Often Overlooked, Menopause Care Is a Critical Piece of Preventive Medicine

Women spend most of their lives in non-reproductive years. Despite this, many struggle to find accurate, evidence-based care for menopause. For decades, menopause has been surrounded by confusion and misinformation.  

Commonly viewed as something that just needs to be “put up with,” women still hear that their symptoms—many of which are disruptive to daily life and functioning—are an inevitable part of aging. Though methods to address symptoms have the power to dramatically improve quality of life, many patients never receive menopause care because their symptoms are minimized, misattributed, or dismissed.  

But according to Padmasini Kandadai, MD, MPH, director of Urogynecology at Boston Medical Center (BMC) and a Menopause Society Certified Practitioner with over 20 years of experience, the future of menopause care is gradually shifting.  

“Menopause care is really very joyful work to do because it legitimizes patients, how they’re feeling,” says Kandadai. “You get to say, ‘You don’t have to have suffering with these symptoms.’” 

Awareness about menopause symptoms and treatment options are growing. New generations of clinicians are demanding better, more comprehensive training, and patients are increasingly calling for evidence-based and compassionate care. 

What is menopause?  

Menopause is the cessation of ovarian function—formally diagnosed when the menstrual cycle has ceased for 12 consecutive months. Commonly, this occurs for women aged 45 to 55. Starting five to 10 years earlier, perimenopause, an often rollercoaster-like period, represents the phase when the ovaries begin to decrease estrogen production and the body moves towards menopause. However, this doesn’t typically progress in a linear fashion. Women may experience hormone levels wildly fluctuating for several years during perimenopause, causing widespread and varied symptoms. 

Perimenopause symptoms include everything from changes to the menstrual cycle to brain fog, anxiety, hot flashes, sleep dysfunction, and night sweats. Gradual decreases in bone density and worsening of cardiometabolic health also accompany perimenopause and menopause. Adding further complexity, many social and economic milestones also collide for women during this phase of life—raising children, caring for aging parents and family members, advancing careers and retirement planning—making it even more challenging for providers and patients to definitively say “that’s caused by perimenopause.” 

According to the AARP, only 54% of women correctly define menopause. And while an estimated 85% of perimenopausal and menopausal women say that this constellation of symptoms impact their quality of life, only 60% seek clinical help and 75% subsequently go untreated.  

Dispelling common menopause misconceptions

A big piece of this puzzle is a 2002 NIH study, the Women’s Health Initiative, which changed the national discourse around hormone-based menopause therapies and seeded the common belief that these therapies could increase the risk for negative outcomes, including heart attacks and breast cancer. This discourse turned many, providers and patients alike, away from hormone-based options for menopause symptom relief, even though prior to 2002 nearly 80% of women were using hormone therapy regularly. 

Yet most conversation around the Women’s Health Initiative, failed to note that the average study participant was 63 years old—much older than the average perimenopausal patient who would be seeking symptom relief. Findings from this older population were not generalizable to the younger participant population, where risks for heart attacks decreased and for those taking only estrogen, breast cancer were shown to decrease. What didn’t make the headlines were decreased fracture and colorectal cancer risks.  

The result? A generation of patients abruptly stopped seeking out hormone-based menopause therapies, and a generation of providers stopped prescribing them, leaving patients with significantly reduced symptom treatment options.  

Kandadai says that she received two hours of menopause training in her four years of residency—and her experience aligns with national data. According to AARP, 80% of graduating internal medicine residents did not feel competent to discuss or treat menopause. Only 20% of OBGYN residencies offer menopause training, and half of all U.S. OBGYN residencies thought they needed more education on menopause medicine. 

Holistic menopause care across specialties

Today, the goal of menopause care is symptom relief and enhancing quality of life for patients. At BMC, this takes shape through a more holistic approach to care.   

For many patients experiencing menopause-related symptoms, a certified menopause practitioner is an integral part of their overall care team. Going beyond direct in-office care, menopause practitioners also serve as advocates and partners, empowering colleagues across different specialties with education on the effects of menopause and how symptoms might present. 

“When we treat menopause, we treat related problems,” Dr. Kandadai says. “It’s all interrelated. You can’t just silo every single thing.” 

In many ways, menopause treatment acts as preventative care for other health issues that could arise commonly in this age group, 45 to 55—ranging from cardiovascular disease, orthopedic issues and falling, urinary tract infections, sleep dysfunction, and cognition problems.  

For example, Dr. Kandadai explains, musculoskeletal pain is a common symptom for patients aged 45 to 55. When women experience this pain, like joint pain, they are commonly referred to seek orthopedic care. But bone density is intwined in perimenopause, and menopausal women begin losing about 1% of their bone density each year starting around age 30, with that decline accelerating sharply in the first five years after menopause. With knowledge of menopause symptoms and effects, an orthopedic provider can partner with a menopause practitioner to address the root cause—loss of bone density—through interventions, including hormone-based menopause therapy or even a new strength training regime. By having menopause training and understanding, clinicians beyond OBGYN can identify menopause‑related bone changes early and intervene with treatments or lifestyle strategies that help prevent fractures and support long‑term skeletal health.  

Similarly, many patients going through perimenopause experience recurrent urinary tract infections (UTIs). According to Dr. Kandadai, this happens because women in this stage don’t have estrogen in their vagina protecting their urethra from the bacteria that cause UTIs. Recurrent UTIs can be more than just a nuisance, and some can even lead to sepsis and require hospitalization. Although the standard treatment for patients with recurrent UTIs includes the use of vaginal estrogen for prevention, most providers are not aware of this, and are not aware of the safety of vaginal hormone therapy, mistakenly attributing cardiovascular and breast cancer risk to it. A recent study found that widespread use of vaginal estrogen for perimenopausal women could significantly reduce UTIs, benefiting not only patients but also the broader healthcare system—with researchers estimating that a reduction in UTIs amongst perimenopausal women could save Medicare billions of dollars annually.  

In psychiatry, patients may come in to talk about anxiety, and if no one talks to them about how menopause may be exacerbating their anxiety, they miss an opportunity to help them feel better, Dr. Kandadai says. For example, she says, if the patient’s anxiety is rooted in libido changes, common in perimenopause, but if treated with SSRIs, libido and their anxiety may worsen. 

“All of these things are interconnected, and the little things that we all can do to improve health, to improve the symptoms as a woman’s body is transitioning through this period, is important.” 

 Padmasini Kandadai, MD, MPH, director of Urogynecology at Boston Medical Center

“We don’t use hormone therapy to treat major depressive disorder,” she explains, “but psychiatrists could consider the role of hormone therapy in these cases.”  

As menopause medicine gains long‑overdue attention, women’s health providers are helping redefine what supportive, evidence‑based treatment looks like. By validating symptoms and collaborating across specialties, clinicians can offer patients meaningful relief and a clearer path forward. And to take full advantage of the improvements for overall health and wellbeing, including preventative medicine, Dr. Kandadai is an advocate for all providers treating women in these age field to incorporate menopause care. 

“There’s a lot of advocacy happening to really make sure that every specialty knows about the effects of menopause in their field,” she says. “All of these things are interconnected, and the little things that we all can do to improve health, to improve the symptoms as a woman’s body is transitioning through this period, is important.”