Menopause Diagnoses Documented in Just 7.8% of Midlife Women's Outpatient Visits, Study Finds

Menopause-related diagnoses were documented in fewer than 8% of outpatient encounters among midlife women, with significant differences in coding by clinical specialty, race, and insurance status, according to a retrospective study presented at The Menopause Society 2026 Annual Meeting, held October 20-24 in San Diego, California.¹

In an analysis of 666 606 encounters involving nearly 110 000 women, obstetrics/gynecology visits were nearly 4 times as likely as family medicine visits to include a menopause-related diagnosis code (adjusted odds ratio [OR], 3.88; 95% CI, 3.73-4.04). Overall, only 7.8% of encounters included menopause coding, while 28% of patients had at least 1 menopause-coded visit during the study period.¹

The findings suggest potential gaps in menopause documentation across outpatient care settings, particularly in primary care, where clinicians frequently manage symptoms associated with the menopause transition.

Investigators led by Arina Chesnokova, MD, MPH, of the University of Pennsylvania Health System, analyzed electronic health record data from outpatient family medicine, internal medicine, and general obstetrics/gynecology visits between January 2022 and April 2026. The study included female patients aged 45 to 60 years at cohort entry, with subsequent encounters retained regardless of age. Specialist visits were excluded.¹

The analytic cohort included 109 937 patients with a mean age of 52.6 years. Most were non-Hispanic White (58.2%), followed by non-Hispanic Black (20.8%), non-Hispanic Asian (7.6%), and Hispanic (5.1%) participants. Private insurance was reported for 86.8% of participants, while 8% had Medicaid.

Menopause-related encounters were identified using selected ICD-10 diagnosis codes, including those for menopausal and perimenopausal disorders, postmenopausal status, and long-term hormone replacement therapy use. Investigators used multivariable logistic regression to identify factors associated with menopause coding and examined prescribing patterns at the index menopause encounter.¹

Racial, Insurance Disparities Identified in Menopause Coding

Overall, 51,932 encounters (7.8%) included a menopause-related diagnosis, and 30,787 patients (28%) had at least 1 menopause-coded visit during the study period.

After adjustment, older age was associated with slightly greater odds of a menopause-coded encounter (OR, 1.03 per year; 95% CI, 1.02-1.03). However, significant differences emerged across racial and ethnic groups.

Compared with non-Hispanic White patients, the adjusted odds of a menopause-coded encounter were lower among:

• Non-Hispanic Black patients: OR, 0.62 (95% CI, 0.60-0.65).
• Non-Hispanic Asian patients: OR, 0.83 (95% CI, 0.78-0.87).
• Hispanic patients: OR, 0.89 (95% CI, 0.83-0.95).
• Patients with unknown or declined race/ethnicity: OR, 0.76 (95% CI, 0.70-0.81).

Insurance status was also associated with menopause coding. Compared with privately insured patients, those with Medicaid (OR, 0.72; 95% CI, 0.68-0.77), Medicare (OR, 0.74; 95% CI, 0.69-0.80), or no insurance (OR, 0.63; 95% CI, 0.52-0.76) had significantly lower odds of a menopause-coded encounter.¹

Clinical specialty was another strong predictor. Obstetrics/gynecology encounters were nearly 4 times as likely as family medicine encounters to include menopause coding (OR, 3.88; 95% CI, 3.73-4.04). Clinician role, however, was not associated with coding after adjustment, with no significant difference between advanced practice practitioners and physicians (OR, 1.00; P=.86).

The observed disparities suggest that menopause-related conditions may be documented differently across patient populations and clinical settings. However, because the analysis relied on diagnosis codes, it could not establish whether patients without menopause coding had symptoms that were unrecognized, undiscussed, or treated without a corresponding diagnosis.

Fewer Than 1 in 5 Patients Received Menopause Medication

Among patients evaluated at their index menopause-coded encounter, 5195 (17.7%) received a prescription for a menopause-related medication. Of these, 3637 (12.4%) received HT or CC, 1603 (5.5%) received nonhormonal therapy, and 45 (0.2%) received both.¹

Investigators also identified 3989 patients (13.6%) with a documented contraindication to HT by the index encounter. Among those with contraindications, 153 (3.8%) received HT or CC and 312 (7.8%) received nonhormonal treatment.

Among patients without documented contraindications, 1246 (4.9%) received nonhormonal therapy.

In mutually exclusive prescribing categories, 82.3% of patients received no medication at their index menopause-coded encounter, 11.9% received HT or CC without a documented contraindication, and 0.5% received HT or CC despite a documented contraindication. Another 4.2% received nonhormonal therapy without a documented HT contraindication, while 1.1% received nonhormonal therapy with a contraindication.¹

The researchers characterized some of these patterns as potentially guideline-discordant, although the presence or absence of an HT contraindication alone does not determine treatment appropriateness. Nonhormonal therapies may be appropriate for women who prefer to avoid HT, while prescribing decisions also depend on symptom severity, individual risk factors, patient preferences, and clinical indications.

Hormone Prescribing With Contraindications Increased Over Time

One of the study's most notable findings was an increase in the rate of HT or CC prescribing among patients with documented contraindications.

After adjustment for annual encounter volume, prescribing rates increased from 3.2 per 10,000 encounters in 2022 to 14.8 per 10,000 in 2025. The rate reached 23.1 per 10,000 encounters through April 2026, although data for that year were incomplete.

Poisson regression showed a significant annual increase in HT or CC prescribing among patients with contraindications (incidence rate ratio per year, 1.64; 95% CI, 1.54-1.75; P<.001).¹

The findings raise questions about how contraindications are identified and incorporated into treatment decisions in routine outpatient care. However, the abstract did not specify the types of contraindications documented, the indications for individual prescriptions, or whether the prescriptions represented new treatment initiation or continuation of existing therapy.

Implications for Menopause Care in Primary Care

The findings underscore opportunities to improve menopause assessment, documentation, and treatment decision-making in primary care, where women may present with vasomotor symptoms, sleep disturbances, genitourinary symptoms, or other concerns associated with the menopause transition.

The substantially higher odds of menopause coding in obstetrics/gynecology compared with family medicine also suggest potential differences in how menopause-related conditions are identified and documented across specialties.

However, low coding rates should not be interpreted as equivalent to low rates of menopause assessment or treatment. Similarly, the absence of a medication prescription at an index encounter does not necessarily indicate undertreatment, as some patients may not require pharmacotherapy or may prefer nonpharmacologic management.

For clinicians, the findings reinforce the importance of documenting menopausal symptoms, evaluating individual indications and contraindications before prescribing HT, and incorporating patient preferences into shared treatment decisions.

The investigators concluded that menopause was infrequently coded in outpatient primary care and general obstetrics/gynecology visits, with lower coding rates among racially minoritized and publicly insured patients. They also highlighted the increasing rate of HT or CC prescribing among patients with documented contraindications as an area warranting further evaluation.

The authors called for health-system interventions to support more equitable, evidence-based menopause care, including improvements in clinical documentation and prescribing practices.

Reference

1. Chesnokova A, Bayes B, Blady S, Hamm R. Patterns of menopause diagnosis and prescribing in a large academic health system. Poster P-19. Presented at: The Menopause Society 2026 Annual Meeting; October 20-24, 2026; San Diego, CA.