More people than ever are interested in menopause. Family physicians should be, too.

Menopause and perimenopause are having their moments.

Recently, a social media clip of actresses Amy Poehler and Jennifer Lawrence went viral. Lawrence, 35, mentioned her itchy ears in an offhand comment as they sat down together filming an episode for Poehler’s podcast. Poehler, 54, quipped that itchy ears were a symptom of perimenopause. Lawrence was visibly stunned. She had no idea.

This simple back-and-forth is emblematic of similar conversations happening across the country and across social media. When stars and political leaders and physicians who are on social media talk about perimenopause and menopause, it allows people to wonder: “Oh, I have that symptom, too. I just thought this was part of my life. Is there a way for me to get rid of it?”

This is where family physicians can step in with expertise and recommendations that directly improve our patients’ quality of life.

Menopause treatment and knowledge matters

On average, menopause begins around age 51, but it can start as early as 40, with perimenopausal symptoms appearing even earlier.

What’s notable about that is your 40s are a time of life where many people have multiple social responsibilities—kids, career, care of aging parents and more. Good-quality sleep is often elusive. And several standard perimenopausal and menopausal symptoms are general enough that many people, even physicians, look first to lifestyle choices before considering menopause.

But the reality is that some of these symptoms are due to menopause.

When we started really adding menopause education for my residents, we quickly saw diagnoses that they might not have otherwise made. For instance, when they see somebody in their 40s who comes in with insomnia but beautiful sleep hygiene, and they say have done therapy but aren't improving, my residents think to ask if the patient is having any other menopausal symptoms.

It’s in these situations when knowledge of menopause isn’t simply academic. If menopause isn’t on the differential, it won’t be diagnosed. We might miss the opportunity to get that patient higher-quality sleep by getting them on estrogen and progesterone, and improving their vasomotor symptoms.

New evidence, improved treatments

Family physicians like myself love treating patients of all ages and life experiences. The challenge to that full-spectrum care is keeping up with all the literature. There’s always a new study, always a new paper, always a new guideline.

As a result, that opens the door for famous, well-known studies to remain in our consciousness for longer than others. In the world of menopause and perimenopause treatment, it’s the 2002 Women’s Health Initiative (WHI) finding that hormone replacement therapy (HRT) might be harming patients more than it’s helping. As physicians, that’s a scary thing to be told.  

But in the years since then, further analysis of the WHI data and other studies strongly suggest that age groups played a significant role in the original findings. For younger patients—within 10 years of starting menopause or younger than 60—they benefit significantly in quality of life and severity of symptoms when prescribed HRT.

This is such a big shift, but it’s an important one. The Menopause Society’s panel of experts recommend that you offer HRT as first-line treatment for menopause. This treatment is evidence-based, and it is incredibly rewarding to see the joy that comes from an improvement in our patients’ lives.

Perimenopause and menopause training for family medicine professionals

This spring, I am excited to have the opportunity to expand our training with a two-day perimenopause and menopause online CME conference April 23-24. We’ll cover topics including

• Screening and prevention,
• Contraception,
• Symptoms and management, and
• Care for gender-diverse patients. 

While I’m chairing the course, we’re also featuring multiple other experts in the field and people who have been doing the most up-to-date, evidence-based treatment in their communities. Our goal is for you to finish on Friday afternoon and be ready to start implementing what you’ve learned on Monday.

If you can’t make the course dates, there are other ways to learn. The Family Medicine Experience is a great place to learn about menopause and other timely topics, and I regularly teach sessions about menopause. And of course, you can check out AAFP’s clinical information about menopause and other topics.

Maya Bass, MD, MA, FAAFP, is a practicing family physician and program director for the Cooper/Cooper Medical School of Rowan University family medicine residency. She completed the Leadership Training Academy from Physicians for Reproductive Health.