A nationwide assessment in the US of obstetrics and gynecology residency programmes revealed the need for more training in how to provide the best care for women going through menopause, according to investigators at the Medical College of Georgia.
“When you look at projections over the next few decades, by 2060, there will be around 90 million women in the US alone, who will be in the post-menopausal range”, said Jennifer Allen, MD, associate professor and director of the Obstetrics and Gynecology Residency Program at MCG and Wellstar MCG Health. “Yet, it’s a tiny fraction of the curriculum, if any at all, in most ob-gyn residencies. Compare that to something like pregnancy. In 2020, there were about three million live births, but we teach about pregnancy every single day in residency training.”
This is not a new problem, Allen said, noting that she received very little menopause education during her own residency at MCG and Wellstar MCG Health. It was not until she began practising that she realised the enormous need. She sought out additional training and became certified as a menopause practitioner from the North American Menopause Society – one of only four in Augusta and the surrounding area. She also created lectures that she offers to residents at MCG and Wellstar MCG Health, and she began having them spend time rotating through her menopause clinic. “Our curriculum really needed to be built up”, she commented.
When Allen became director of the Obstetrics and Gynecology Residency Program in 2020, she set out to do just that, in Augusta, and around the US.
Allen recently surveyed 145 residency programme directors across the country. Of the 99 who responded, almost all – 93% – strongly agreed that residents should have access to a standardised menopause curriculum, she recently reported in Menopause, the journal of the North American Menopause Society. Only 31% of programmes reported having any menopause curriculum at all.
“A lot of programme directors don’t actually practise a tonne of menopause medicine themselves, so it is hard for them to figure out how to teach residents about it”, she said. “Unless you have a menopause expert or someone having a menopause clinic at your institution, that’s a challenging thing to teach your learners. That is the basis for what I hope to do in the future, which is to help create a national curriculum.”
As a member of the Education Committee of the International Menopause Society, Allen explained that there is a system in place for practising providers called IMPART, short for International Menopause Society Professional Activity for Refresher Training, which features eight online training modules. “We are trying to modify and expand those modules to meet resident learner needs and that way we’re not completely reinventing the wheel. I’m hopeful that this is going to finally move the needle in a forward direction.”
More menopause education could also be helpful to other types of physicians, such as primary care providers like family medicine physicians or internists, and even sub-specialists like endocrinologists, for example, because their female patients could present with symptoms in their offices first.
Menopause symptoms are more than the signature hot flashes, Allen said. Women can experience symptoms from head to toe, including things like sleep disturbances; hair, nail, and skin changes; bone loss; mood instability; depression; and anxiety. And treatment options can include both hormone and non-hormonal therapy.
“When a physician is well informed about all of these things, then the patients get better counselling, they learn about safe options, and can make the best joint decision with their doctor about how to best manage their care”, she said. “Without menopause education for physicians, patients may get a response such as ‘Well, that’s just ageing’ or ‘That’s menopause, and you’ve just got to deal with it’. That’s not fair to our patients. They deserve better care, so that’s my goal – better training for physicians and, ultimately, improving patient care.”