Hearings to examine the menopause care gap in America.

Special Committee on Aging will now come to order. As Chairman, I am proud of this committee's long history of working together on a bipartisan basis to address topics that impact aging Americans. Today we continue this tradition with Ranking Member Gillibrand chairing their first ever congressional hearing focused on menopause. I now recognize Ranking Member Gillibrand for her opening statement.

Thank you, Mister Chairman, for giving me the opportunity, um, and uh the opportunity for all of us to have this hearing. I'm super excited. Uh, it's one of the most under-researched, under-treated, and under-discussed topics. We call it the menopause care gap. And thank you to the witnesses for sharing your experience and expertise today. We're very excited to hear from you. Seventy five million American women are in perimenopause, menopause, or postmenopause right now. Congress has never held a single hearing. on the gaps in in care that they face, and that changes today. Menopause affects half the population. For generations, women have been told to suffer in silence. I'm done with silence. Menopause affects half the population, and this is something that we have to address. The neglect of menopause research, education, and treatment is a healthcare failure, an economic failure, and a policy failure. While medical education continues to evolve, previous studies have shown eighty percent of OBGYN residents say they're unprepared to talk about menopause. Eighty percent of the doctors that are supposed to be the most knowledgeable, say they're unprepared to talk about menopause. Fewer than one third of residency programs teach it at all. Wow. That is a shocker. And three out of four women who seek care for symptoms leave untreated. That is unacceptable. We've made great advances in treating symptoms, but access remains a significant barrier. Whether it be misleading labels or insurance not covering it, or past shortages, it's clear women are not getting the care that they need. The cost is enormous for women and the economy. The Mayo Clinic puts the price of menopause in the United States at twenty-six point six billion dollars per year. One point eight billion of that is lost. As many as one in ten women leave the work, leave the workforce because of menopause. They walk out at the peak of their careers and take decades of knowledge and experience with them. It's a tragedy, and it's avoidable. And the federal government has never adequately funded the research that could fix it. We need a comprehensive strategy to prioritize midlife women's health in research, like the one in the bipartisan bill that Senators Murray and Murkowski lead. Research is the foundation. It drives clinical, it drives clinician training, better information and evidence-based treatment for patients. We also have to make sure women can actually get in the door. The average wait time to see an OB-GYN in this country is over a month. In rural communities it's longer. For women who have been experiencing debilitating pain, heavy bleeding and symptoms she can't explain, a month is far too long. We must strengthen this workforce facing critical shortages and make sure it's ready when patients arrive. To do that, we need to know where to start. So I'm proud to lead a bipartisan request to GAO alongside our Chairman, Chairman Scott, and members of this committee. It will tell us what the federal government actually does on menopause, how well our doctors are trained, and where the gaps are. You can't fix what you refuse to even measure. Women have carried this alone for generations. Not anymore. We must meet the moment, and I look forward to hearing from our witnesses today and discussing the critical issue.

