Menopause
California plans US$3.4m menopause care overhaul
California plans US$3.4m for menopause care, screening and treatment access in a budget proposal advocates say could begin to close care gaps.
If approved by the legislature through the budget process, the proposal would require menopause screening for all women from age 40, direct health plans to expand coverage of FDA-approved menopause treatments, meaning treatments cleared by the US regulator, “as medically necessary”, fund menopause services, education and awareness programmes, and allow clinicians to receive continuing education credit for completing menopause training.
The proposal follows governor Gavin Newsom twice vetoing similar legislation in recent years, citing cost and insurance coverage concerns.
In October, when he vetoed a bipartisan bill seeking similar changes, he said he supported better care but directed state agencies to explore alternatives through the budget process.
Newsom said in a statement last month that the proposal “will expand access to essential, evidence-based care in a way that’s affordable and fiscally responsible”.
Assemblymember Rebecca Bauer-Kahan, who authored two of the vetoed bills, supports the budget proposal but has raised concerns that it does not apply to Medi-Cal, the state’s health insurance programme for low-income residents.
The 7.6 million women and girls served by Medi-Cal are disproportionately Latina and Black.
“That is a gaping hole in this, just so we are clear,” Bauer-Kahan said.
“That will be one of the next fights.”
For Bauer-Kahan, 47, the policy grew out of personal experience.
She said: “It started by being a perimenopausal woman who couldn’t get care. I was going through this and started talking to friends and others about it, and I realised it was more pervasive than I previously understood.”
Experiencing severe brain fog, which can mean problems with memory and concentration, she sought care from multiple doctors who reassured her nothing was wrong, leaving her worried about early onset Alzheimer’s because of intense forgetfulness.
Relief came only after visiting a menopause specialist.
“He sent me a questionnaire that was pages long about my symptoms, and I was tearing up,” she said.
“When I finally got the care I needed, it was game-changing. I feel like myself again.”
Menopause happens after a woman has gone 12 consecutive months without a menstrual cycle, though the transition usually begins years earlier in perimenopause, when fluctuating hormone levels can cause symptoms including hot flushes, brain fog, joint pain, fatigue, irregular periods, mood swings and insomnia.
Studies have found the sudden drop in oestrogen is associated with cardiovascular disease, cognitive impairments and dementia.
Dr Rajita Patil, assistant clinical professor in the obstetrics and gynaecology department at UCLA health and director of its Comprehensive Menopause Program, said: “This is an opportunity to best optimise long-term health and make sure they have optimal longevity.”
However, training for physicians has been limited.
Many providers receive only a brief menopause lecture in medical school, if they get one at all, according to Patil.
A study from the AARP Public Policy Institute released last year found that only about one-fifth of women receive menopause treatment, and women of colour are much less likely to receive it.
“There is exponential demand for care that should have been there in the first place,” Patil said.
“Doctors are not really trained for this kind of care.”
Patil said the lack of training and a widely reported 2002 study from the Women’s Health Initiative, which suggested hormone therapy increased certain health risks but was later criticised and refuted by researchers, set menopause care back by decades.
Nationally, California is lagging behind other states. Last year, nearly two dozen states saw more than 50 menopause-related bills introduced, and eight became law in states including Oregon, Washington and Rhode Island, according to the nonprofit Let’s Talk Menopause.
Janet Lee-Ortiz, a Los Angeles middle school teacher who began experiencing symptoms about a year ago, said: “It should be treated like a big deal because it’s a big freakin’ deal. I’m in the middle of trying to figure it out, and I really feel alone, navigating it by myself.”
The proposal also raises equity concerns.
Research shows Latina and particularly Black women often enter menopause earlier and experience more severe symptoms for longer than white and some Asian women, yet the proposal’s expanded coverage, training and education provisions apply only to commercial health plans.
Bauer-Kahan said: “There are real racial equity issues built in. How do you get everybody in the doors to be treated? How do you make it more equitable for everybody?”
She said initiatives like this one often start with private insurance and then expand to public programmes once costs become clearer, adding: “It’s going to lead to healthier, happier and longer lives for women.”
An AI atlas has mapped how reproductive organs age through menopause, with the ovaries, vagina and uterus changing on different timelines.
To better understand how this process affects health, researchers at the Barcelona Supercomputing Center developed what they describe as the first large-scale atlas of female reproductive system ageing, using artificial intelligence.
The team combined 1,112 tissue images from 659 samples, covering 304 women aged 20 to 70, with gene expression data from thousands of genes.
This allowed them to reconstruct how seven key reproductive organs, including the uterus, ovary, vagina, cervix, breast and fallopian tubes, age over time.
The study used the supercomputing power of MareNostrum 5 together with advanced image-recognition methods to process the data.
Using deep learning techniques, the researchers detected visible tissue changes as well as the underlying molecular processes linked to ageing in each organ.
The result was a detailed, organ-by-organ map of the reproductive system’s ageing process.
The researchers found that not all organs age in the same way or at the same speed. The ovaries and vagina showed a more gradual ageing process that begins even before menopause officially starts.
By contrast, the uterus appeared to undergo more sudden changes around the time of menopause.
Even within a single organ, different tissues aged at different rates. In the uterus, for example, the mucosa, its inner lining, and the muscular layer did not change in sync. These tissues also appeared to be particularly sensitive to the hormonal and biological shifts associated with menopause.
Marta Melé, leader of the transcriptomics and functional genomics group at BSC and director of the study, said: “Our results show that it acts as a turning point that profoundly reorganises other organs and tissues of the reproductive system, and allows us to identify the genes and molecular processes that could be behind these changes.”
