• The social media discourse on menopause largely neglects the importance of individualized management.
• A panel of expert physicians shared practical ways clinicians can approach conversations with patients.

Providing perimenopausal and menopausal patient care can be challenging, even for seasoned clinicians.

In a 2024 JAMA Health Forum study, researchers noted that the prevalence of menopausal hormone therapy (MHT) use declined from 26.9% of postmenopausal women in 1999 to 4.7% in 2020, creating an environment in which many healthcare professionals today lack the training and experience to prescribe MHT as a treatment option for menopausal symptoms.

In early 2026, extensive lay media coverage of the FDA’s labeling changes for menopausal hormone therapy products brought this topic to the forefront of public discourse. Patients using social media will find both increased discussion about menopause symptoms and hormonal treatments as well as concomitant skepticism around hormones in general. A mix of facts and misinformation online can make it harder for patients to understand the role of MHT and to weigh risks, benefits and alternatives.

In addition to confusing the public (and clinicians) with polarized portrayals of treatment options, the social media discourse on menopause largely neglects the importance of culturally competent, individualized management. To address this concern, a panel of expert physicians specializing in both sexual and reproductive healthcare and health equity recently convened to discuss individualized, equitable healthcare for patients in the menopause transition and beyond. This article summarizes those insights and highlights practical, actionable ways clinicians can approach conversations with patients who are perimenopausal and menopausal.

What are the barriers to equitable, individualized menopause care in our current healthcare system? Our panel elucidated multifaceted issues including:

Cultural stigma. In many communities, there is cultural silence surrounding reproductive health in general, making it less likely for patients to bring up menopause-related concerns during clinical visits. Cultural narratives may exist that minimize or stigmatize menopause, and menopause may be considered a private or shameful topic, leading patients to avoid discussing symptoms such as night sweats or brain fog with their clinicians.

Provider constraints. As mentioned previously, clinicians who completed training recently or those who trained outside of women’s health may be woefully unprepared to address menopause concerns and treatment options. A survey of trainees across primary care disciplines, including obstetrics and gynecology, found that about 7% of respondents felt prepared to manage menopause symptoms in their patients. In addition, providers often lack the time during routine visits to address menopause symptoms comprehensively, especially when there are multiple competing priorities in a single visit.

Lack of representation. There is a scarcity of culturally relevant menopause information in lay and social media, particularly for non-English speakers and women of color. One Spanish-speaking panelist noted that despite having a bilingual social media feed, she has never seen a menopause influencer speak a language other than English. She also recognized the limited representation of women of color among menopause specialists like OB/GYNs, which can sometimes cause patients to avoid reporting sensitive sexual health symptoms to clinicians who may not feel relatable in the patients’ cultural contexts.

Systemic access problems. Financial barriers and limited clinician availability disproportionately affect minority and rural communities. One panelist noted that specialized menopause centers in urban areas are often only available to privately insured patients, thus disproportionately limiting care for publicly insured and uninsured patients. Another panelist in a midsized city shared that because she offers longer visits to provide better care for patients, an unintended consequence is a 4-month wait time for her appointments.

Recognizing these and other barriers to care, how can clinicians approach patients in ways that mitigate factors negatively impacting menopause care utilization?

Makeba Williams, MD, FACOG, MSCP, wrote the first patient-centered, culturally responsive framework for menopausal patient care. The first principle in this framework is “cultural curiosity,” which Williams describes as humble recognition that clinicians and patients do not share the same unique cultural identities, and clinicians can provide better care when they understand individual patients’ beliefs, customs and values.

The second principle, “respectful query,” recognizes that not only are patient identities unique, but their menopause journeys are unique as well. To apply this principle, clinicians can inquire about individual symptom patterns, health beliefs and healthcare decision-making processes.

The framework’s final principle, guided by the first two principles, is “connected care”: prioritizing shared decision-making after reviewing patient preferences and available treatment options. Importantly, healthcare professionals should recognize that some patients may not be interested in certain treatment options despite their efficacy.

Using the framework described by Williams above, the panelists then considered a hypothetical case: A 52-year-old Black woman presents for a wellness visit and reports her last menstrual period occurred about 16 months ago. Upon review of the intake form, the clinician notes that the patient did not raise any menopausal concerns when speaking with the medical assistant.

Cultural curiosity: The panel discussed several reasons why a patient may be hesitant to speak with a provider about menopausal symptoms, including cultural silence, mistrust of the medical establishment, embarrassment if symptoms are sexual in nature (such as dyspareunia or low libido), family or cultural beliefs that menopause symptoms should be tolerated without treatment, and concerns about treatment side effects or cost.

Clinicians may fear they appear to lack knowledge if they ask questions about patients’ cultural identities, but cultural curiosity can demonstrate humility and reduce power imbalances in the clinician/patient relationship, thus increasing patient trust. One panelist pointed out that clinicians can both educate patients and share vulnerability by discussing shifts in menopause care over time. For example, a clinician could discuss how scientific understanding of treatment options for menopause management has changed dramatically over the past 3 decades and describe the need for continuing education on menopause to better care for patients, creating a sense of shared experience and solidarity with the patient journey.

Respectful query: Panelists stressed the importance of cultural humility plus empathetic, respectful query to build rapport with patients. The clinician might say to our hypothetical patient, “I see that your last menstrual period was more than a year ago. The medical definition of menopause is 12 months without any bleeding, which means that you are menopausal. Would you like to talk more about that today?”

Assuming the patient agrees, Williams suggests several initial questions to better understand the patient’s cultural context:

• Have you ever had a conversation about menopause with friends or family? What did you talk about?
• Where did you learn about menopause?
• How do you feel about going through menopause?

