At Congress’ first-ever hearing devoted to menopause, Jennifer Weiss-Wolf urged lawmakers to invest in modern research, improve medical education and ensure access to quality care and evidence-based treatment.Galina Espinoza, Dr. Jessica Shepherd and Jennifer Weiss-Wolf at the SHE Media Co-Lab “Whole Life Health” at SXSW 2025 on March 7, 2025, in Austin, Texas. (Izzy Nuzzo / SHE Media via Getty Images)

Editor’s note: This essay is adapted from the written testimony Jennifer Weiss-Wolf submitted to the U.S. Senate Special Committee on Aging for its Sept. 16 hearing, “Half the Country, Zero Hearings: Meeting the Moment to End the Menopause Care Gap in America.” It has been edited for length and style.

On Wednesday, Sept. 16, I testified before the U.S. Senate Special Committee on Aging at Congress’ first-ever hearing devoted to menopause.

I am an attorney, advocate and author whose primary professional focus is menstruation, menopause and the law—an unusual sphere of expertise, I know. These are universal experiences for every girl and woman that too often go neglected and are deeply deserving of public policy attention and intervention.

My work entails analyzing laws and regulatory systems to see where gaps and inequities may exist—ranging from tax codes and public benefits to scientific research and medical education—and then proposing policies to remedy them. My new book, When in Menopause: A User’s Manual and Citizen’s Guide, out next month, is intended to help everyday people likewise engage. So too does my role as a board member of Let’s Talk Menopause, a nonprofit that provides information, community and resources.

Over the past decade, policymakers at all levels of government, state and federal, and of all political affiliations, have begun to advance related reforms.

Nearly every member of the Senate Aging Committee hails from a state that has eliminated the “tampon tax”—including Florida, where Chair Rick Scott signed the repeal into law in 2017 while serving as governor.

The only two federal laws in our nation’s history that address menstrual product access and affordability, the First Step Act of 2018 and the CARES Act of 2020, were signed by President Trump during his first term.

Menopause policy is gaining momentum too: Since 2024, more than 60 bills to improve menopause care, education and access to treatment have been introduced in 28 states. The Food and Drug Administration recently removed an outdated, inaccurate labeling requirement on certain menopause hormone treatments. The agency is also holding public panels this week—one on female-dosed testosterone and another addressing the shortage of estradiol patches.

These developments provide an opportunity for Congress to meet the urgent need to fuel modern research, improve medical education, increase public information and ensure access to quality care and evidence-based treatment.

Perimenopause is the time leading up to menopause when key reproductive hormones, especially estrogen and progesterone, fluctuate and become increasingly erratic before ultimately declining. It typically begins in a woman’s mid-40s.

Menopause refers to 12 consecutive months without a period, ushering in the end of hormone production by the ovaries. The average age of menopause for women in the United States is 51; Black and Hispanic women generally reach menopause earlier, at an average age of 49.

… U.S. women spend more than one-third of their lives in perimenopause, menopause and post-menopause.

Associated symptoms can last anywhere from four to 10 years and may include hot flashes, night sweats, brain fog, insomnia and anxiety, as well as less commonly recognized indicators like frozen shoulder, joint pain and heart palpitations. These may start in perimenopause and can go on to have a long-term impact on bone, brain and heart health, as well as longevity.

Around 1 percent of all women experience premature menopause before age 40, and 5 percent go through early menopause before age 45. Medical or surgical menopause occurs when both ovaries are surgically removed or permanently damaged—often by cancer interventions like radiation and chemotherapy—and is marked by its sudden, immediate onset.

All told, menopause is a whole-body transition affecting women’s immediate and long-term physical, cognitive, mental and metabolic health. Too often, women navigate these changes without the support they need.

There are now a billion women around the globe who have reached or are already in menopause. In the United States, about 1.3 million women enter menopause each year—roughly 6,000 per day. With an average female life expectancy of 81, U.S. women spend more than one-third of their lives in perimenopause, menopause and post-menopause.

Black women in the United States experience more severe symptoms for a longer duration, yet are 26 percent less likely—and Hispanic women 32 percent less likely—to be prescribed hormone therapy.

An estimated 27 million U.S. women, or about 20 percent of the workforce, are in the menopause transition. Yet there are only around 4,000 certified menopause practitioners across the country, and menopause care deserts are common, especially in rural areas and across the South and Midwest.