Building on the finding that organs age according to different patterns, co-first author Laura Ventura said the research “paves the way for personalised medicine where treatments are tailored to a woman’s specific molecular profile and the specific tissues showing the most age-related distress.”
The study also identified molecular signals linked to reproductive ageing that can be detected in blood samples from more than 21,441 women.
These biomarkers could allow doctors to monitor the condition of reproductive organs in a non-invasive way, potentially helping to anticipate risks such as pelvic floor complications without the need for biopsies.
According to the researchers, this could lead to simpler and more accessible clinical tools for tracking women’s health over time.
The government and NHS England should work with pharmacies to show how the sector can help women experiencing menopause symptoms, according to a joint statement released by several pharmacy bodies.
A consensus statement endorsed by the Royal College of Pharmacy warned there remains significant unmet need for clear, evidence-based guidance and advice on the condition.
The statement, ‘Menopause, unmissed’, published on 24 April 2026, was endorsed by bodies including the Royal College of Pharmacy, the Company Chemists’ Association and the National Pharmacy Association.
Amandeep Doll, director for England at the Royal College of Pharmacy, said: “Pharmacy teams are highly accessible and already support people experiencing menopause with advice, self-care and signposting to other services.
“We endorsed this statement because improving access to clear information and joined-up care is essential, particularly for those facing inequalities.”
According to the NHS, around 75 per cent of women experience some symptoms during perimenopause and menopause, while 25 per cent report that their symptoms are severe.
In the joint statement, the pharmacy bodies welcomed increased awareness of menopause in recent years but warned this had also led to a sea of misinformation and that there remains significant unmet need, particularly for clear, evidence-based and accessible information and guidance.
The document set out eight recommendations to improve menopause care, including a public awareness campaign on menopause symptoms and opportunities for self-care, alongside guidance on how pharmacies can support women with menopause.
It also recommended that integrated care boards and women’s health hubs should report progress on implementing the upcoming equity framework in menopause care.
In its renewed women’s health strategy for England, published on 15 April 2026, the Department of Health and Social Care set out plans to publish an equity good practice guide to help integrated care boards better understand and reduce inequalities in heavy periods and menopause.
The joint statement asked that the Department of Health and Social Care and NHS England work with champions in minority communities to ensure menopause materials reflect a diverse range of experiences.
It added that women living in areas of high deprivation and those from Black, Asian and minority ethnic communities can experience menopause differently and are more likely to face health inequalities in their care.
Doll said: “With the right support, training and commissioning, community pharmacy can play a greater role in delivering timely, convenient menopause care closer to home, working as part of neighbourhood health teams and in partnership with women’s health hubs.”
Theramex has been censured over HRT failures that regulators said jeopardised patient safety.
The UK producer of HRT drugs, including Evorel and Intrarosa, was found to have breached fundamental compliance standards.
These included not updating crucial prescribing information, in some cases for several years, and not making clear that one drug must not be used during pregnancy.
The Prescription Medicines Code of Practice Authority issued the public reprimand after Theramex staff blew the whistle over what it described as “alarming” compliance issues and incomplete prescribing information for Evorel and Intrarosa that “jeopardise patient safety”.
Evorel patches, which contain estradiol, are among the most prescribed forms of transdermal HRT, meaning hormone treatment delivered through the skin. More than 250,000 items were issued in the last financial year, according to NHS Business Services Authority figures.
Overall, nearly 10m items of estradiol, including gels, were prescribed in the 2024/25 financial year.
The employees’ concerns included failing to provide comprehensive side-effect information in Evorel’s prescribing information, and not updating Intrarosa’s product information since 2019.
The PMCPA also reprimanded the company over failures to specify in advertising at a reproduction and advertising conference that Yselty, used to treat uterine fibroids, should not be taken during pregnancy.
In total, the PMCPA found Theramex had breached the Association of the British Pharmaceutical Industry’s code of practice 21 times.
The panel said the breaches not only jeopardised patient safety, but that Theramex had “brought discredit upon, and reduced confidence in, the pharmaceutical industry”.
The PMCPA also condemned Theramex’s decision to leave the regulator’s jurisdiction.
“By leaving the self-regulatory framework and requiring the Medicines and Healthcare products Regulatory Agency to assume full responsibility for regulating it, Theramex has inevitably delayed any regulatory action and oversight,” it said.
Dr Amit Aggarwal, medical director of the ABPI, said: “Theramex has fallen seriously short of the standards expected under our strict ABPI code of practice, and it’s right that the PMCPA took action.
“It’s also disappointing that as a result, the company has decided to leave the pharmaceutical industry’s self-regulatory system, which holds companies to standards above and beyond the law.”
Julian Beach, MHRA’s executive director of healthcare quality and access, said he was disappointed Theramex had left the PMCPA, but that the MHRA would take any necessary steps to ensure patient safety.
He said: “Leaving the jurisdiction of the PMCPA does not mean a company escapes scrutiny.
“The MHRA has legal powers to investigate and act on concerns about medicines that may impact public safety. Breaches of regulations can amount to criminal offences.”
A spokesperson for Theramex said: “Upholding ethical standards, compliance, and patient safety is very important to us. We acted promptly to address these historical matters as soon as we became aware of them.
“We take these matters seriously and have undertaken a comprehensive review of our compliance framework, including commissioning an independent external audit and implementing a broad programme of enhancements.
“As part of this process, we concluded it is most appropriate to be regulated with respect to UK medicines legislation by the MHRA, while continuing to uphold the spirit and principles of the EFPIA and ABPI codes of practice.
“Therefore, we withdrew from the PMCPA’s jurisdiction in January 2026. This approach allows us to focus our resources on maintaining high standards of ethical and compliant behaviour, with patient safety.”
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