Menopause Status, Symptoms Remain Inconsistently Documented

Menopause status, reproductive stage, and symptoms remain inconsistently captured across electronic health record (EHR) systems, according to a scoping review published in Menopause. Researchers from the University of Minnesota, the University of Wisconsin-Milwaukee, and the University of California, San Francisco, reviewed 19 studies to examine how menopause-related data are structured and operationalized within EHR-based research.¹

The review found that most studies identified menopausal status using age ranges, diagnostic codes, or proxy indicators such as hormone therapy (HT) prescriptions, rather than structured reproductive-stage documentation.¹

A Growing Population, an Incomplete Record

Approximately 1.3 million women in the United States enter the menopause transition each year, and by 2025, an estimated 1.1 billion women worldwide are expected to be postmenopausal. Natural menopause typically occurs between ages 45 and 55 years, with an average age around 51 in the United States. Despite the size of this population, the review authors noted that best practice guidance for documenting menopause status and symptoms in EHRs remains limited.¹

To identify eligible studies, the research team searched Ovid MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and IEEE Xplore for studies published between January 2004 and March 2026, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.¹

Of 472 records identified, 19 studies met inclusion criteria, with publication years ranging from 2013 to 2026. Most used a retrospective cross-sectional design, and seven of the 19 studies were conducted within the Veterans Health Administration (VA), which historically used a unified EHR platform across its facilities. Sample sizes across the included studies ranged from 45 to 307,512 women, and most were rated level 3—nonexperimental or qualitative evidence—on the Johns Hopkins Evidence-Based Practice model.¹

Only 2 of the 19 studies explicitly classified participants as postmenopausal using EHR-based staging criteria. The rest relied on age thresholds, diagnostic codes, or medication proxies, and few studies differentiated perimenopause from postmenopause. Key data points such as last menstrual period and final menstrual period (FMP) were rarely available as structured, extractable fields—even when documented somewhere in narrative clinical notes.¹

Documentation Gaps Dominate the Literature

Thematic analysis of the 19 studies identified three interconnected patterns: documentation limitations (10 studies), undertreatment of menopause (6 studies), and underreporting of symptoms (3 studies).¹

Documentation limitations were the most frequently identified theme and included the absence of structured menopause-specific data fields, a mismatch between under-coded structured data and narrative text, and constraints on establishing the timing of menopause onset.¹

As an example, the review authors pointed to genitourinary syndrome of menopause (GSM). Although the term has replaced "postmenopausal atrophic vaginitis" in current clinical consensus statements, no distinct International Classification of Diseases, Ninth or Tenth Revision (ICD-9/ICD-10), code for GSM exists, so coding in the included studies still relied on that legacy terminology.¹

When Symptoms Go Undertreated

The undertreatment theme showed how documentation gaps carried clinical consequences. In a VA-based study by Cordasco et al, approximately 58% of cases met documented guideline-based prescribing criteria for hormone therapy, though elements such as treatment indications and contraindications were frequently absent from the EHR documentation. In another VA study, by DePree et al, nearly 40% of women with documented bothersome symptoms had no prescription therapy recorded, and 13% had no treatment documented at all.¹

A study by Bevry et al found that only a minority of women with patient-reported moderate to severe vasomotor symptoms had those symptoms captured in structured EHR fields, and even fewer received hormone therapy or nonhormonal treatment. In a study of women veterans, Blanken et al found that only 5% had documented menopause symptoms in the EHR despite known higher symptom prevalence in that population, with documentation disparities also emerging across racial and ethnic groups.¹

A separate study of women veterans with chronic pain, by Gibson et al, found that documented menopausal symptoms in the EHR were associated with significantly higher odds of long-term and high-risk opioid prescribing, illustrating how structured menopause documentation can shape downstream treatment patterns.¹