How One Announcement Reshaped Menopause Care

Commissioned by the National Institutes of Health in 1991, the Women’s Health Initiative remains not only the largest and most expensive undertaking ever to investigate health outcomes for menopausal women, but also the largest randomized clinical trial in history to involve only women.

The WHI set out to study health outcomes for 160,000 postmenopausal women over the course of up to 15 years—in particular, whether the cardiovascular benefits of hormone therapy seen in observational studies applied to older women at substantial risk.

In July 2002, one arm of the study, using conjugated equine estrogen plus progestin, was shut down suddenly through a National Press Club announcement that tied the treatment to elevated risks of breast cancer, heart disease and stroke.

We now know the announcement was based on statistically insignificant findings and sweeping overgeneralizations. But the panic that ensued led a generation of doctors and patients to abandon any form of menopause hormone treatment. The proportion of eligible women prescribed hormone therapy declined from about 27 percent in 1999 to 2 percent in 2023.

In 2026, persistent gaps in menopause information, care and treatment remain directly or indirectly tied to the legacy of that announcement.

Menopause is woefully understudied and receives around 1 percent of federal research funding; less than 1 percent of published studies focus on menopause. NIH allocated just $56 million to menopause studies in fiscal year 2023, $59 million in 2024 and $78 million in 2025, against a total annual NIH budget of roughly $48 billion.

Medical training is similarly inadequate. Only 31.3 percent of U.S. residency programs offer a formal menopause curriculum. Nearly 80 percent of medical residents report they are “barely comfortable” discussing or treating menopause.

Most women enter perimenopause without knowing what it is, what to expect or that effective treatments exist. A quarter of women ages 50 to 65 say their doctor never informed them they were in perimenopause or menopause, despite the vast majority reporting symptoms. As a result, more than 80 percent of midlife women never seek medical care, and only about one in four receive any treatment.

Insurance creates another barrier. Only one in four women have full insurance coverage for menopause-related prescriptions, and nearly half have had a prescription denied. Prior authorization and formulary restrictions can also inhibit access to FDA-approved hormone therapy.

Neither Medicaid nor Medicare requires menopause coverage, even though adult women make up 37 percent of the overall Medicaid population and more than half of all Medicare beneficiaries.

This neglect is costly. Untreated menopause symptoms increase long-term health risks—including osteoporosis, cardiovascular disease, diabetes and cognitive decline—driving avoidable costs for women, employers, Medicare, Medicaid and taxpayers. Menopause symptoms cost the U.S. economy $1.8 billion annually in lost work time and $26.6 billion when healthcare costs are included.

What the Statistics Look Like in Women’s Lives

Menopause is an individual and collective health story. But it also is a marriage and family story. A career and economic story. An aging and longevity story. And most certainly a public policy story.

As much as statistics matter, so do real women’s stories.

One woman whose experience I recount in my book—using a pseudonym—is Beth, 58. Her internist misdiagnosed vaginal dryness and pain until she found herself rushed to the emergency room with an excruciating urinary tract infection that kept her home for three weeks. A menopause specialist cleared it up immediately with a vaginal estrogen prescription.

Another is Kira, 46, who had zero interest in sex with her longtime partner and barely slept a wink for months. When she asked at her annual checkup whether the symptoms could be connected to perimenopause, she was dismissed as “clearly watching too many TikTok videos” and advised to “just relax and have a glass of wine.”

Dr. Rachel Rubin, a board-certified urologist and menopause expert at Georgetown University Hospital, shared an especially harrowing story at the FDA’s July 2025 public panel on menopause hormone-treatment warning labels. When her comatose, immunocompromised elderly mother was in immediate danger of developing urosepsis, the emergency medical team denied Rubin’s request for vaginal estrogen, incorrectly claiming it would cause her mother to form blood clots. After Rubin eventually secured a prescription, the hospital pharmacist refused to dispense it, citing the mere existence of its warning label—which the FDA has now removed.

If this is how hard an expert had to fight to get an urgent prescription filled, with life-and-death consequences, that speaks volumes about what is at stake for everyday people.

I have my own workplace experiences too. Hindsight on my working-through-menopause chapter is more telling than I necessarily appreciated at the time. I’ve since thought back to when my periods were so unbearably heavy that I had to max out on maxi pads—doubled-up overnight pads didn’t even do the trick—and still could not sit at my desk for more than 30 minutes without having to dash out to change. The embarrassment of bleeding through my clothes and onto my chair; both happened more than once. The times I lost my temper, lost my train of thought, lost painstaking documents that I literally forgot to click save on.