Thank you, Ranking Member, and thank you um for your leadership on this issue. Women make up half of the American population and eight to ten million Americans experience menopausal sym symptoms each year. While menopause is a natural part of aging for women, every woman is impacted differently. And more often than not, they're not simply dealing with a minor they're facing symptoms that have real consequences on their quality of life. Not to mention, have to navigate finding a doctor, understanding their symptoms, developing a treatment plan, and managing changes to their health, all while balancing jobs, families, and everything else life throws at them. That's unacceptable. Women should not suffer in silence. Too often women still enter this stage of their lives without the information they need or clear understanding of what to expect. And then their focus, they're they're forced to figure out what a as they go through it. There's simply no excuse for the lack of resources and information to help every woman navigate menopause and the challenges that come with it. The hearing is not about a one size fits all solution. It's about ensuring that every woman in this country has access to good information, the right health care provider, and treatment options, so they can advocate for themselves and make the best decisions for their health. To empower women with information so they can be the best advocates for their health we must first identify the gaps. That's why I'm proud to work with ranking members of the brand on letter to the GAO, asking them to identify gaps in menopause research and care. We also need providers who have most up-to-date training, who are able to clearly discuss treatment options with their patients. Right now, women have several treatment options at their disposal to manage their symptoms including hormone replacement therapy. For years, however, questions and concerns concerns about the safety of hormone therapy and the FDA's black box warning on these products, left women and doctors unsure how to proceed. Thankfully, we now know that hormone replacement therapy is the safe option for many women. Still, access barriers like lack of information and limited availability can make it difficult for women to access these medications. I applaud the FDA for improving access to menopausal treatment by taking steps like removing the black box warning on hormone replacement therapy treatments and empowering women to make the best decision for themselves and their health. Following the FDA's removal of the black box warning last November, the data is already showing that women are using that treatments like hormone replacement therapy and estrogen patches more. Treatment is a huge piece of the piece of the puzzle, but the shortage of healthcare provider create creates barriers to access accessing it in the first place. There are simply not enough specialists to meet the growing demand. Approximately two main women enter menopause each year, and the number of residents and physicians is not keeping pace with the aging population. These shortages result in a lack of access and physician burnout. The doctors we do have are facing tremendous pressure. More than forty-five percent of OBGYNs have reported experiencing burnouts. Just earlier this year, this committee had a hearing where we heard firsthand about this happening. Congress should look at what we can do to eliminate unnecessary regulatory barriers and menstruating burdens that take doctors away from their patients and contribute to burnout. Every woman has a difficult journey, has a different journey, and difficult, with menopause and menopause can have wide range in effects, which is why it's so important that women have access to providers and treatment. Changes in hormone levels associated with menopause can affect bone, heart, and other aspects of women's health, and appropriate treatments can make a real difference in a woman's symptoms and quality of life. Hormone replacement therapy not only helps women manage their menopause symptoms, but it can also improve their quality of life post-menopause. America has incredible doctors, nurses, researchers, treatments. Our job should be to make sure women know what options are available, have good information, and get the care they need. Today's hearing is an important first step in how we talk about menopause and women's health in Congress. I'm proud to bring awareness Uh to it with the members of the committee, I wanna again thank uh my colleague, ranking member Gillibrand for leading on this issue. Um this affects so many Americans and I look forward to today's discussion. I think I'll turn it back to ranking member Gillibrand and she'll introduce our first three witnesses.

Thank you, Mister Chairman, um our next witness or our first witness is Doctor Gene Wachtel mmm Wachtel Wachtowski Wachtowski, Wendy, Wendy, Wachtowski, Wendy. Dr. Wachtowski-Wendy is the Dean of SUNY and SUNY Distinguished Professor at the School of Public Health and Health Professions at the University at Buffalo. There she leads the Women's Health Initiative Regional Northeast Regional Center and conducts research on factors influencing women's health. Previously, she served as the Chair of the WHI Steering Committee and has served as Principal Investigator on dozens of NIH funded research studies. She brings forty years of in women's health research to our discussion today. You may begin.

Thank you.

Excuse me. Chairman Scott, ranking member Gillibrand, and honorable members of the Senate Special Committee on Aging. Thank you for this opportunity to testify today on one of the most important and historically overlooked issues in American health. the health of women as they age, particularly during the menopause transition and the decades that follow. I'm Jeanne Wichtowski-Wendy, an epidemiologist whose research has focused on women's health for more than forty years. I serve as SUNY distinguished professor and dean of the school of public health and health professions at the university of Buffalo. Since nineteen ninety-three, I have been a funded investigator, in the Women's Health Initiative, one of the largest and most influential studies of women's health ever conducted. WHI enrolled more than a hundred sixty thousand postmenopausal women across the United States to study the effects of hormone therapy, diet, and calcium and vitamin D supplementation, and the major health outcomes in older women, including heart disease, cancer, stroke, osteoporosis, cognition, and mortality. Three decades later, nearly forty thousand participants remain actively engaged in this study. Their contributions have transformed our understanding of women's health, and have helped millions of women make more informed health decisions. Menopause, as you said, Senator Gilderbrand, is experienced by approximately half our population. And more than one million American women enter menopause each year. Today, about sixty four thousand, or sixty four million, um, women fifty or older are postmenopausal, and that number is expected to exceed eighty million by twenty fifty. These women represent one of the fasting, fastest growing segments of our population. Yet many of their health needs remain inadequately studied. and addressed. I will highlight four priorities that deserve national attention. First, we must increase investment in funded research on women's health across the lifespan. Women's health research, particularly in older women, has been underfunded. We need studies that further examine how hormonal changes across the lifespan influence healthy longevity. Women are not simply smaller versions of men. Biologic differences matter. And understanding those differences is essential for developing effective prevention, treatment, strategies. Second, we must address the growing burden of chronic disease in aging women. The greatest health challenges facing older women include cardiovascular disease, dementia, cancer, osteoporosis, and frailty. Women account for the majority of Alzheimer's disease cases in the United States, and heart disease remains the leading cause of death in women. Cancer survivorship is increasing, but many survivors face long-term effects of treatment that impact independence and quality of life. Healthy aging must focus not simply on extending life, but on preserving function and independence. Third, we must improve education and clinical care for women a- after menopause. Many women report difficulty obtaining accurate information and evidence-based care. Menopausal symptoms can significantly affect quality of life, yet many clinicians receive limited formal training in menopause management. Women deserve access to health professionals who are informed by the latest science and can provide individualize evidence-based health recommendations. Fourth, we must recognize the importance of healthy behaviors across the life course. Nutrition, physical activity, smoking avoidance, sleep health, mental well-being in women at younger ages influence their health decades later. Investments in prevention beginning early in life can reduce chronic disease and frailty at later ages. We know that events women experience in pregnancy can be associated with health c- health gout outcomes as they age. We've learned a lot about health and women's health from WHI. And WHI uh uh opened many new questions. In nineteen ninety-three, I helped to launch WHI when I was a new mom of a young daughter. Today I'm the grandmother of a ten month old granddaughter. Like millions of American families, I want the women in her generation to have access to the evidence, care, and opportunities needed to live long, healthy, and independent lives. Health of aging women is one of the greatest public health challenges and opportunities of our time. Thank you both for your leadership and commitment to advancing women's health. I welcome your questions.

