Building an EHR Pathway to Support Menopause Care in Primary Care

Primary care clinicians want to manage menopause, but they need a simple, safe algorithm and a human backstop when questions come up, according to Arina Chesnokova, MD, MPH, assistant professor of obstetrics and gynecology at the University of Pennsylvania.

At The Menopause Society 2026 Annual Meeting, held October 20-24 in San Diego, California, Chesnokova presented an electronic health record (EHR) study showing that menopause was coded in only 7.8% of 666,606 outpatient family medicine, internal medicine, and general obstetrics and gynecology (OB/GYN) encounters among women aged 45 to 60 years in the University of Pennsylvania Health System. Only 17.7% of women had a menopause medication prescribed at their first menopause-coded visit.¹

To understand why, Chesnokova and colleagues interviewed nearly 30 primary care clinicians in her health system; those findings have not yet been published. "Most primary care clinicians were like, I would love to do it more. I do think that it belongs in the primary care space," she said. Many described fumbling when patients asked for menopause care. That echoes a 2019 survey of 183 residents in family medicine, internal medicine, and OB/GYN, in which only 6.8% felt adequately prepared to manage menopause.²

The team is now preparing to launch a menopause pathway built on AgileMD, a clinical decision support platform used within Epic. The flowchart asks whether a patient has a uterus, her age, her breast cancer risk, and whether she has contraindications to hormone therapy, then leads to an evidence-based prescription or a referral.³

Chesnokova also describes what clinicians asked for: clickable orders, prewritten patient education, and a specialist to catch cases that fall outside the algorithm. "The algorithm can't exist by itself without...a little bit of a cushion, human cushion as well," she said.

Watch the video to hear how the pathway is designed to fit into a busy primary care visit.

References

1. Chesnokova A, Bayes B, Blady S, Hamm R. Patterns of menopause diagnosis and prescribing in a large academic health system. Poster presented at: The Menopause Society 2026 Annual Meeting; October 20-24, 2026; San Diego, CA. Abstract P-19.
2. Kling JM, MacLaughlin KL, Schnatz PF, et al. Menopause management knowledge in postgraduate family medicine, internal medicine, and obstetrics and gynecology residents: a cross-sectional survey. Mayo Clin Proc. 2019;94(2):242-253. doi:10.1016/j.mayocp.2018.08.033
3. The 2022 Hormone Therapy Position Statement of The North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028