PART 1: The Menopause Education Crisis: Why We're Failing Half the Population

This is Part 1 of a two-part series on menopause care. For practical guidance on hormone therapy options, read part 2

I just finished listening to Dr. Rachel Rubin on Peter Attia's podcast, and I had to turn off the episode multiple times because the anger was making my blood pressure rise. What I heard wasn't just disappointing—it was infuriating. And it should make every woman angry too.

Let me share what's most concerning: Less than 6% of doctors receive even an hour of menopause education during their entire medical training. Read that again. The transition that affects 100% of women—and by extension, 100% of the human population—gets less attention in medical school than learning to suture wounds.

But what's equally troubling: We didn't just lose a generation of women to poor menopause care. We lost the entire generation of doctors who actually knew how to help them.

As a massage therapist, personal trainer, nutrition coach, and menopause coaching specialist, I find myself in an uncomfortable position: women reach out to me almost daily, desperate for help with their menopause symptoms after being dismissed by their physicians. There's something profoundly wrong with a healthcare system where a wellness professional like myself might have more current information about menopause treatment than many medical doctors. I'm acutely aware of the ethical scope of practice considerations here—I'm not a physician and shouldn't need to be the one providing this information. Yet the gaps in care are so severe that women are turning anywhere they can for help. This reality isn't a reflection of my expertise, but rather a damning indictment of how completely our medical system has failed women. I share what I'm learning through my training and research not because I should be the source of this information, but because too often, no one else is providing it.

The Lost Generation of Medical Knowledge

Dr. Rubin explained something profound: The doctors who understood hormone replacement therapy (HRT)—who had decades of experience seeing how effective it was for women—either retired or died without training their successors. They took their knowledge with them.

The Women's Health Initiative (WHI) study wasn't just misrepresented (though it was catastrophically so). It created a brain drain. Young doctors were taught that hormones were dangerous, period. The nuanced understanding of when to start, how to dose, and which formulations work best? Gone.

As Dr. Rubin said, "We are now trying to make up for lost time to train people how to write prescriptions [for HRT]." We're literally having to rebuild this knowledge from scratch.

My Personal Journey: Self-Education Out of Necessity

At 43, I'm early in perimenopause and already on HRT. But here's how I got there: I educated myself through my menopause coaching certification, podcasts, and other resources. I found a cash-pay practitioner, walked in knowing exactly what I wanted, and got it.

This shouldn't be the only path. But for most women my age, it is.

Every other middle-aged woman I know who's successfully on HRT has either:

• Gone through a similar self-education process

• Used telehealth services specifically tailored to menopause

• Fought tooth and nail with traditional providers

Meanwhile, women who went through traditional channels—their OB/GYNs, family doctors—tell stories of being told HRT is "dangerous," of having their symptoms dismissed, of leaving appointments feeling hopeless and unheard.

The Numbers Don't Lie: We're Failing Women

Here are some facts that should make every healthcare administrator uncomfortable:

• Only 4% of women who would benefit from HRT are currently receiving it

• Less than 6% of doctors receive adequate menopause training

• 100% of women will experience menopause

• 84 million women in the US are over 40, heading into or through this transition

Do the math. Even if every trained menopause specialist saw 3,000 patients (which is humanly impossible), we'd still fall catastrophically short.

The Billion-Dollar Impact We're Ignoring: Vaginal Estrogen & UTIs

Dr. Rubin's research shows that if Medicare patients used vaginal estrogen to prevent UTIs, we would save Medicare between $6-22 billion per year.

Why does vaginal estrogen work so effectively for UTIs? The science is clear:

• As estrogen levels drop, vaginal pH becomes less acidic (changing from ~4.0 to 6.0+)

• This pH change allows harmful bacteria to thrive

• The vaginal tissue becomes thinner with less natural defense

• Protective lactobacilli bacteria populations decrease dramatically

• Bladder and urethral tissues also become more susceptible to infection

Vaginal estrogen reverses these changes by:

• Restoring proper acidic pH that naturally fights bacteria

• Thickening and strengthening the tissue to provide better barrier protection

• Supporting the growth of healthy protective bacteria

• Improving overall health of the genital and urinary tract tissues

The research shows vaginal estrogen reduces UTI occurrence by 50-60%. This isn't just about comfort—UTIs are a leading cause of sepsis in elderly women and can be fatal.

And yet, because of misunderstanding and lack of education, we're not using this remarkably safe, effective, and inexpensive treatment. Many doctors and nurses aren't even aware it's an option.

The Systemic Barriers Are Real

Here's a systemic issue that illustrates how broken the system is: Psychiatrists routinely prescribe hormonal birth control to treat postpartum depression (a standard practice). Yet, these same psychiatrists can lose their malpractice insurance if they prescribe HRT for perimenopausal depression—despite HRT being what Dr. Rubin calls "one of the greatest antidepressants in the history of medicine" for the very condition it treats best.

So psychiatrists can prescribe one hormone therapy but not another? This inconsistency reveals the depth of misunderstanding about HRT within healthcare systems and insurance policies.

This isn't medicine. This is institutionalized discrimination.

The WHI Study: A Misinterpretation That Harmed Millions

The Women's Health Initiative study—conducted on women with an average age of 63, many with existing health conditions, using oral hormones we don't even prescribe anymore—was catastrophically misrepresented, creating decades of fear-based medicine.

The headline screamed "25% increased risk of breast cancer!" The reality? One additional case per 1,000 women, with no increase in mortality from breast cancer. Women on estrogen alone actually had a decreased risk of breast cancer.

As Peter Attia said, "This is the greatest injustice imposed by the modern medical system in our lifetime."

Peter calculated that over 20 million women were deprived of the benefits of HRT because of this misinterpretation. The excess mortality and disability from hip fractures, cardiovascular disease, and other complications is staggering.

What We Can Do

I refuse to end this on a hopeless note, because there is hope. Here's what needs to happen, and how we can make it happen:

For Women:

1. Educate yourself. You shouldn't have to, but right now, you do. Find healthcare voices that resonate with you and are committed to evidence-based information.

2. Find providers who get it. Look for menopause-certified practitioners through organizations dedicated to women's health.

3. Consider cash-pay options. It's unfortunate that we often have to pay out of pocket for quality care, but sometimes it's the fastest route to getting help.

4. Share your story. When HRT works for you, tell other women. We need to break through the fear with real experiences.

For the Medical System:

1. Mandatory menopause education for all medical students and residents, especially those in internal medicine, family practice, psychiatry, and cardiology.

2. Update the black box warnings on HRT products to reflect current evidence, not 20-year-old misinterpretations.

3. Recognize menopause as the whole-body transition it is, not just an OB/GYN issue.

4. Fund research on women's health at the same level as men's health.

The Bottom Line

I'm sharing this not to scare you, but to empower you. The current state of menopause care is unacceptable, but knowledge is power. The more women who understand what's available, what's safe, and what's effective, the faster we can change this broken system.

As Dr. Rubin said, "Women's health, menopause health in particular, is important to nobody. When it's nobody's problem, nobody takes ownership of it."

Well, I'm taking ownership. You should too. And together, we can ensure that the next generation of women doesn't have to fight this hard for basic, evidence-based care.

The science is clear. The benefits are proven. The only thing standing between women and better health is an outdated, uninformed medical system that's too afraid to admit it got it wrong.

It's time to get angry. It's time to get educated. It's time to demand better.