Thank you. I now wanna introduce our next witness, Mrs. Miss Jennifer Weiss-Wolf. Miss Weiss-Wolf is, oh, I skipped one. I wanna introduce our next witness, which is Doctor Lynn Coslett Charlton. Um, she is a Board Certified Gynecologist and Legislative Committee Chairman for the Pennsylvania section of the American College of Obstetricians and Gynecologists where she leads regional legislative efforts while specializing in minimally invasive and robotic assisted surgical procedures. Previously she served as Administrative Chief Resident at Pennsylvania Hospital of the University of Pennsylvania and currently serves on the American College of Obstetricians and Gynecologist National Committee on Government Affairs. You may begin. Good afternoon. My name is Doctor Lynn Clauser-Tarlton. I'm a private practice gynecologist who has been serving my community in Northeastern Pennsylvania.

for the last twenty seven years. I'm a fellow of the American College of Obstetricians and Gynecologists, or ACOG, which has a membership of more than sixty thousand physicians and partners specializing in and dedicated to advancing women's health. Thank you to Senator Gillibrand, Senator Scott, and the Special Committee on Aging for holding the first hearing on menopause in your efforts to close the gap in menopause care and improve the quality of health, for midlife women. OB-GYNs like myself care for women throughout their entire life cycle, from adolescence through pregnancies, the perimenopausal and menopausal transition, and the postmenopausal years. Over the years, my patients have entrusted me through their surgeries, delivering their children, screenings for cancer, and contraceptive counseling. Like my colleagues, I cherish the relationships with these patients, and I have the privilege now of navigating menopause with many of them. Menopause is a normal expected stage of life marked by the permanent end of menstruation, typically occurring around age fifty. Women may spend, like we said, nearly half of their lives in the perimenopausal and postmenopausal years. The menopausal transition, or perimenopause, typically begins in mid forties and brings significant hormonal changes that can affect a woman's health and well-being. My patients experience a wide range of symptoms during this transition. including hot flashes, vaginal dryness and atrophy, difficulty sleeping, altered mood and metabolism, and other effects of hormonal change. For some women, these symptoms can be debilitating, interfering with daily routine, work, and overall quality of life. Yet, many women face substantial barriers to obtaining timely and effective menopause care for their symptoms. Underinvestment in women's health research, physician shortages, especially in rural areas, inadequate health insurance coverage can create significant barriers to care, which are even more burdensome for underserved and low-resource communities. Despite the challenges, there are some reasons to be optimistic. The FDA's removal of the box warning on estrogen therapies was a huge step in the right direction for improving access to care. For years, that box warning did not reflect the accumulating scientific evidence and discouraged patients and clinicians from using an effective treatment. I have seen this in my own practice. While this move was long overdue, especially for low-dose vaginal estrogen treatment with an overall, very high safety profile, it does have some nuances. Menopause care is not a one-size-fits-all, and for some patients, systemic hormone therapy may come with an increased risk, emphasizing the importance of access to an individualized, thoughtful approach to menopause management, based on each patient's unique risk factors. Moving forward from this seismic change, further research into effective treatment options will lead to better and more individualized care. By nature, scientific discovery is fluid, and so is medical training. When I trained, I was fortunate to receive um training in menopause care from excellent leaders in menopause science and left residency equipped with the tools to provide provide comprehensive care to midlife women. This was pre-WHI. More research leads to a better prepared physician workforce. In response to new evidence and discoveries, medical education, residency training, and continued education programs for practicing physicians evolve. Increased public awareness and efforts to de-stigmatize, menopause will lead to better outcomes. I'm encouraged by the positive improvements in public perception of menopause treatment. Celebrity voices in social media have helped to normalize menopause and have empowered women to recognize that their symptoms are common and treatable. Unfortunately, however, social media has also become a vehicle for misinformation. Menopause has become big business, and many women are training to influencers rather than train clinicians for advice. Much of my time is spent counseling patients about different supplements and unregulated products marketed online on different platforms. This is why ACOG and other organizations have invested in education to direct patients to safe, evidence-based, and medically appropriate care. Fortunately, there is a path forward. ACOG supports Senator Murray's advancing menopause care and midlife women's health act, to strengthen and expand federal research, health care workforce training, awareness and effective education, and public health promotion and prevention activities. Alongside advocacy and opportunities like this hearing, together we can make serious progress for my patients, and for all midlife women. Thank you for having me here today, and I look forward to your questions.

