Takeaways
- Provider specialty and type strongly influenced prescribing patterns for menopause symptom management, with ob-gyn clinicians more likely to prescribe systemic estrogen and internal and family medicine clinicians more likely to prescribe SSRIs.
- Midwives and nurse practitioners prescribed systemic estrogen more often than attending physicians, while physician assistants, nurse practitioners, and residents were more likely to prescribe SSRIs.
- The findings highlight a lack of standardized menopause education across medical specialties, emphasizing the need for consistent training to improve patient care quality and treatment access.
Menopause affects up to 80% of women and represents a major physiological and psychosocial transition. Although menopausal hormone therapy (MHT) has proven effective in managing symptoms, its use has declined significantly in recent decades. A new study presented at The Menopause Society’s 2025 Annual Meeting in Orlando examined how provider type and specialty influence whether women receive prescription medication for menopause-related symptoms and what kinds of medications are prescribed.1,2
Researchers from Wake Forest University School of Medicine conducted a retrospective cohort analysis of data extracted from the electronic health records of a large academic health care system between January 1, 2016, and December 31, 2023. The cohort included 5,491 women aged 40 to 55 who had an outpatient encounter related to menopause, identified by International Classification of Diseases, 10th Revision (ICD-10) codes.
Variation in treatment by specialty and provider type
Among study participants, 64.4% were seen by obstetrics and gynecology (ob-gyn), 17.6% by internal medicine (IM), 12.4% by family medicine (FM), and 4.5% by endocrinology. Only 17.1% of the women received pharmacologic treatment for menopause symptoms. Of those treated, 34% received systemic estrogen, 47% received vaginal estrogen, and 16% received selective serotonin reuptake inhibitors (SSRIs).
Patients were most likely to receive systemic estrogen if treated by an ob-gyn. When compared with ob-gyn, patients seen by IM, FM, or endocrinology providers were significantly less likely to be prescribed systemic estrogen (odds ratios [ORs], 0.43 [95% CI, 0.29-0.64]; 0.50 [95% CI, 0.33-0.76]; and 0.16 [95% CI, 0.05-0.52], respectively). Conversely, patients seen by IM and FM providers were more likely to receive SSRIs (ORs, 1.89 [95% CI, 1.24-2.87] and 2.66 [95% CI, 1.77-3.99], respectively) compared with OB/Gyn providers.
Differences also emerged based on provider type. Patients were more likely to receive systemic estrogen from midwives (OR, 2.32 [95% CI, 1.42-3.77]) and nurse practitioners (NPs) (OR, 1.88 [95% CI, 1.43-2.48]) than from attending physicians. SSRIs were more often prescribed by physician assistants (PAs) (OR, 2.60 [95% CI, 1.70-3.97]), NPs (OR, 2.99 [95% CI, 1.95-4.60]), and residents (OR, 2.10 [95% CI, 1.06-4.20]) than by attending physicians.
