California plans US$3.4m menopause care overhaul

California plans US$3.4m for menopause care, screening and treatment access in a budget proposal advocates say could begin to close care gaps.

If approved by the legislature through the budget process, the proposal would require menopause screening for all women from age 40, direct health plans to expand coverage of FDA-approved menopause treatments, meaning treatments cleared by the US regulator, “as medically necessary”, fund menopause services, education and awareness programmes, and allow clinicians to receive continuing education credit for completing menopause training.

The proposal follows governor Gavin Newsom twice vetoing similar legislation in recent years, citing cost and insurance coverage concerns.

In October, when he vetoed a bipartisan bill seeking similar changes, he said he supported better care but directed state agencies to explore alternatives through the budget process.

Newsom said in a statement last month that the proposal “will expand access to essential, evidence-based care in a way that’s affordable and fiscally responsible”.

Assemblymember Rebecca Bauer-Kahan, who authored two of the vetoed bills, supports the budget proposal but has raised concerns that it does not apply to Medi-Cal, the state’s health insurance programme for low-income residents.

The 7.6 million women and girls served by Medi-Cal are disproportionately Latina and Black.

“That is a gaping hole in this, just so we are clear,” Bauer-Kahan said.

“That will be one of the next fights.”

For Bauer-Kahan, 47, the policy grew out of personal experience.

She said: “It started by being a perimenopausal woman who couldn’t get care. I was going through this and started talking to friends and others about it, and I realised it was more pervasive than I previously understood.”

Experiencing severe brain fog, which can mean problems with memory and concentration, she sought care from multiple doctors who reassured her nothing was wrong, leaving her worried about early onset Alzheimer’s because of intense forgetfulness.

Relief came only after visiting a menopause specialist.

“He sent me a questionnaire that was pages long about my symptoms, and I was tearing up,” she said.

“When I finally got the care I needed, it was game-changing. I feel like myself again.”

Menopause happens after a woman has gone 12 consecutive months without a menstrual cycle, though the transition usually begins years earlier in perimenopause, when fluctuating hormone levels can cause symptoms including hot flushes, brain fog, joint pain, fatigue, irregular periods, mood swings and insomnia.

Studies have found the sudden drop in oestrogen is associated with cardiovascular disease, cognitive impairments and dementia.

Dr Rajita Patil, assistant clinical professor in the obstetrics and gynaecology department at UCLA health and director of its Comprehensive Menopause Program, said: “This is an opportunity to best optimise long-term health and make sure they have optimal longevity.”

However, training for physicians has been limited.

Many providers receive only a brief menopause lecture in medical school, if they get one at all, according to Patil.

A study from the AARP Public Policy Institute released last year found that only about one-fifth of women receive menopause treatment, and women of colour are much less likely to receive it.

“There is exponential demand for care that should have been there in the first place,” Patil said.

“Doctors are not really trained for this kind of care.”

Patil said the lack of training and a widely reported 2002 study from the Women’s Health Initiative, which suggested hormone therapy increased certain health risks but was later criticised and refuted by researchers, set menopause care back by decades.

Nationally, California is lagging behind other states. Last year, nearly two dozen states saw more than 50 menopause-related bills introduced, and eight became law in states including Oregon, Washington and Rhode Island, according to the nonprofit Let’s Talk Menopause.

Janet Lee-Ortiz, a Los Angeles middle school teacher who began experiencing symptoms about a year ago, said: “It should be treated like a big deal because it’s a big freakin’ deal. I’m in the middle of trying to figure it out, and I really feel alone, navigating it by myself.”

The proposal also raises equity concerns.

Research shows Latina and particularly Black women often enter menopause earlier and experience more severe symptoms for longer than white and some Asian women, yet the proposal’s expanded coverage, training and education provisions apply only to commercial health plans.

Bauer-Kahan said: “There are real racial equity issues built in. How do you get everybody in the doors to be treated? How do you make it more equitable for everybody?”

She said initiatives like this one often start with private insurance and then expand to public programmes once costs become clearer, adding: “It’s going to lead to healthier, happier and longer lives for women.”