Thank you. I now like to introduce our next witness, Miss Jennifer Weiss-Wolf. Miss Weiss-Wolf is the Executive Director of NYU Law's Birnbaum Women's Leadership Center, where she works closely with leaders and advocates to pursue policy reforms related to menstruation and menopause. Previously, she authored a Citizen's Guide to Menopause Advocacy. and was presented and has presented testimony on legal policy before Congress, the White House, and state legislatures across the country. You may begin.

Thank you, Chair Scott, Ranking Member Gill- Gillibrand, and members of the committee for convening this historic hearing. I'm Jennifer Weiss-Wolf, and as you said, my work focuses on menstruation, menopause, and the law. It's an uncommon sphere of expertise, I know, but these are universal experiences for half the population that too often go neglected and are deserving of public policy attention. I'm here today for two reasons. First, to help shine a light on the challenges millions of women in the United States experience throughout menopause. And second, to describe policies that can help course correct. Federal agencies like the FDA, as well as state governments, including both of your home states, are already stepping up. Uh, but none of that is a substitute for the authority of Congress and the impact that you can have on moving the needle nationwide. I'm not a doctor, um, and I leave the medical expertise to my fellow panelists, and I second the jarring statistics about lack of research, training, and awareness that Senator Gillibrand and Scott have already put forth. But numbers can't fully capture the depths of frustration so many women encounter. I often think of my friend, Doctor Rachel Rubin, who is a board certified Urologist here in DC at Georgetown, and she addressed HHS this morning on menopause issues. Um, when Doctor Rubin's comatose immunocompromised mother was in immediate danger of going into Eurosepsis, the ICU denied Doctor Rubin's request to prescribe vaginal estrogen, incorrectly claiming it would cause blood clots. After Doctor Rubin eventually secured a prescription, the pharmacist refused to dispense it, citing the mere existence of its long-standing and accurate warning label, which as people have mentioned, gratefully the FFDA removed and rewrote earlier this year. If this is how hard an expert had to fight to get an urgent prescription filled, that speaks volumes about what the rest of us face. So what kind of policies can Congress advance to make real-time changes? I have a few suggestions. Uh, number one would be to please fund a modern research agenda. Less than one percent of federal research funding goes to menopause and mid well midlife women's health. We have not studied women who started taking systemic menopause hormone therapy and paramenopause, or who stayed on it continuously from their fifties through their sixties. Modern clinical trials that include millennial women and Gen X women, diverse racial, ethnic, and geographical representation, and data collection and symptom tracking using modern technology, all of that is sorely needed. We especially deserve to know if there are preventative benefits to our chronic, b- brain, bone, and heart health. To that end, women in the US, two thirds of all Alzheimer's cases, yet only twelve percent of NIH funding for Alzheimer's and related dementia research is focused on women. Might estrogen support cognitive function? Please don't look at the daily headlines, especially this past week, because you'll see a hundred different answers. We deserve gold standard clinical trials. And I can't help but add that there has been no shortage of studies on Viagra's link to lower risk of Alzheimer's for men. There are three current federal bills that all aim to increase research that you the Advancing Menopause Care and Midlife Women's Health Act, the Service Women and Veterans Menopause Research Act, and the Hormone Health Data and Research Act. The second pile s- policy priority would be to improve education. There's consensus that the medical establishment does not adequately educate future and current doctors about menopause. That's not just OBGYNs and internists, but includes cardiologists, orthopedists, endocrinologists, urologists, neurologists, oncologists, all the specialists we may see. Congress can intervene, um, by getting behind the Menopause Education for Medical Students Act, introduced in the House, um, and also pushing Medicare and the Departments of Defense and Veterans Affairs, which have control over funding for graduate medical education, to ensure that menopause, um, education is part of the accreditation standard. States have already begun addressing this, too. They've been incentivizing, um, through their state medical boards to include menopause in continuing professional education for clinicians. The third policy area that requires your attention is to ensuring affordable accessible care and treatments. Menopause prescriptions can be pricey. A monthly supply of systemic hormone therapy will run over a hundred dollars. Tell you mine is seventy-five with insurance and that is when I can get it, which is few and far between these days, thanks to the alarming short supply of estradiol patches. And I'll share too that my co-pay is tripled because I can only get a one month supply now with the same single co-pay. Um Non-hormonal treatments for hot flashes are even more and not covered by insurance, and these are not covered regularly by Medicare or Medicaid. Um, Louisiana was the first state to mandate that its own state Medicaid and insurance programs in the state mandate menopause treatments and six other states have followed suit. Fifteen years ago, Representative Barbaralee from California introduced the Menopausal Hormone Replacement Therapies Act in Congress for twenty eleven. Please resurrect that. Um, I want to just give two quick closing thoughts from the advocacy trenches. Please know that there are so many brilliant people making massive contributions every day in medicine and innovation and philanthropy who are ready to stand with you in pushing for bipartisan reforms and second, if you've seen a headline or two or ten saying menopause is having a moment, it most definitely is, but it's not a moment. It's here to stay and just ask all the loud millennials standing behind me, this proud Gen Xer wants to thank you for holding this hearing and I look forward to working with you in the future.