The physicians emphasized the need to normalize talking about menopause, validate patients’ concerns or fears about the menopause transition and/or treatment options, and educate patients about both potential common symptoms and the individuality of the menopause experience.

A panelist discussed that respectful query is an important component of comprehensive history-taking in her clinical practice, which serves an immigrant and Latina patient population. Williams’s sample questions — “How do you manage your menopause symptoms?” and “Are there foods, herbs or behaviors that increase or decrease your menopause symptoms?” — sometimes reveal use of complementary and alternative medicine, including MHT products obtained over the counter from family members abroad that would require a prescription in the United States. Often, these patients are unsure of exactly what medication they are receiving from family members and, thus, may not mention it during patient intake.

The patient shares that her parents were born outside of the United States and “we didn’t talk about periods in my family.” When asked about potential menopause symptoms, she states that over the past year she has experienced worsening hot flushes that interrupt her work performance and her sleep, causing fatigue. She also shares that an older cousin was recently diagnosed with breast cancer, and some family members attributed the cancer diagnosis to the cousin’s prior use of hormones. The patient is unsure what type of hormones the cousin took (contraception v s. MHT).

Connected care: After building trust with cultural curiosity and respectful query, the clinician and patient can then work together to individualize a care plan that improves menopausal symptoms while respecting the patient’s cultural beliefs and treatment goals. Williams describes the importance of standardizing the opening care plan discussion, promoting equitable access to both information and treatment options. For our panelists, the universal components of this initial discussion include:

• empathic validation of the patient’s symptoms to normalize the menopausal experience;
• recognition that many communities and families have not historically discussed the menopause transition;
• acknowledgement that information about menopause and menopause treatments from friends, family and social media may be conflicting;
• explanation that the scientific body of knowledge regarding menopause and hormonal treatment of menopause has evolved over the past decades; and
• information on a broad range of menopausal treatment options — both hormonal and nonhormonal — while acknowledging that the patient may not be interested in certain options, since menopause care is not “one size fits all.”

For patients without contraindications, this discussion of management options will include MHT as an effective treatment for many symptoms of menopause. However, patients may approach this discussion with preconceived perceptions of MHT. First, clinicians must recognize and acknowledge the history of reproductive oppression and coercion of certain communities of color and other marginalized groups in the U.S. that has created decades of distrust of the U.S. medical system in general, and hormonal therapies specifically. Second, patients are receiving potentially conflicting MHT information and misinformation from many sources, including social media, but first- and second-generation Americans may also be following contradictory guidance and recommendations from medical systems outside the U.S., further increasing confusion on this topic.

Advances in the scientific body of knowledge surrounding menopause have created confusion about the risks, benefits and alternatives for MHT for both patients and their clinicians. Like many patients, our hypothetical patient voices her family’s concerns about MHT and cancer risk. One panelist described her practice of using straightforward education to address fears about hormone therapy, including explaining the history and evolution of hormone research, validating patient concerns about both misinformation and actual risks of MHT, addressing the risk/benefits/alternatives of MHT, and providing context about past studies like the Women’s Health Initiative trial. In contrast to those patients with doubts about MHT, other patients come from a sociocultural context — both live and online — in which MHT is painted as a cure-all for every woman in any stage of the menopause transition. These pro- and anti-hormone biases create confusion for patients and extra work for clinicians who must clear up patients’ misunderstandings, provide evidence-based care, and be transparent about research gaps specific to diverse populations.

In closing, our panelists emphasized the importance of providing culturally competent care while actively listening to patients to ensure treatment plans are feasible and aligned with patient values. Suggestions for putting these ideas into practice included:

• Participate in cultural sensitivity training to improve provider-patient communication and ensure care is respectful of diverse backgrounds.
• Evaluate the possibility of adjusting appointment scheduling to allow more time for menopause visits, allowing patients to discuss sensitive topics at their own pace.
• Ensure providers are educated to ask patients about complementary and alternative medications, including treatments obtained from outside the U.S., and understand relevant cultural practices impacting menopause care.
• Consider standardizing care by utilizing position statements, toolkits or decision support tools such as: Menopause Practice: A Clinician’s Guide from The Menopause Society; Therapy Position Statements from The Menopause Society; The 2023 Practitioner's Toolkit for Managing Menopause; MQ6 Interactive Treatment Algorithm from the Canadian Menopause Society.
• Incorporate cost considerations into menopause treatment planning, including offering affordable options when hormone therapy or other expensive medications are not accessible.
• Provide menopause care resources that address healthcare literacy, language barriers and access issues for underrepresented communities.

While providing menopause care in the age of social media may be challenging, excellent patient care always emphasizes trust and collaboration between patient and clinician. Taking a few extra minutes to express cultural curiosity through respectful query can uncover patient beliefs and motivations that may have otherwise gone unknown. When patient beliefs and cultural practices are then incorporated into treatment planning, connected care is the result.

Kristen Feldman, MD, FACOG, BCMAS, is a board-certified OB/GYN and vice president of medical affairs at Afaxys. She can be reached at womenshealth@healio.com.

Donna Adams-Pickett, PhD, MD, FACOG, is a board-certified OB/GYN, owner of Augusta Women's Health & Wellness Center and CEO of Four Girls For Girls Foundation and Afya Partners in Health Equity and Health Education.

Serina Floyd, MD, MSPH, FACOG, is a board-certified OB/GYN and chief medical officer at Planned Parenthood of Metropolitan Washington DC.

Ann Schutt-Ainé, MD, FACOG, is a board-certified OB/GYN and associate professor in the department of OB/GYN at Baylor College of Medicine.

Melissa Martinez-Adorno, MD, CPE, FACOG, is the women’s health medical director at the VA Medical Center in Manchester, New Hampshire.