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.”
Abdominal obesity may lead to worse menopause symptoms, including forgetfulness, irritability and night sweats, a new study suggests.
The findings point to a possible link between fat stored around the waist and more severe midlife symptoms.
Researchers said waist-to-height ratio could help identify women who may benefit from more targeted support.
Dr Monica Christmas is associate medical director for The Menopause Society.
Christmas said: “Unintended weight gain during the menopause transition, especially in the midsection, is one of the most commonly reported complaints, with the most significant gains experienced in the years leading up to the final menstrual period and a couple of years after.
“This not only affects self-image but also imposes negative health risks and, as the study highlights, is associated with higher prevalence and severity of menopause symptoms.”
The study used data from more than 1,100 women who took part in the Study of Women’s Health Across the Nation.
Abdominal obesity is a build-up of fat around the waist. It often includes visceral fat, which is deep, active fat surrounding internal organs.
This type of fat releases inflammatory proteins and toxic fatty acids that can contribute to insulin resistance, cardiovascular disease, high blood pressure and a higher risk of some cancers.
Insulin resistance means the body does not respond properly to insulin, the hormone that helps control blood sugar.
The Menopause Society said abdominal obesity is estimated to affect more than 60 per cent of menopausal women.
As oestrogen levels fall during menopause, women tend to store more fat around the waist rather than the hips, even if their overall weight does not change.
The researchers noted that obesity patterns and menopause symptom burden can vary by region, but research into the effect of abdominal obesity on these symptoms remains limited.
They also said earlier studies have mainly looked at single symptoms, rather than how symptoms connect with each other.
In this study, researchers used network analysis, a method that looks at how symptoms are linked, to compare symptom patterns in women with and without abdominal obesity.
They identified abdominal obesity using waist-to-height ratios, which compare waist size with height and can be used as a simple measure of health risk linked to body fat around the middle.
The researchers concluded that women with abdominal obesity had both a higher prevalence and greater severity of a range of symptoms, as well as a distinct symptom network structure.
In particular, women with abdominal obesity reported a higher prevalence and greater severity of dizziness, hot flashes and night sweats than women without abdominal obesity.
Sleep disturbances and palpitations were also reported more often in women with abdominal obesity. Palpitations are feelings of a fast, fluttering or pounding heartbeat.
The researchers said assessment of abdominal obesity using waist-to-height ratios may help stratify women who are likely to benefit from targeted, network-based interventions rather than isolated symptom management.
Christmas said: “Educating women early about healthy lifestyle interventions to prevent midlife weight gain is key to improving mental and physical well-being during a tumultuous time frame.”
Perimenopause may offer a key window to spot heart disease risk earlier, with women in the transition twice as likely to have low heart health scores, new research suggests.
The findings suggest the transition to menopause could be an important time to reassess risk and prompt lifestyle changes.
Garima Arora is senior author of the study and professor of medicine in the division of cardiovascular disease at the University of Alabama at Birmingham.
Arora said: “Mid-life women should think of the perimenopausal period as a ‘window of opportunity.’
They should be proactive and not wait until they reach menopause to start checking their blood pressure, cholesterol and blood sugar levels.
“Women should talk with their health care team about their reproductive status and any changes they are experiencing. It may be the perfect time to get a baseline for their heart health.”
The analysis included 9,248 women aged 18 to 80 who took part in the National Health and Nutrition Examination Survey between 2007 and 2020.
Researchers used Life’s Essential 8, a heart health score developed by the American Heart Association. It measures diet, physical activity, tobacco use, sleep, blood pressure, cholesterol, body weight and blood sugar on a 100-point scale.
Median scores fell as women moved through reproductive stages, from 73.3 out of 100 in premenopausal women to 69.1 in perimenopausal women and 63.9 in postmenopausal women.
Among the individual Life’s Essential 8 measures, diet consistently had the lowest scores and continued to decline across all reproductive stages.
After accounting for age, perimenopausal women were twice as likely to have a low overall score as premenopausal women.
They were also 76 per cent more likely to have a low cholesterol score and 83 per cent more likely to have a low blood sugar score.
The researchers said fluctuations in oestrogen levels during perimenopause may contribute to lower cardiovascular health because they may affect cholesterol, insulin resistance, blood pressure and weight management.
Insulin resistance means the body does not respond properly to insulin, the hormone that helps control blood sugar.
Sleep duration scores remained high across all reproductive stages, despite perimenopausal women reporting difficulty sleeping, suggesting sleep quality may be more affected than sleep length.
Amrita Nayak, lead author of the study and research fellow in the division of cardiovascular disease at the University of Alabama at Birmingham, said the findings highlight a point where risk may begin to rise.
She said: “Our analysis highlights that perimenopause, women’s reproductive transition period to menopause, is the critical time when the increase in cardiovascular risk seems magnified.
“When we compared women’s LE8 scores to the premenopausal baseline, the perimenopausal group was the first to show a significant jump in the odds of having low heart health.”
Arora added that nutrition could be an important area for early intervention.
“Nutrition can be a central factor for early and proactive intervention.
“Focusing on heart-healthy habits early, especially getting regular exercise and following a healthy eating plan like the DASH diet with a focus on lowering salt can help improve cardiovascular health for perimenopausal women in the years to come.”
Stacey E. Rosen, volunteer president of the American Heart Association, who was not involved in the study, said the findings underline the need to consider women-specific risk factors across life stages.
“This research highlights yet another aspect of the unique factors that increase a woman’s risk of cardiovascular disease throughout the stages of her lifespan.
“Significant health changes during pregnancy, perimenopause and menopause make it particularly important to pay close attention to increases in health risk factors during those times.
“I encourage women to talk with their primary care and specialty health care teams to learn about early detection and modification of traditional and ‘female-specific’ risk factors.
“Women can take proven steps to improve their cardiovascular health at all ages.”
The researchers said the next step is to follow women over several years to track hormone levels and heart health, which may help clarify the long-term impact of perimenopause and how lifestyle changes could reduce risk.
Osteoporosis may raise the risk of death in postmenopausal women by up to 47 per cent, a new study suggests.
The findings point to an inverse relationship between femoral bone mineral density and mortality risk, especially within certain ranges.
Femoral bone mineral density is the amount of mineral in the thigh bone, which is often measured to assess bone strength and osteoporosis risk.
Dr Monica Christmas is associate medical director for The Menopause Society.
She said: “Osteoporosis often remains a silent threat after menopause, despite its profound effect on women’s lives—from loss of height, poor balance, and reduced mobility to disfigurement, pain, and even premature death.
“Early screening and preventive measures, including a calcium-rich diet (preferably from food sources), regular weight-bearing exercise, and hormone therapy when appropriate, can significantly improve bone health and reduce risks not only of fractures but also cardiovascular disease, certain cancers, and dementia.
“It’s time we bring this conversation to the forefront.”
In the study involving nearly 3,000 postmenopausal women, bone mineral density at four femoral sites was assessed using dual-energy x-ray absorptiometry, a scan commonly used to measure bone strength and fracture risk.
The analysis found that mortality risk was significantly higher when femoral bone mineral density reached the osteoporotic threshold or when osteoporotic fractures were present.
After full adjustment, osteoporosis was associated with a 47 per cent increased risk of mortality.
A stronger inverse association between increased bone mineral density and mortality risk was seen within specific ranges, suggesting bone mineral density could serve as a prognostic marker of wider health.
The relationship appeared especially notable within the range of 0.46 to 0.71 g/cm² for total femur bone mineral density.
Previous research has shown that postmenopausal women face a significantly higher risk of death within one year of hip or vertebral fractures.
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