Well, first off, thanks for the witnesses. Uh, now I'll int- introduce our last witness. Doctor Suzanne Finske is a double board certified gynecologist and founder of TerraMed MD a women's health practice in New York City that specializes in integrative gynecology functional medicine new menopause hormone optimization and longevity medicine is also a health ambassador for the US Department of Health and Human Services office on women's health and has worked to raise awareness of menopause

Thank you, Chairman Scott, and Ranking Member Gillibrand, and members of the Sunday Special Committee on Aging, for the opportunity to testify today. I'm here both as a provider and as a midlife perimenopausal woman navigating the healthcare system. When I ask patients what they hope to get from their care, I often hear, I wanna feel like myself again. I understand this because I felt it myself, the unfamiliar anxiety,

Mm.

irritability, insomnia, night sweats, brain fog, difficulty doing work, and loss of interest in things I once enjoyed. Access to appropriate menopause care can help women regain that sense of self. That is what is at stake for women when we're here to represent. I present to advocate for greater investment in women's health research, education, and prevention across the lifespan, but particularly perimenopause, menopause, and the postmenopausal years. My own OBGYN education was focused largely on reproductive issues and pregnancy. I received very little menopausal training in my core curriculum. Every day I see how women's concerns, and especially midlife and older women, have fallen through the cracks of our healthcare system. Menopause care isn't just about managing symptoms, although that's important. Menopause is a turning point, and therefore a great window of opportunity for a woman because this phase shapes a disease risk and health for the rest of her life. Before menopause, a woman's risk of chronic disease is typically lower than a man's, but after menopause her risk significantly increases. To name just a few, heart disease, hip fractures, and urinary sepsis as causes of death in older women. Heart disease remains the leading cause of death for women. The loss of ovarian hormones with menopause increases the risk for heart disease because of changes to body compositions, lipids, insulin sensitivity, and blood pressure. However, HRT initiated around the time of menopause or within ten years, reduces cardiovascular disease and all cause mortality. Treatment decisions require individualized assessment and benefits and risks. Recent outpatient data shows HRT use in approximately seven percent of women, ages forty-five to fifty-four. We need to understand how much a men need remains and address the barriers that prevent women from receiving appropriate care. Women have almost three times as many hip fractures as men. By age eighty, one in five women will have a hip fracture, by ninety-one in two. Twenty percent of those women will die within one year. Bone loss accelerates around menopause, which occurs on average age about fifty-one. Routine bone density screening starts at sixty-five. Early risk assessment and prevention are essential. We are missing a huge opportunity for prevention. And HRT can prevent bone loss and osteoporosis related factors when initiated around menopause. While some menopausal symptoms may improve after the menopausal transitions complete, other symptoms, such as vaginal and urinary symptoms, including urinary tract infections, often get worse. These symptoms are part of the larger condition genital urinary syndrome of menopause, which affects eighty-four percent of women. Recurrent UTIs in older women are particularly dangerous because they can lead to sepsis and even death. In a study of more than fifty-six hundred women in with recurrent UTIs, once vaginal estrogen was initiated, there was a fifty percent decline in UTIs. To address these gaps, we need greater investment in women's health research. A National Academy's analysis found that only eight point eight percent of NIH grant spending from twenty thirteen to twenty twenty-three focused on women's health research.

