Every day, approximately 6,000 people in the United States enter menopause. Menopause symptoms — such as hot flashes, bone loss, sleep disturbances, and cognitive changes — can be life-altering, and even disabling, but treatable. Yet for millions of people, especially Medicaid enrollees, low-income individuals, and Black, Indigenous, and People of Color, accessing treatment often means navigating barriers.
Coverage Barriers
Coverage gaps in menopause care are significant. Medicaid enrollees are 47% more likely to go without treatment for menopause symptoms than people with private insurance.
While Medicaid generally covers some prescription drugs, many menopause therapies rely on widely accepted off-label prescribing. Off-label prescriptions are often flagged for prior authorization which can delay or block access to needed care. In addition, when patients require customized compounded hormone formulations, Medicaid generally does not cover them at all, forcing many individuals to pay a significant amount of money out of pocket or go without treatment entirely.
Beyond prescription coverage, people undergoing menopause may also require diagnostic services (e.g. bone density screenings) and specialist care (e.g. pelvic floor physical therapy). Even though these treatments are part of mandatory Medicaid benefits (such as emergency and nonemergency medical transportation and inpatient hospital services), individuals may face barriers to meaningful access such as state- and plan-imposed medical necessity standards, inadequate reimbursement rates, and more.
A growing number of states — including Louisiana, Illinois, New Jersey, Oregon, and Virginia — have enacted laws requiring insurance coverage for menopause care, with some explicitly extending those protections to Medicaid. This momentum is meaningful, but these state-by-state solutions still leave millions of people without protections from coverage gaps.
Equitable access to menopause care requires stronger coverage protections. Federal and state policymakers should ensure that public and private insurance programs provide comprehensive coverage for menopause care.
Policymakers should also prohibit restrictive prior authorization and step-therapy requirements that delay or block access to treatment. Coverage should include necessary compounded therapies and other supportive menopause-related care when FDA-approved treatments are ineffective or contraindicated.
Discrimination
Coverage barriers are only one gap in menopause care; discrimination also plagues treatment. Menopause symptoms are routinely unrecognized and misdiagnosed by health care providers. This dismissal reflects a long history of race- and gender-based bias in medicine that continues to shape how individuals are treated today. This dismissal may also violate civil rights laws, such as Section 1557 of the Affordable Care Act, the first federal civil rights law to broadly prohibit sex and intersectional discrimination in health care, in addition to protections against discrimination based on race, color, national origin, disability, and age.
Due to the cumulative effects of systemic chronic stress and interconnected social determinants of health, on average, Black women* enter menopause earlier than white women, experience more severe and longer-lasting symptoms, and face higher rates of menopause-related depression. Yet despite this greater clinical need, Black women are less likely to be prescribed hormone therapy. These inequities raise serious concerns about race-based discrimination in health care and may implicate federal civil rights protections. Indigenous and People of Color may also encounter discrimination in menopause care.
Age is another concern. Providers may dismiss menopause-related symptoms because they assume someone’s symptoms are simply a normal part of aging, or because a patient is perceived as “too young” to enter menopause. This dismissal may also violate civil rights.
Sex-based symptom dismissal is also a significant concern. Research suggests that sex stereotypes can contribute to provider dismissal, minimization, or undertreatment of symptoms such as stress, anxiety, or aging, contributing to delayed diagnoses and undertreatment.
During the Biden Administration, NHeLP successfully advocated the U.S. Department of Health and Human Services to recognize that if a covered provider undertreats a patient’s pain based on the stereotype that women exaggerate their pain, the provider may violate Section 1557 of the Affordable Care Act. Nevertheless, many people covered by these protections remain unaware of their nondiscrimination rights and how to enforce them when they are violated. This underscores the importance of public education campaigns, “know your rights” efforts, and sufficient appropriations for civil rights enforcement activities.
Conclusion
Menopause is not an inconvenience. It is a significant health transition that deserves to be taken seriously. People should not have to fight discrimination or coverage gaps to receive appropriate care.
*Throughout this blog and within our work NHeLP strives to use gender inclusive language to accurately reflect the scope of people with various reproductive and sexual health care needs and related experiences. We employ “women” in limited instances when necessary to accurately reference legal terms or cisgender women-centered research and to honor how advocates or groups self-identify. More inclusive policy language and research is needed to better serve, understand, and illuminate the needs of all people who need equitable access to health care, including sexual and reproductive care.
