| By Shelagh Larson, DNP, APRN, WHNP-BC, MSCP, FAANP
Unlike most health events, menopause isn’t a risk that comes with age, it’s a guarantee. In Texas, it is a reality for about 3.5 million of our mothers, sisters, colleagues, and neighbors aged 45 to 64.
The symptoms of menopause can interfere with a woman’s employment, parenting, and relationships, affecting her sleep schedule, concentration, and emotional regulation.
While symptoms are treatable, far too many women are left to navigate it alone and end up going without care.
I’ve spent my career caring for Texas women, first as a labor and delivery nurse and now as a women’s health nurse practitioner. I founded the Menopause and Sexual Health Clinic at JPS Health Network in Tarrant County serving low-income and underserved women. Again and again, I meet women who arrive after years of struggling, often after they were told by other medical professionals that their symptoms are something they just have to live with. It’s not uncommon for them to have seen several other specialists and to have multiple prescriptions for symptom-relief medications, when menopause or perimenopause may be the root cause and hormone therapy may be the solution.
Too many never get there. According to The Menopause Society, 35% of women see four or more providers before anyone makes a diagnosis. Nationally, only 20-25%of women in menopause receive any treatment whatsoever. For women in rural and underserved communities, where specialists are scarce, every extra referral can mean more months of waiting and more miles on the road. The cost reaches beyond the individual. RAND estimates menopause results in lost productivity of $5.4 billion nationwide every year, with about $433 million of that loss in Texas.
The solution is increasing access by removing unnecessary barriers.
Most medical and nursing programs teach little about menopause. It should be taught more extensively in every medical school, nursing program, and residency, with continuing education offered to clinicians already in practice. Every provider who sees women patients should be able to recognize menopause and know when to refer them for additional care.
Administrative hurdles and red tape can unnecessarily delay or block a medication that a clinician has prescribed. For a woman who has driven an hour or more to her appointment, that denied prescription is more than an inconvenience, it’s a denial of care. Those hurdles should be reviewed and reduced, allowing patients and their providers to make the decision together.
Medicaid enrollees are 47% more likely than privately insured women to go entirely untreated for disruptive symptoms. Many effective treatments for menopause symptoms are medications originally approved for other conditions, which can make it hard for women to get them covered. Closing that gap would give Texas women who rely on Medicaid the same options as everyone else.
Nurse practitioners stand ready to help close the gap between the number of women who need care and the number who actually receive it. Licensed by the Board of Nursing, nurse practitioners with prescriptive authority evaluate and treat menopause every day, including through hormone therapy. More women are getting this care from NPs each year. Unnecessary state regulations currently make it more difficult for NPs to serve women in underserved areas where they are needed most. These unnecessary regulations should be evaluated and removed.
More access means addressing gaps and preventing bigger, costlier health problems later.
Menopause should never be a medical dead end, and where a Texas woman lives should never decide whether or not she gets the care she needs. With better training, fewer obstacles, and expanded access, Texas women can be assured to get the care they deserve and depend upon.
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