Mm.

that is desperately needed is around breast cancer survivors and the safety and efficacy of hrt these women are often left out of the hrt conversation and may miss out on the potential benefits for future health and quality of life we also need more education both for women so they know what solutions they have and what to advocate for and for healthcare providers we currently have a physician shortage and desperately need more doctors trained in providing menopausal care we also need every other medical specialty to understand how menopause affects what they observe and practice everyday The government is in a unique position to help with immediate concerns regarding HRT availability. First, we're facing a dire shortage of HRT medications, especially patches and daily gel use. As more women seek menopausal care and choose HRT, we need to meet that demand. We cannot push forward without having the availability of treatments. Second, we have FDA-approved estrogen and progesterone, but we desperately need testosterone. It's not just about libido. It also supports mood. body composition and energy, to name a few. For some women, it's the piece that can finally help them feel like themselves again. As a final thought, as we fund more women's health research and train more doctors, we need to be thinking about prevention. As physicians, we learn how to treat heart disease in osteoporosis once diagnosed, but it's a different skill set to catch a disease in its earliest stage, or even prevent it. How we address menopause is an incredible opportunity to improve vitality and quality of life women as they age.

which I would argue benefits all of society. Prevention of disease improves quality of life, saves lives, and lessens economic burden. I'd like to thank the Senate community for this opportunity, and I look forward to continued collaboration on this mission to advance women's health care.

Thank you, Doctor F- Fenske. Let's, I'll start with uh the ranking member if you wanna start asking questions first.

Thank you. Um.

Like to first address the barriers to treatment. Um, despite limited federal investment in menopause and midlife women's health research, we've made great advancements in treating symptoms of menopause, particularly with hormone therapy. However, many women still cannot access the care that they need. Um, Doctor Khosla-Carlton, from your perspective as a clinician, what are the most significant barriers impacting women's ability to access treatment, and how does that change based on where they live?

So, in my practice I treat, um, women on all types of Um, there's definitely, we definitely see gaps in the availability and the coverage on those health insurances. Um, some treatments are covered, other treatments are not, eh, as, as well as providing clinical care. Much, much of my day is often spent kind of navigating, this will be covered for her, no, this won't be covered for her. I really think about my patients and their out-of-pocket costs because I'm in a community where you know every dollar counts to a lot of really hard-working women and um the accesses to barriers with insurance coverage is a is a big problem. Second of all, recently I've been finding in my clinical practice that I have to get prior authorization for low cost FTA approved hormonal therapy. That's a huge burden on the practice. I have one nurse that does prior authorizations all day. These are well proven treatment and any efforts that Congress can make to decrease the amount of of administration administrative burden for physicians is greatly appreciated.

Doctor uh Silberman-Fenke.

So, so many things. Uh, first off, what um issues remain are that regarding kind of the access, this comes down to essentially initially uh insurance reimbursement. So there's not much incentive for physicians to take care of menopausal women. The way that the our reimbursement insurance perspective, the hospital system can't support and the private practitioners can't afford to take care of a menopausal women for her visit. because the amount of money she's reimbursed for that visit.

Does Medicaid have a better or Medicare have a better reimbursement rate?

Very low reimbursement rate for the for for those codes,

All of them.

for those codes, yeah.

Hmm.

