New Study Shows Menopause Undercoded in Primary Care, With Gaps by Race and Insurance

Menopause is coded at a fraction of the rate its symptoms would predict in primary care, and the gap is widest among racially minoritized and publicly insured women, 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 a retrospective electronic health record (EHR) study of 666 606 outpatient family medicine, internal medicine, and general obstetrics and gynecology (OB/GYN) encounters among 109,937 women aged 45 to 60 years in the University of Pennsylvania Health System from January 2022 to April 2026.¹ Only 7.8% of encounters included a menopause ICD-10 code, and 28.0% of women ever had a menopause-coded visit.

"We know, for instance, hot flashes and night sweats are experienced by at least 80% of folks who go through the menopausal transition," Chesnokova said. Coding, she added, is "nowhere close to reflective of the symptomatology that people experience."

In adjusted analyses, non-Hispanic Black women had lower odds of a menopause-coded visit than non-Hispanic White women (OR, 0.62; 95% CI, 0.60-0.65), as did Asian and Hispanic women. Medicaid, Medicare, and no insurance were each linked to lower odds than private insurance.¹ The racial gap stands out because Black women have the longest duration of vasomotor symptoms, a median of 10.1 years in the Study of Women's Health Across the Nation.² OB/GYN encounters were nearly 4 times as likely as family medicine encounters to include menopause coding (OR, 3.88; 95% CI, 3.73-4.04).¹

Chesnokova points to several likely contributors, including racism, comorbidities that crowd short visits, and differences in how patients advocate for themselves. She also explains why her team set out to establish a baseline and why she believes routine menopause care belongs in primary care.

Watch the video to hear Chesnokova discuss what may be driving these gaps.

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. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-539. doi:10.1001/jamainternmed.2014.8063