It never occurred to me that not only was this within the range of normal, but that it would have been infinitely more manageable if openness and information were the baseline. Not just a lifesaver for me, mind you, but an asset for my colleagues and all who relied on me.

Menopause is an individual and collective health story. But it also is a marriage and family story. A career and economic story. An aging and longevity story. And most certainly a public policy story.

There is no singular reform that will respond to every scenario or address every challenge facing every woman in midlife. But a collection of proposals already on the table in Congress, under consideration at federal agencies and advancing in statehouses offer a meaningful start.

Policy Priorities1. Invest in a Modern Research Agenda

In the words of neuroscientist Dr. Lisa Mosconi, “Menopause remains one of the most under-diagnosed, under-researched, under-treated, and under-funded fields in medicine. We owe women centuries of research.”

Certainly decades.

Among the fallout from the 2002 WHI press conference, the announcement chilled public discourse about hormone-therapy use—and, worse, killed commitments to future research on midlife women’s health.

Dr. Philip Sarrel of Yale School of Medicine has estimated that in the decade after the WHI was halted, the decrease in hormone-therapy use led between 18,000 and 90,000 women to lose their lives prematurely.

Even at the time of the WHI release, the data showed the potential for avoiding osteoporosis and bone fractures. Today, nearly one in five women age 50 and older has osteoporosis, half of whom will break a bone because of osteoporosis in her lifetime. The annual cost of osteoporotic fractures among U.S. women age 65 and older, including indirect costs, was estimated at $57 billion in 2018 and is projected to exceed $95 billion by 2040.

Women in the United States account for two-thirds of all Alzheimer’s cases, a phenomenon not simply explained by their longer lifespans. Yet only 12 percent of NIH funding for Alzheimer’s and related dementia research focuses on women. Might estrogen support cognitive function in perimenopausal women? Many experts surmise it could, as have recent observational studies, but it is impossible to know because there has never been a randomized trial among that age group.

The nation’s scientific research engines have an affirmative obligation to reset the record and reboot the research.

The WHI itself has issued a slow trickle of piecemeal updates and more affirmative clarifying statements, though many are in academic articles behind paywalls and receive little attention. What would be better? A full-court press conference and long-term public education plan—something as headline-grabbing and declarative as the National Press Club event in 2002.

It is also high time for a redesigned, comprehensive women’s health initiative: a next generation of federally funded research and government commitments that leverage modern data collection and new ideas.

We must determine whether menopausal hormone therapy offers preventive, preemptive or proactive benefits for chronic brain, bone and heart health—and whether there is a window in which treatment might maximize those benefits. We need to know whether newer formulations or delivery methods could lessen certain risks, including for women with a history of breast cancer. We must study racial disparities in the timing and severity of menopause symptoms and use that information to provide better, unbiased and more thoughtfully calibrated care.

Because time is of the essence—we have already lost more than 20 years—we must also find ways to combine and leverage observational data from previously underfunded, smaller-scale studies to produce real-time recommendations that do not take decades to enact.

Congress already has proposals before it. The Advancing Menopause Care and Midlife Women’s Health Act would authorize $275 million over five years to expand federal research, provider training and public health education. The Servicewomen and Veterans Menopause Research Act would direct the Departments of Defense and Veterans Affairs to address research gaps affecting servicewomen and veterans. The Hormone Health Data and Research Act would direct NIH and the Department of Health and Human Services to study hormone variability and testing in perimenopausal women and report its findings to Congress.

2. Improve Medical Education

There is overwhelming consensus that the medical establishment does not adequately educate the profession about menopause. For those who started residency after 2002—statistically, more than half of all practicing OB-GYNs in the United States today—the majority have not had meaningful or even any menopause training.

Dr. Mary Jane Minkin of Yale School of Medicine sums up the collateral damage of the WHI on medical education: “You have to teach a resident how to deliver a baby. You have to teach a resident how to do a hysterectomy. They figured if nobody was going to be prescribing estrogen, maybe they didn’t have to teach residents about menopause, so menopause education went by the by. It was basically cut from curricula almost totally.”

The numbers bear that out. A decade after the 2002 press conference, researchers found that only one in five U.S. medical-school OB-GYN residency programs had a formal menopause curriculum. Nearly two-thirds of residents reported not feeling knowledgeable about the connection between menopause and cardiovascular disease; less than half felt well versed in osteoporosis treatment and prevention.