The so for access to it, and then there comes down to the education, when you look across sort of an the unfortunately you had a wonderful education, but there's there's no guidelines on the education. When you're an OBGYN resident, you know that you need a minimum of two hundred vaginal deliveries in your to complete your residency. there is no mention of how much education you need on menopause so you have these residents graduating not being educated the final issue in regard

who decides those standards

i think it comes down to the acgme and how many women are on that board i'm not certain actually um doctor uh witewski wendy do you have an a a pinning on access

oh it's not

an area that i uh you know so it's not an area that i research but i do have uh personal experience and access from family members that uh describe some of the similar things that happen uh to women not enough healthcare not enough trained gynecologists that really focus on menopause and uh so i think it really does limit uh the the excess of women to get the care they need.

Mm-hmm. Thank you. Um, Miss Weiss-Wolfe, from your perspective as an advocate and as an author, what are the most significant barriers impacting women's ability to access treatment? And how does that change based on where they live?

So I'd say the answer is, is pretty similar, what to the, the physicians on either side said to me, but I hear it from the patient's point of view, um, and the frustration that they experience. I think that confu- the, the connection of lack of training and lack of research leads to a a variety of conflicting messages, then, that come down from providers. Um, and people will also be forced to go from doctor to doctor if they don't either hear the answer that they want to hear, need to hear, or that adequately serves them. And then that ends up causing additional costs, frustration, oftentimes they'll wind up in the ER. So, I think that the I mean, when you look at it from the patient point of view, it's the same problem. but it's just how it's it's experienced. The the question about geographic um uh the the relevance of geographic location, um even while there are certainly care deserts in this country, in particular in the south and the midwest, even in metropolises where there seems to be, you know, plenty of care, somebody could still have to wait a month, six months, a year for an appointment. Um and one one intervention that I think should be high on uh congress's list is telehealth um there are opportunities for menopause care and telehealth that i think are unique to the way that that care is provided um and telehealth could fill a real gap in terms of concentrating uh menopause experts and we have to be just very careful that telehealth is accessible to all as well um and that there aren't barriers that are created by connectivity or insurance otherwise

thank you mr. chairman senator kim uh thank you chairman and i just wanna thank the ranking member as well for just your leadership and giving us a space to be able to talk about menopause talk about this in a form that often hasn't happened here in the senate or on capitol hill as a whole so your leadership is much appreciated uh i wanted to just dive into a few different angles of this uh miss weiswolf i'd like to just start with you just uh i'm grateful for just the record that you've been able to produce of just these testimonials and and statements from many different women. And I guess I wanted to ask you, uh, about the impact on women's work experience, uh, and the challenges on that front. This is something I'm hearing more and more of as my generation is growing older, of just, you know, women, uh, uncertain how to be able to balance, uh, their careers, especially as we're often getting into, hopefully, the heights of our careers in these ages. Uh, but then also, um, understanding you know their their own challenges uh when it comes to their their uh uh perimenopause menopause and some of the difficulties in terms of being able to understand how that intersects with it also workplaces and oftentimes bosses and and others maybe not understanding the needs that women might be having through those transitions so i wanted to just hear is that something that you heard about as you were uh as you've been documenting this and engaging with women And are there, you know, certain types of workplace or policy changes that you think would be having the greatest impact on reducing absenteeism turnover wage loss and other challenges that women might be facing?

Thank you for the question, Senator Kim, and your home state of New Jersey is also a leader uh in the menopause front. Um, the workplace is a really interesting issue to me because, yes, it is true that women would be at the prime of their leadership in terms of income in terms of influence and in terms of the um the the way that they create um you know a a a a chain of success for others their mentorship capacity on institutional knowledge and skill that they have um there have been a wide variety of workplace accommodations and benefits that private sector employees have sought to bring about they they do see how popular the menopause discourse is and i think want to intervene with some of the best intentions We've also heard the, you know, the economic analysis, too, about what is lost when we don't try to keep women in the workplace and and support them during this stage. I will say that I I actually harbor some real concerns about those accommodations and those benefits even done with the best intentions because right now we certainly do not have federal anti-discrimination protection should somebody choose to take their employer up on those benefits. Um, some states, both Illinois and Rhode Island, have actually passed laws that both require that the accommodations follow suit with how pregnancy accommodations are provided, and similarly provide that anti-discrimination protection. Um, but without that, I'm actually very lukewarm about workplace benefits. Um, and

Because of the lack of federal protection.

