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Understanding Menopause and the Lack of Medical Training (and How It Affects You!)

Understanding Menopause and the Lack of Medical Training

“Most primary care residency programs in the United States don’t provide adequate education in women’s health in general or in menopause management in particular” Dr. Manson and Dr. Kaunitz write.

Originally Posted April 2016
Updated July 2019

Currently nearly 47 million women are peri- or post-menopausal and by 2020 more than 50 million will be 51 years old – the average age of menopause. What that means is a significant percentage of the female population is suffering from menopausal symptoms. The problem is, women often suffer in silence because they are told it’s simply a part of growing older; or it’s something every woman will eventually be faced with; that however, doesn’t have to be the case.

Learn more about perimenopause and menopause here.

Symptoms can include hot flashes, night sweats, anxiety, fatigue, interrupted sleep, mood swings, osteoporosis, among others and one in four women will experience debilitating symptoms that can last up to 15 years. Perimenopause is the time-period of ten to twenty years before menopause, which are often do to a drop in progesterone, while menopause is due to a drop in estrogen.

Learn more about the symptoms of perimenopause and menopause here.

Poor Medical Training for Care of Menopausal and Perimenopausal Women

Unfortunately, medical schools are not providing proper training in perimenopausal and menopausal management to medical graduates, gynecologists, family care physicians and endocrinologists; and their lack of training and awareness results in inadequate care, needless anxiety for patients and a feeling of helplessness in their doctor and suffering for so many women in this country, as well as increase risk of heart disease, depression, fatigue, breast cancer, weight gain and mental decline to name a few.

Menopause/perimenopause can occur when a woman is in her 20s, 30s, 40s or 50s with the average being age 51. Menopause is defined as a loss of menstrual period for one year, but perimenopause, which can occur decades before is defined as a time when there is a significant drop in the production of progesterone, and the balance of hormones becomes disrupted. Symptoms of perimenopause/menopause are directly connected with the shift in hormones and can dramatically decrease the quality of a woman’s life. According to JoAnn E. Manson, MD, DrPH, from Brigham and Women’s Hospital at Harvard Medical School in Boston, and Andrew M. Kaunitz, MD, from the University of Florida College of Medicine in Jacksonville, many women are unevaluated and untreated though hormonal and non-hormonal treatments exist. “Reluctance to treat symptoms has derailed and fragmented the clinical care of midlife women, creating a large and unnecessary burden of suffering.”

Understanding Proper Treatment of Menopause and Perimenopause

A clinical trial performed by the Women’s Health Initiative (WHI) demonstrated that the risks of synthetic hormone replacement therapy (HRT) far outweighed the benefits. The risks of giving these synthetic hormones included breast cancer, heart attack, blood clots, and stroke. Since the publication of the study in 2002, synthetic HRT use has declined by 80%. The study was focused on the combination use of Provera and Premarin, which is progestin, a synthetic form of progesterone and horse estrogen, which is not natural to humans. The trial results have caused a large percentage of women suffering from moderate to severe symptoms of menopause to steer clear of HRT treatment.

An alternative to HRT is bioidentical hormone replacement therapy (BHRT). Bioidenticals are natural hormones that are identical to the hormones produced within the body. They are natural estrogen and progesterone that are identical on a molecular level to a woman’s natural hormones. BHRT has shown to reduce the risk of breast cancer, osteoporosis, Alzheimer’s disease, osteoarthritis, and colon cancer. In fact, BHRT has shown to provide greater protection against breast cancer when compared to women who are not on any HRT. Said a different way, women who don’t use any hormone replacement tend to have a higher risk for breast cancer than those who use bioidentical hormone replacement.

Learn more about the difference between HRT and BHRT here.

Paula Amato, MD, an associate professor of obstetrics and gynecology at Oregon Health & Science University in Portland told Medscape Medical News, that no findings from WHI should preclude short-term use of hormone therapy for menopausal symptoms, especially closer to the time of transition. Also, long-term BHRT is associated with significant benefits and very little risk if administered by a knowledgeable doctor.

Learn more about the safety and efficacy of BHRT in this interview with Dr. Holtorf.

Providing Quality Care for Women

The bottom line is that menopausal management should not be ignored or overlooked by medical professionals. It can pose a tremendous threat to the quality of a woman’s life. “I think menopause is often given short shrift because it is not a procedure-heavy discipline, but instead requires lots of time, counseling, and reimbursement is much lower.” (Amato). The reality is America is aging and although medical physicians regard the care of menopause important they are limited as to the type of care or treatment, if any, that they are capable of providing.

At Holtorf Medical Group, our physicians are trained to properly diagnose and treat perimenopause and menopause using BHRT and other innovative therapies. If you are experiencing symptoms of perimenopause/menopause, but aren’t getting the treatment you need, call us at 877-508-1177 to see how we can help you!


1. Kent Holtorf, MD. “The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy?”
2. Kent Holtorf, MD. “Hormone Study Confusion.”
3. Kent Holtorf, MD. “Natural (Bio-identical) vs. Synthetic HRT.”
3. Kent Holtorf, MD. “Breast Cancer and BHRT.”

Understanding Menopause and the Lack of Medical Training (and How It Affects You!) was last modified: July 18th, 2019 by Holtorf Medical Group

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