Those findings were nearly identical by 2019. More than 20 percent of surveyed residents had never received a single formal lecture about menopause in medical school; 58 percent had received only one; and just 6.8 percent said they felt adequately prepared to treat menopausal patients.

All specialties—not only OB-GYNs and internists, but cardiologists, endocrinologists, neurologists, oncologists, orthopedists and urologists, among others—need to understand that hormonal changes affect every major organ system. Otherwise, symptoms are missed, misattributed or treated in isolation. On average, women spend seven years seeking a diagnosis.

Congress has levers available. Graduate medical education is primarily supported by Medicare, as well as the Departments of Defense and Veterans Affairs. Federal funding and accreditation standards could be linked to menopause-education requirements. The proposed Menopause Education for Medical Students Act would require public medical schools receiving federal grants to include menopause training in their curricula.

States are already acting. California, Maryland and New Jersey have passed laws encouraging or incentivizing state medical boards to include menopause coursework in continuing professional education requirements. These efforts should become a national baseline.

3. Ensure Affordable, Accessible Care and Treatment

A 2025 study found that only 26 percent of women have health insurance that covers FDA-approved menopause treatments, and one in five delayed or passed up treatment because of financial concerns. Menopause-medication prices have risen as much as 58 percent over the past decade. A monthly supply of systemic hormone therapy can now run roughly $100 to $250, while nonhormonal treatments for hot flashes can cost up to $700 per month and may not be covered by insurance.

Even getting menopause prescriptions filled can be frustrating and expensive. Treatments are still routinely denied because of doctors’ lack of training, and costs mount for patients who must seek a second, third or fourth clinician—or even go to an emergency room—to correct a misdiagnosis.

Neither Medicaid nor Medicare mandates menopause coverage, to the detriment of both patient care and public cost. Urosepsis in women over 65 is a major driver of Medicare spending. A recent study of more than one million Medicare patients found that less than one in 10 women with recurring urinary tract infections were prescribed vaginal estrogen; researchers estimate that doing so could save lives and save Medicare billions of dollars each year.

Congress can urge the U.S. Preventive Services Task Force to classify menopause appointments as a preventive service, automatically triggering zero-cost-sharing coverage across most private plans and Medicaid. It can direct the Centers for Medicare and Medicaid Services to evaluate and adjust reimbursement models to reflect the time and complexity of menopause care, establish minimum coverage standards for FDA-approved treatments and eliminate restrictions that reflect outdated assumptions about hormone therapy.

Fifteen years ago, Rep. Barbara Lee of California introduced the Menopausal Hormone Replacement Therapies and Alternative Treatments and Fairness Act of 2011, which would have mandated coverage under Medicare and Medicaid, other federal health-insurance programs, private group health plans and individual insurance. The bill never received real-time attention. Its resurrection is now timely.

State legislatures have taken the lead in advancing policies appropriate to their jurisdictions—improving medical education, mandating insurance and Medicaid coverage, expanding workplace antidiscrimination protections to include menopause and declaring statewide Menopause Awareness Days.

More than half of all states have introduced at least one piece of menopause-related legislation. Twenty-one laws have now been enacted across 10 states. Members of Congress can follow the progress in their states, examine which approaches are working and consider how to scale them nationwide.

A Better Future

Over the decade I have spent advocating around these issues, I have experienced a real-time transformation of my own—and I do not mean just making it to the other side of menopause.

I began with what I presumed was a simple inquiry: What would it take to make menopause a public policy priority? I suspected stigma was the main barrier to progress and that the reforms that followed might look like a version of the menstruation policies I helped envision and advance a decade earlier.

Little did I know.

I quickly came to understand that the forces marginalizing menopause go well beyond shame and silence and fully implicate science and policy.

I found a cadre of brilliant experts making extraordinary contributions—in medicine, research, organizing, storytelling, innovation, media and public and political leadership—who are driving forward a collaborative, effective and now fully bipartisan movement.

I saw that the desire to talk about menopause was suddenly everywhere: in living rooms, on Instagram, in news headlines, on bestseller lists, in celebrity conversations and on Capitol Hill. All of it can play a role in moving the needle.

I met so many people eager not only to solve their own health issues, but hungry to learn how to mobilize for systemic change so they could fight for their daughters and granddaughters.

Testifying at Congress’ first hearing on menopause was part of my own contribution to expanding what is possible at this moment—and helping advocate for a better future.

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