—I was fortunate to avoid severe hot flashes, night sweats and debilitating brain fog. However, other subtle issues arose, which, looking back, I believe began during perimenopause—that critical transition when hormone levels first fluctuate and decline.

Despite having an excellent obstetrician-gynecologist (OB/GYN) for most of my adult life, as I entered this phase, I was never proactively offered any hormone replacement options. Now, 15 years after my menopausal transition officially began, I’ve been told by several providers that I am no longer a safe candidate for HRT.

The staggering cost of omission

My current physician reassured me that alternative methods exist to manage my bone loss, intermittent, undiagnosed pains and the new, disconcerting periods of anxiety. But each of these remedies requires another cocktail of medications—a host of drugs that might have been easily circumvented by a judicious, timely course of HRT.

Two of the specialists I consulted delivered an unsettling message: While they personally didn’t think it was safe for me, they believed “someone out there” would still be willing to prescribe the hormones. The comment felt like a stark reminder that in the high-stakes game of medication, if you are willing to spend the dollar, you will find the “dealer.” Did you consider: When did necessary health care become a transactional pursuit reserved only for the determined and the wealthy?

A public health crisis in hiding

Why is it so difficult to find timely and thoughtful care for women? Half of the world’s population is female, and every single one of us will experience menopause—whether as a factor of aging or due to trauma.

How are our family doctors preparing us for this inevitable transition?

Are OB/GYNs effectively educating their patients on the coming challenges and how to best negotiate the transition, or are we left to navigate it solo?

Menopause is not an illness; it is a condition that is a natural part of the continuum of life. Yet the systemic failure to address it appropriately has created a silent public health crisis.

The unacceptable education gap

This leads to the core problem: How are our doctors educated about a condition that all of their female patients will eventually face?

While many women anecdotally report significant benefits from HRT—more energy, more stable mood, better short-term memory and a general sense of strength—the clinical evidence supporting hormones is especially compelling. Normal hormone levels are proven to protect and increase bone density, prevent urinary tract infections, mitigate heart disease risk and preserve cognitive function and mood. Given these high-stakes benefits, it is critical to distinguish between valid research and hearsay.

There is no shortage of double-blind studies supporting the need for hormone replacement in appropriate candidates, yet our doctors appear woefully undereducated on how to help their female patients.

A shocking 2023 needs-assessment survey of U.S. OB/GYN residency programs found that only about 31.3 percent offered any structured menopause curriculum. This survey inventoried future specialists. Medical students receive even less instruction, often just one hour of curriculum exposure. As a rule of thumb, the focus has historically been on “band-aid” interventions to relieve suffering, rather than comprehensively assessing this complex life transition.

Prevention vs. repair: The economic tangle

This gap in education leads to misinformation, misdiagnosis and inadequate treatment options. To help women—who experience menopause in highly varied ways—requires staying up to date not only on the research but, more importantly, on how that research is accurately interpreted.

The recent reversal in the interpretation of major findings regarding HRT’s risks—specifically concerning cardiovascular disease, breast cancer and probable dementia—is a powerful example of how errors in interpretation and study design can fundamentally alter decades of patient care advice.

Did you consider: From a public health perspective, is it not economically cheaper to educate and prevent problems than to fix them after they arise?

Did you consider: Why is it so prohibitively expensive for women to access preventative care that could ward off hip fractures, chronic urinary tract infections and debilitating bouts of anxiety and depression?

This is not a condemnation, but an urgent observation: We deserve timely, evidence-based care that acknowledges menopause as a complex health issue requiring comprehensive expertise, not a poorly understood condition requiring a patchwork of reactive, secondary prescriptions.

Share the conversation and find resources

You, dear reader, may not be facing menopause yourself, or perhaps you are male, but you certainly know someone with whom to share this article. We encourage you to open a dialogue and perhaps ask them:

Have you been having frequent night sweats and hot flashes?

Has your mood or mental health changed recently without a precipitating life event?

Do you feel tired all the time even after a good rest?

Is intimacy no longer desirable, enjoyable, or comfortable?

Have you noticed increased forgetfulness episodes?

For more information that you can rely on, seek articles from these trusted sources, which can provide valid information about your options:

ScienceDirect: www.sciencedirect.com/science/article/abs/pii/S1530891X25012595

National Institutes of Health (NIH): www.nia.nih.gov/health/menopause/what-menopause#:~:text=Learn%20more%20about%20women’s%20health,trials%20and%20NIH%2Dfunded%20research

The Menopause Society: www.menopause.org

Hedy Schneller is the founder of illumia Skincare, which features products crafted with local, fresh and healthy ingredients. In her previous professional life, Schneller was an occupational therapist and rehabilitation director. Visit www.illumiaproducts.com.