Study Finds Menopause Missing From 93% of Women's Electronic Health Records

Nearly 400,000 women. One basic biological fact. Missing from the medical record 93 percent of the time.

A University of Colorado Anschutz study published in the journal Menopause analyzed data from 395,912 women enrolled in the National Institutes of Health's All of Us Research Program. Researchers compared what women told surveyors about their own menopause status against what actually appeared in their electronic health records (EHRs). The gap was enormous.

The Numbers

Survey responses identified roughly 193,000 reports of menopause among participants. Electronic health records captured only about 28,000 menopause diagnoses. That's nearly seven times fewer records than reports, according to the study's lead author, Audrey Hendricks, an associate professor of bioinformatics at CU Anschutz.

Overall, menopause was documented in EHRs for just 7 percent of women in the dataset. Narrow the lens to women who explicitly told surveyors they'd gone through menopause, and only about 14 percent of them had that status recorded in their chart, Hendricks told Newsweek.

The records that did exist were generally accurate. Women with a menopause diagnosis on file almost always also reported menopause in the survey. The problem wasn't bad documentation. It was no documentation.

Why It's Not There

Hendricks put the reason plainly: "The biggest reason is we don't ask." Menopause isn't tracked like blood pressure or weight, which get logged in standardized fields at every visit. It often only makes it into a chart if a patient brings it up herself, and even then it may end up buried in a physician's free-text notes rather than a searchable field.

Age at menopause, a detail researchers say matters for studying long-term chronic disease risk, was frequently missing from both EHRs and survey data alike, according to the CU Anschutz research team.

Hendricks summed up the stakes: "Ultimately, we cannot study what we do not measure. We cannot treat what we do not know."

Why It Matters

Menopause is a physiological transition tied to cardiovascular, metabolic, skeletal and neurological health. Large federal data programs like All of Us exist specifically to cross-reference self-reported health information with clinical records so researchers can study exactly these kinds of questions. But that only works if the underlying data is actually there. Right now, for menopause, it mostly isn't.

The Political Backdrop

The timing lines up with a separate development in Washington. Democratic Senator Kirsten Gillibrand of New York is leading what The New York Times described as the first-ever congressional hearing on menopause, scheduled for this week. Gillibrand wants federal funding directed at menopause research, arguing the lack of treatment options and attention affects an estimated 75 million people.

Sceptics of expanding federal health spending have a reasonable point that Washington doesn't need a new grant program every time a research gap gets discovered. A Democratic senator spotlighting a health issue in the middle of a midterm election cycle, as the Times itself framed it, deserves scrutiny for political motive as much as substance.

That skepticism doesn't undercut the CU Anschutz findings, though. This isn't a case where researchers are asking for a bureaucracy. Doctors aren't asking the question at annual physicals, and EHR software doesn't have a standard field to record the answer when a patient volunteers it. That's a documentation and workflow problem, not an ideological one, and it would need fixing whether or not a Senate hearing happens.

A Related Supply Problem

The documentation gap isn't the only menopause-care issue in the news this month. Women have struggled for nearly a year to find estrogen patches, even as the FDA maintained there was no shortage. The American Society of Health-System Pharmacists has tracked close to 20 estrogen patch formulations affected, double the number from earlier this year. The FDA has since acknowledged access problems and says it is working with six manufacturers to boost supply.

What Happens Next

Hendricks says the study's findings will help other researchers using All of Us data define menopause-related study populations and design better studies going forward. Whether that fixes the underlying problem—doctors not asking and charts not having a field to answer—is a separate question. No federal mandate currently requires standardized menopause documentation in EHRs, and no such rule was announced or proposed in the sources reviewed. Gillibrand's hearing this week may be the first place that idea gets a formal airing in Congress.