Primary care settings failing to address women's hot flashes

Timely identification and treatment of bothersome hot flashes have the potential to improve the lives of many women and save employers countless days of related absenteeism and lost work productivity. Yet, a new study finds that such symptoms are often not documented in electronic health records (EHRs) or not adequately addressed during primary care visits. The study is published online today in Menopause, the journal of The Menopause Society.

Approximately 75% of women experience hot flashes as they go through the menopause transition. Despite the common occurrence of these bothersome symptoms in midlife women, these symptoms receive inadequate attention in primary care settings.

There have been multiple theories proposed for why this is the case. Women may avoid the conversation with their healthcare professionals because they have felt dismissed when previously discussing menopause. Another problem is that both patients and clinicians often lack knowledge regarding the availability of safe and effective treatment options for menopause symptoms.

In other cases, women and their healthcare professionals may be hesitant to discuss hormone therapy (HT) because of safety concerns, even though it is recognized as the most effective treatment for managing menopause symptoms and considered relatively safe. This last reason is largely moot because today there are many effective nonhormone treatment options available for women who have true contraindications to HT use.

Results of this latest study, designed to better understand why many menopause symptoms go undiagnosed and untreated, were based on surveys done with 229 women in a primary care setting who had self-reported moderate to very severe hot flashes. Less than one-fourth (22.7%) of these women had their symptoms documented in their EHRs. Use of systemic HT in the women who did not have contraindications to its use and who had not previously used systemic HT was low at 6.1%. Nonhormone prescription therapy use for these women was higher at 14.8%.

The researchers conducting the survey believe these findings highlight a concerning lack of discussion and consideration for appropriate management of hot flashes. They additionally pinpoint a need for better methods for identifying midlife women with bothersome menopause symptoms in primary care clinics so that appropriate treatment options, including HT, can be discussed and offered.

Study results are published in the article "Addressing menopause symptoms in the primary care setting: opportunity to bridge care delivery gaps."

This study highlights gaps in menopause symptom documentation in the electronic health record and in treatment of symptoms. Additional efforts are needed to educate women and the healthcare professionals caring for them on the importance of identifying and treating bothersome menopause symptoms in the primary care setting."

Dr. Stephanie Faubion, Medical Director, The Menopause Society