A new white paper is calling for menopause to be embedded across medical school education, arguing that gaps in doctors’ training carry costs far beyond menopause care - from unnecessary healthcare spending to lost productivity and missed innovation.
The Business Case for Integrating Menopause Education into the Medical School Curriculum: a Central Issue, Not a Peripheral One, co-authored by physician and medical educator Lara Zibners, co-founder of Calla Lily Clinical Care, and physician and business professor Adam Brown, founder of ABIG Health, makes an economic case for reforming medical education.
Rather than adding a standalone menopause curriculum, Lara and Adam argue its effects should be integrated into teaching across different systems of the body - so doctors understand its relevance before they specialise.
One study cited in the paper found just 6.8% of residents in family medicine, internal medicine and obstetrics and gynaecology felt prepared to manage menopause, while 20.3% reported receiving no menopause lectures during residency. Another found 58% of medical textbooks surveyed globally did not mention menopause.
For Lara, the aim was to move the debate beyond the case for better care alone.
“There is certainly talk about the need for menopause education for healthcare providers. However, much of the conversation thus far has been from a population health, moral and ethical viewpoint,” she told FutureFemHealth.
“At the end of the day, change is most often driven by economic considerations. We wanted to frame the conversation from just that. A financial incentive for medical schools, healthcare systems, policy makers and society at large to ensure that we are including essential education that addresses the needs of half the population from the start.”
Menopause doesn’t belong to one specialty
The central argument is that menopause shouldn’t be treated primarily as a gynaecological issue.
The hormonal changes associated with menopause intersect with cardiovascular, metabolic, musculoskeletal, neurological and genitourinary health, among others. Yet education is often concentrated within particular specialties and can begin only after doctors have entered internship or residency.
As Lara writes in the paper: “The lack of inclusion of a topic in medical school sends a clear signal to students: it doesn’t matter.”
Medical school is also the point at which future doctors across different specialties are still learning together, creating an opportunity to establish that knowledge before they specialise.
Adam said his own medical education helped motivate the project.
“As a physician, I received little to no training on menopause. It barely came up,” he told FutureFemHealth.
“And what we were taught, largely from the early Women’s Health Initiative, has since been walked back. An entire generation of doctors was educated on a subject that affects half our patients using information that was wrong or simply absent.”
The cost of the knowledge gap
The paper attempts to quantify some of the wider economic consequences.
Menopause symptoms alone are estimated to account for $25bn annually in direct medical expenses among US women aged 45–60, while downstream conditions associated with menopause, including cardiovascular disease, osteoporosis and fractures, add substantially to healthcare spending.
An actuarial analysis cited in the paper estimated more than $4,600 in wasteful healthcare spending per patient per year associated with inadequate menopause care.
The costs extend into the workplace. Lost work days associated with menopause symptoms have been estimated to cost $1.8bn annually, rising above $5.4bn when career opportunity costs including early retirement and moves into lower-paid positions are included.
The authors argue that better education could support earlier recognition, reduce unnecessary investigations and referrals and improve preventative care and management. They don’t claim to have calculated the return on investment from changing medical curricula - the paper acknowledges that establishing the economic benefit directly will require post-implementation data.
The innovation gap
Adam also points to the potential impact on healthcare innovation.
“As a business professor and business owner who works with innovators, I see the other cost,” he said.
“Innovators cannot fix a problem they were never shown. Keep menopause invisible, and you quietly cap what is possible. You limit future treatments, and you limit innovation. From a business standpoint, we need people trained to innovate for half the world’s population.”
The paper argues that equipping physicians with a better understanding of menopause could also support their involvement in the development of new products and services and their ability to guide patients towards clinically sound solutions.
Moving menopause upstream
The proposal is to weave menopause into subjects already being taught - its implications for cardiovascular health when students learn cardiology, for example, or bone and muscle health within the musculoskeletal system - rather than increase students’ overall class load.
There is already support for more education. In one survey cited in the paper, 92.9% of OBGYN programme directors agreed residents nationally should have access to a standardised menopause curriculum.
Lara and Adam are making the paper and accompanying resources freely available, including audio summaries and a slide deck.
“We’d like to spark a movement,” Lara said. “One that genuinely begins with the viewpoint of a medical student and incorporates the voices of contributors from very different perspectives.”
Adam added:
“I want schools and residencies to stop treating menopause as a blip in the curriculum, a single slide before everyone moves on,” he said.
“Most of all, I want to change how we see women’s health. Not as a charity. Not something we fund out of goodwill. It is a massive, underfunded, underappreciated opportunity for research and innovation. Get this right, and everybody benefits.”
The paper is unusually clear that it has not yet calculated the return on curriculum reform. That makes post-implementation measurement crucial. Preparedness surveys are a start, but changes in referral patterns, avoidable testing and patients’ experience would show whether teaching menopause across specialties actually changes care.