After the release of a major study in 2002 that linked hormone therapy for menopause to chronic diseases, the use of such treatments among women in midlife dropped sharply. According to Dr. Rajita Patil, an OB-GYN at UCLA Health, this led to a long period during which both research and care for menopause stagnated.
“Progress in this field ground to a halt for 20 years,” Dr. Patil said. “It made people fearful to where doctors basically stopped writing prescriptions.” By 2020, fewer than one in twenty women in midlife were using hormone therapy.
Interest in menopause is now increasing, with more public discussion and demand for care. “I definitely think menopause is having a moment,” Dr. Patil said. “More women have realized that they don’t have to stay silent and they don’t have to suffer. That increased awareness has driven a huge increase in demand for care.”
Dr. Patil started the Comprehensive Menopause Care program at UCLA to address these needs by offering evidence-based, multidisciplinary support throughout the transition through menopause.
She explained that part of the renewed attention came after media coverage revisited the original Women’s Health Initiative (WHI) study from 2002, which had reported higher risks of cardiovascular disease, stroke, breast disease and blood clots among women taking hormone therapy.
Dr. Patil noted several issues with how the WHI study was conducted: “For one thing, it wasn’t really studying the population of people who used hormone therapy to treat menopause symptoms — people in their 40s and 50s, mainly. The average age of study participants was 65.” She added that reintroducing estrogen after many years without it can pose different risks compared to starting treatment earlier.
She also pointed out that while there was some increased risk found by the study—less than ten additional cases per ten thousand women—the risk level is considered very low. Later analysis showed no increased risk among women who began hormone therapy in their early fifties.
The lack of access to effective treatment over two decades has affected many women dealing with significant symptoms during busy periods of their lives at home and work. Dr. Patil described how patients often seek relief but may struggle to find knowledgeable providers: “We have knowledgeable providers who are practicing evidence-based medicine, but not nearly enough of us… The lack of access to competent providers has created a space for major confusion, misinformation and misconception.”
She addressed misconceptions about individualized hormone testing: “There’s no magic hormone level we’re trying to achieve… That’s why the best evidence-based care is still focused on managing and treating clinical symptoms, and on the constellation of factors that each patient brings in, from genetics to lifestyle to family history.”
To improve consistency and quality of care at UCLA’s program, Dr. Patil developed an assessment system called MAPSS (Menopause Assessment and Pathways Support System). This system uses digital questionnaires before appointments so clinicians can focus on decision-making rather than collecting basic information during visits.
“We created the UCLA Menopause Assessment and Pathways Support System (MAPSS) to ensure that every patient — regardless of background, health literacy or prior access to care — receives the same high‑quality, comprehensive menopause evaluation,” she said.
The program includes specialists across multiple disciplines such as cardiology, sleep medicine, cognition, mental health and endocrinology; together they designed eleven clinical pathways covering all aspects affected by menopause.
Efforts are underway within University of California campuses statewide as well as policy proposals at state government level aimed at expanding training opportunities for physicians treating menopausal patients over forty years old.
“On the training side at UCLA we added menopause as one of the core components for OB-GYN residency… A major reason we’ve been able to grow is our commitment to training the existing OB/GYN and primary care workforce,” Dr. Patil stated.
Last year California allocated three million dollars specifically for expanding perimenopause and menopause services across UC campuses—a move intended both broaden access statewide and standardize high-quality care throughout California.
