Historically, medical practices surrounding women’s health in the United States have evolved significantly. In the early 20th century, childbirth in America frequently involved practices such as “twilight sleep,” a drug-induced unconscious state for delivery. During this period, women were sometimes physically restrained and often lacked advocates in the delivery room, with limited input into their birthing process. This approach often resulted in women having no memory of delivering their babies. This historical context serves as a reference point for contemporary discussions regarding systemic shortcomings in women’s healthcare.
Today, concerns are being raised about the adequacy of care for women experiencing menopause, drawing parallels to past medical oversights. Philanthropist and global advocate for women and girls, Melinda French Gates, has publicly highlighted what she describes as a systemic failure in the healthcare system’s approach to menopause care. Gates suggests that future generations may view current practices with similar disapproval to how historical practices like “twilight sleep” are regarded today, emphasizing the need for a comprehensive reevaluation of midlife women’s health services.
Women navigating menopause frequently report encountering a healthcare system that struggles to provide adequate diagnosis, treatment, or management plans for their symptoms. Reports indicate a common scenario where women present to their doctors with increasingly debilitating symptoms—including disrupted sleep, aching joints, heart palpitations, and cognitive difficulties such as memory slippage—only to leave without a clear diagnosis or effective treatment strategy. This experience is widespread, with nearly one in three U.S. women over 40 experiencing severe menopause symptoms that can significantly disrupt daily life.
The symptoms associated with menopause extend beyond discomfort, encompassing conditions such as waves of depression, severe insomnia, and an increased risk of long-term health issues. The underlying hormonal changes during menopause are known to elevate a woman’s risk of developing cardiovascular disease, osteoporosis, and certain types of cancer. Furthermore, untreated insomnia during this period can heighten the risk of cognitive decline and Type 2 diabetes. These symptoms often manifest when women are at pivotal stages of their careers, managing family responsibilities, and caring for aging parents, placing significant strain on individuals and their support networks.
The economic impact of inadequate menopause care is substantial. The Mayo Clinic estimates that menopause-related symptoms cost the United States an estimated $26 billion annually. This figure accounts for both direct medical expenses and productivity losses due to missed work or reduced capacity. Despite the prevalence and severity of these symptoms and their broader societal costs, only approximately one in four women in menopause in the United States currently receives treatment for her symptoms. This leaves a significant majority of women to manage debilitating conditions without medical intervention, leading to continued suffering and potential long-term health consequences, often compounded by a lack of recognition or understanding from the medical community.
In response to these systemic challenges, Melinda French Gates has announced a significant expansion of her philanthropic efforts in women’s health. This includes new funding specifically directed towards midlife and menopause care, bringing her total commitments in women’s health over the past two years to more than $600 million. Gates emphasized her ongoing commitment to reproductive and maternal health, noting that the new funding also allocates additional support for these critical areas. She advocates for a multifaceted approach to women’s health issues, recognizing the interconnectedness of various life stages.
Critiques of the current healthcare system’s approach to menopause care often point to fundamental flaws that have historically marginalized women’s health concerns. A striking statistic highlights this inadequacy: according to one survey, less than a third of American OB-GYN residency programs incorporate a menopause curriculum of any kind. This suggests a significant gap in foundational medical training for the very specialists entrusted with women’s bodies, leaving many unprepared to manage a universal biological event. The lack of comprehensive training contributes to a broader deficit in treatment options and medical knowledge for midlife women.
Beyond the training deficit, there are significant disparities in treatment uptake and research investment. The proportion of postmenopausal women in the United States utilizing hormone therapy, currently considered the most effective solution for managing many menopause symptoms, has dramatically declined to less than 5 percent. While it is understood that menopause has implications for bone density, cardiovascular health, and cognitive function, there remains a substantial gap in understanding how to effectively protect women from these associated risks. This knowledge gap underscores the urgent need for increased research and targeted interventions.
Advocates, including Melinda French Gates, are calling for a “menopause revolution” in the United States, proposing several key areas for reform. Improved medical training is identified as a primary starting point. This includes integrating comprehensive menopause care into both foundational and continuing education for healthcare practitioners. Medical schools and residency programs are urged to embed menopause care within their curriculums, with accreditation bodies and licensing boards making it a required component of training, not only for OB-GYNs but for all healthcare professionals who treat women in midlife.
Policy action, particularly at the state level, is also deemed crucial. Proponents suggest that lawmakers should be pressed to implement new educational requirements for medical professionals, expand insurance and Medicaid coverage for menopause treatments, and ensure workplace protections for women experiencing menopause. These protections, similar to those afforded during pregnancy, could include the ability to take time off to seek care, thereby allowing women to maintain their employment without compromising their health due to severe symptoms.
Public education campaigns are also seen as vital for initiating broader societal conversations about menopause and for addressing structural barriers that contribute to disparities in care access. Data indicates significant disparities, with postmenopausal white women in the United States being more than twice as likely as Black and Hispanic women to use hormone therapy treatment. Such campaigns could help bridge information gaps, challenge existing stigmas, and encourage more equitable access to care across diverse populations.
Finally, a critical need exists for additional research to deepen understanding of the full spectrum of hormonal and other physiological changes occurring with menopause and their long-term implications for women’s well-being. Increased investment in research is essential to accelerate new breakthroughs and develop more effective treatments. Currently, only five cents of every dollar spent globally on medical research and development is allocated to women’s health, a disparity that advocates argue reflects a systemic undervaluation of understanding women’s bodies and health needs.
Despite the existing challenges, there are emerging signs of progress. Healthcare practitioners have recently received updated guidance regarding hormone therapy, which may help clarify its safe and appropriate use, potentially reversing years of confusion and hesitancy among both providers and patients. Concurrently, an increasing number of companies are beginning to offer menopause benefits to their employees, acknowledging the impact of symptoms on workforce participation. Furthermore, several states are introducing legislation aimed at mandating workplace protections or expanding insurance coverage for menopause care. These developments are largely attributed to the growing number of women publicly sharing their experiences and advocating for improved care, initiating a movement that is anticipated to positively impact millions of lives and reshape healthcare approaches for midlife women.
Why This Matters
The current state of menopause care in the United States represents a significant public health issue with far-reaching consequences for individual women, the economy, and the broader healthcare system. For millions of women, untreated menopause symptoms can severely impact their quality of life, professional productivity, and long-term health, increasing risks for chronic conditions like cardiovascular disease, osteoporosis, and cognitive decline. The estimated $26 billion annual cost associated with menopause-related medical expenses and lost work time underscores its substantial economic burden, affecting national productivity and healthcare expenditures.
Systemic deficiencies, including inadequate medical training, limited treatment options, and stark disparities in care access based on race and ethnicity, highlight broader inequities within the healthcare system that disadvantage women. Addressing these issues through enhanced education for medical professionals, expanded insurance coverage, supportive workplace policies, and increased research funding is crucial not only for improving individual women’s health outcomes but also for fostering a more equitable and efficient healthcare system. The call for a “menopause revolution” signifies a growing recognition that comprehensive and empathetic care for women throughout all life stages is a fundamental component of societal well-being, economic stability, and gender equality in healthcare provision.
Melinda French Gates is a philanthropist, businesswoman and global advocate for women and girls. She founded and heads Pivotal, a group of organizations working to accelerate the pace of social progress for women and young people.
The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.
Follow the New York Times Opinion section on Facebook, Instagram, TikTok, Bluesky, WhatsApp and Threads.