Primarily because of the lack of federal protection. That would be the biggest reason. The secondary reason would be, as my fellow panelists have said, menopause is not a one-size-fits-all circumstance. and other forms are focused on very narrow circumstances. Whether it's,

Yeah.

you know, a little bit of flex time or a a cooling room opportunity. These are things that really would only benefit a very small amount of symptoms, a very small amount of employees who work in an office environment, not the wide variety of ways people work today. And they certainly don't address the long-term health consequences that we think about when we think about menopause. CEOs and business leaders investing in the research and investing in the other kinds of systemic reforms that we need than putting a few band-aids in their workplace.

That's helpful perspective. Uh, I wanted to just turn to um, Doctor uh, Cosley Charlton, uh, something that again, uh, I I feel like, you know, I'm hearing more and more from uh, women of my generation, friends and and family, but a real limited understanding about perimenopause, uh, and just uh, understanding um, and trying to understand you know physical cognitive emotional symptoms and i know that they can vary quite wildly uh but that transition is one that i think is is been catching people off guard and uncertainty about um uh about this so i i guess i wanted to ask you how can we raise awareness when it comes to perimenopause that transition and into full menopause of of people who are experiencing it so they can try to recognize symptoms and try to understand uh uh where they might fall within that

so um i think one of the things we were highlighting was that a lot of social media awareness um is out there and menopause is definitely having a moment and one of my patients came in the other day uh in her mid twenties and

mmm

um she was asking me a lot of questions that had to do with typical perimenopausal symptoms and i and i thought it was a little bit odd i'm like are you experiencing any of these and she's like no but perimenopause has a vibe and i wanna be ready

hmm

so i think that like i think the the the the discourse, having hearings like this, having this discussion is really um bringing, really empowering women to take care of themselves, and I think that's really wonderful. Um, I think channeling that by increasing, you know, we ha- we have the same conversation, increasing physician workforce, increasing um patient access to physicians um to give them their medical advice is really, really important. Um, the other thing I wanna note is that a lot of times perimenopausal symptoms can mimic symptoms of natural disease. And even though prairie menopause is normal, and a lot of women deserve a work-up. And I think sometimes the, the frustrations that patients feel and that they don't feel like they're quite being heard, but it might be why they're being worked up for more serious medical conditions that can have a greater impact on their quality of health care and their quality of life. So, um, I think, you know, I think empowering women is a really important thing in educating women. And I'm really, I really think there's a lot of positive, um, a lot of positive discourse happening right now. And that's exciting.

yeah no thank you and as i just wrap up here i mean uh as someone who is also trying to learn up and and have a a deeper understanding both personally within my own family but also uh in the work that we're doing here uh i think what i'm trying to get a deeper sense of is what is it that is uh a lack of awareness that we need to continue to educate and what is uh a lack of research a lack of knowledge and understanding where do we need to be doing more testing more research on links you know i'm somebody that's been doing a lot of work on cognitive decline my father has alzheimer's a lot of issues of dementia we see you know significantly increased rates of alzheimer's and dementia with women you know are there linkages there in different ways that we need to be exploring further when it comes to menopause or other types of of uh linkages with other types of uh ailments so uh you know that's something that i'm i'm glad we're having this hearing because it certainly is focusing it for me as i try to think through uh what is the the way in which we need to make sure we have the knowledge base to be able to build off from so just very grateful for the chairman for the ranking member for holding this and we'll make sure we continue to follow up thank you

thank you sir doctor what is the link between menopause and longevity and how can treatments like hormone replacement therapy help protect women from chronic disease

thank you chairman scott so the link is that basically we know the benefits of If we use, for example, HRT, the benefits of hormone replacement therapy, we, as I mentioned, decrease the risk of cardiovascular disease, diabetes, uh, colon cancer, osteoporosis. And there's a thirty percent reduction in all-cause mortality, if you're on hormone replacement therapy. So it is innately linked to longevity to be on hormone replacement therapy. If women are spending one third of their lives without those hormones and having that impact we start to see those changes. at the at as practicing medicine you start to see ldl cholesterol start to rise you start to see insulin resistance start to happen regardless of their diet and their exercise you start to see their blood pressure start to rise from a cardiovascular stand point the vessels start to harden without without estrogen increases the liability of it so hormone replacement therapy is linked to longevity

you talked about the importance of lifestyle interventions like diet sleep and exercise how can these How can these help women during this process in addition to medical treatment?