Community members push to advance menopause education

Andrea Giancontieri saw nine different providers across multiple specialties before she finally found one to provide evidence-based treatment for her menopause symptoms. Later, when preparing for a total knee replacement, she was instructed to discontinue this very treatment. It took consultations with three certified menopause practitioners and one hematologist to convince her orthopedic surgeon that this was not the right course of action. 

After being repeatedly dismissed and labeled as difficult, Giancontieri repurposed the moniker and founded The Whiny GYNie, a business dedicated to reducing stigma about gynecological issues and menopause. 

“Menopause care in Massachusetts is still too dependent on luck, who you happen to see, who happens to be trained, and whether you have the time, energy and privilege to fight for yourself,” Giancontieri said. “When you're not sleeping and have brain fog, fighting is the last thing you should have to do.” 

Giancontieri was one of 18 people to testify at the Legislature’s Public Health Committee hearing on Tuesday in support of a bill to expand access to perimenopause — the phase leading up to menopause — and menopause care. No one spoke opposing the bill. 

The bill, presented by House Chair Rep. Marjorie Decker, D-Cambridge, aims to establish a 19-member commission on perimenopause and menopause care. Its tasks would include, but not be limited to, assessing available treatment options and identifying gaps in services and medical education. 

If the bill is passed, the commission will submit its findings by Dec. 31, 2027. From there, the Department of Public Health is responsible for distributing the information to the general public and health care workers. 

The commission will also be charged with evaluating racial and ethnic disparities in care. According to Ndidiamaka Amutah-Onukagha, the founder and director of the Tufts University Center for Black Maternal Health and Reproductive Justice, women of color often receive delayed diagnoses and have limited access to evidence-based treatment, patterns that “reflect broader social and structural inequities in our health care delivery systems.” 

Perimenopause and menopause are associated with several comorbidities, including heart, brain, joint and metabolic diseases, according to gynecologist and community health care worker Liza Swodarksi, who testified at the hearing. 

Despite this, physicians lack adequate education and training. While conducting its research, the committee found that medical schools provide only one to five hours of education on perimenopause and menopause, Decker said. Deborah Kwolek, a primary care physician at Harvard Medical School and a menopause consultant at Brigham and Women’s Hospital, told the committee that Harvard Medical School’s curriculum does not cover the topic, while residents at Massachusetts General Hospital receive only one hour of menopause training. 

“I would make a plea that in the same way that end-of-life care and opioid education are essential components of [continuing medical education] … menopause and midlife care would also be required. And that it would have some substance to it, not just one hour,” Kwolek said. “It’s very insufficient, and our women aren’t going to have any access to the care they need as long as the providers aren’t educated.” 

If enacted, the proposed bill would require physicians who treat the relevant population to complete a course about the diagnosis, treatment and care of patients experiencing perimenopause and menopause. 

Several other people spoke about the impact of menopause beyond its effects on women’s bodies. 

Paula Brown, founder of the menopause support group Konnnki Menopause Solutions, said her life and career were “disrupted for years by a healthcare system that did not recognize what was happening to [her] body.” For six years, her perimenopausal symptoms were misdiagnosed as ADHD. Her exhaustion, brain fog and anxiety prevented her from functioning at work, resulting in lost jobs and lost income. 

“Many women are in their peak working and leadership years,” Brown said. “When they cannot access informed care or reasonable workplace support, the consequences ripple outwards to families, employers and the broader community.” 

The Society for Women’s Health Research found that two in five people have considered leaving their jobs, or have done so, due to their menopause experience. According to a Mayo Clinic study, U.S. businesses lose approximately $1.8 billion in work time per year because of menopause and perimenopause. That number rises to $26.6 billion annually when related medical expenses are included. 

The proposed bill attempts to address this issue by prohibiting discrimination against individuals experiencing perimenopause, menopause or a related medical condition. The legislation would also require employers to make reasonable accommodations. 

“Massachusetts has the ecosystem, talent and infrastructure to transform these gaps into scalable solutions, positioning the Commonwealth as a national leader in menopause, focused innovation that delivers better health outcomes and economic growth,” constituent Abbe Berman told the committee. 

The committee referred to the hearing as a “starting point” and did not vote on how to report the bill.