The underreporting theme centered on how symptom information is lost before it reaches structured fields. In a study by Kleinman et al, menopause symptoms were identified solely through ICD-9 claims codes (627.xx), capturing only women who sought care and received a diagnosis. The study authors acknowledged that women with undocumented symptoms were likely misclassified as controls, leading to conservative estimates of symptom burden. In a study by Sussman et al, EHR findings showed lower symptom prevalence than what was reported in surveys and interviews, signaling systematic under-capture within the record.¹

Toward Standardized Menopause Data Elements

The review authors concluded that improving menopause care "requires upstream data infrastructure solutions rather than downstream analytic corrections." They called for the development of a minimum viable set of structured menopause common data elements—including reproductive stage, FMP, symptom type and severity, and treatment status—to strengthen documentation, improve interoperability across systems, and support reliable longitudinal research.¹

"The authors conclude that broader standardization and implementation of validated screening tools within EHRs can enhance clinical care by standardizing staging, informing treatment protocols, facilitating early recognition and management of symptoms, enabling assessment of treatment response, and educating patients about modifiable risk factors during a critical period in women's lives," Monica Christmas, associate medical director for The Menopause Society, said in a news release.²

"In addition to the clinical relevance, addressing the menopause data gap can also inform research by improving the comparability of treatments and interventions across more homogeneous populations," Christmas said.²

Where Pharmacists Fit In

The review's findings carry direct implications for pharmacists, who are often a consistent point of contact for midlife patients managing menopause symptoms and treatment.

A related systematic review, published in Post Reproductive Health, examined community pharmacy-led interventions for peri- and postmenopausal health and identified only 2 qualifying studies, both rated low quality overall. In one, community pharmacists in Malaga, Spain, performed bone ultrasound screening among 100 postmenopausal women and found that 11% were at risk of developing osteoporosis and 61% were at risk of developing osteopenia. Of the women identified at risk of osteoporosis, 6 (54.6%) were recommended for pharmacological treatment by their physicians.³

In the other, pharmacists at 7 community pharmacies in New York delivered a structured menopause education program that produced significant improvements in patients' Management of Menopause survey scores, from a baseline median of 54.2 to 86.1 at 3 months (P<.001) and 89 at 1 year (P=.001).³

Some pharmacists already practice within dedicated menopause care teams. At the Menopause Clinic at the Lois Hole Hospital for Women in Edmonton, Alberta, a pharmacist with additional prescribing authority is part of an interdisciplinary team that also includes a family physician, a gynecologist, nurses, and a dietitian.⁴

The clinic's pharmacist, Nesé Yuksel, BScPharm, PharmD, FCSHP, NCMP, has held prescribing authority since early 2008 and uses it to initiate prescriptions and modify treatment or adjust doses—including for hormone therapy, antidepressants, and sleeping aids—based on patient response.⁴

Incorporating structured menopause fields into certified EHR systems could enhance continuity of care, support systematic symptom assessment, and generate higher-quality real-world data to inform treatment decisions and equitable women's health research, the scoping review authors concluded.¹

REFERENCES

1. Austin RR, Lalich MB, Song M, Holt JM, Gibson C. Bridging the menopause data gap: a scoping review of status, symptoms, and trends in electronic health records. Menopause. Published online September 1, 2026. doi:10.1097/GME.0000000000002868

2. The Menopause Society. Menopause remains inconsistently documented in electronic health record systems. News release. The Menopause Society. September 1, 2026. Accessed September 3, 2026. https://menopause.org/press-releases/menopause-remains-inconsistently-documented-in-electronic-health-record-systems

3. Chow H, Righton O, Berry H, Bell Z, Flynn AC. A systematic review of community pharmacy interventions to improve peri- and post-menopausal health. Post Reprod Health. 2024;30(1):55-63. doi:10.1177/20533691231223681

4. Practice spotlight: pharmacist practice in an outpatient menopause clinic. Can J Hosp Pharm. 2012;65(1):43-44. doi:10.4212/cjhp.v65i1.1103