Lorraine Carter Salazar, a former middle school teacher, faced a challenge many women experience but few openly discuss. About ten years ago, she began having hot flashes during school hours. At 62, she worried that these symptoms might make her seem less competent to coworkers, students, and parents.
“I felt uncomfortable, and it showed,” Carter Salazar said. During meetings, parents could tell she was struggling. Once, a student even joked, fanning her and saying it reminded them of their grandma’s hot flashes.
When she mentioned her symptoms to her doctor, she was dismissed. “So you sweat,” he said. “Nobody dies from sweating.” This response left her feeling unheard and frustrated.
Many women going through perimenopause and menopause report similar experiences. Symptoms like hot flashes, night sweats, mood swings, loss of libido, and memory issues can deeply affect daily life. Yet, many doctors are not prepared to address these concerns properly.
A 2023 study published in Menopause found that fewer than one-third of obstetrics and gynecology residency programs include training on menopause. This is significant since about half of the population will experience menopause.
To address this gap, lawmakers in California and across the United States are proposing new rules. In California, Assembly Bill 432 aims to require doctors to complete menopause education when renewing licenses, especially if they care for many women under 65. Another bill, Assembly Bill 360, would assess current education gaps but was recently tabled.
Assemblymember Rebecca Bauer-Kahan, who introduced AB 432, shared her personal struggles. “I had to see three different doctors before one would have a proper conversation about menopause with me,” she said. Her brain fog was so severe she feared early Alzheimer’s.
California is part of a growing national movement. This legislative session, 13 states have proposed 21 bills related to menopause care and education. Some states, like New Jersey, allow menopause education to count toward doctors’ continuing education. Illinois and Louisiana now require insurance to cover some menopause treatments.
Experts stress that menopause symptoms should be treated, not ignored. Dr. Monica Christmas, who leads the menopause program at the University of Chicago, says, “No one should have to suffer with these symptoms.”
Dr. Christmas noted that few medical schools offer in-depth menopause training. Many doctors seek additional education independently or through groups like The Menopause Society, which offers specialized training.
She also highlighted that menopause experiences vary widely, especially among Black women. Some Black women are reluctant to use hormone treatments due to mistrust or cultural beliefs.
Kim Robinson from Black Women for Wellness explained that Black women face added challenges, including higher rates of uterine fibroids. Some doctors push hysterectomy as a quick solution without fully discussing alternatives like hormone therapy. Robinson stressed that doctors should offer informed choices and better understand how menopause affects Black women differently.
Despite growing awareness, obstacles remain. California Governor Gavin Newsom vetoed a similar bill last year, citing concerns about insurance coverage for costly, non-FDA-approved treatments. He encouraged lawmakers to focus on education and access to care.
Some medical professionals worry that mandatory menopause training adds too much to doctors’ already heavy education requirements. Dr. Tanya Spirtos, former president of the California Medical Association, believes doctors are responsible for keeping up with new knowledge on their own.
Still, advocates remain hopeful. Jennifer Weiss-Wolf of New York University’s Birnbaum Women’s Leadership Center, who tracks menopause legislation, sees growing momentum. “Ten years ago, no one talked about these issues publicly,” she said. “Now, there’s real progress toward better care and understanding.”
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