Gaby Marmolejos (00:00):
... you're going to see a lot more women in midlife and 65 plus over the next few years and they need care.

Rae Woods (00:08):
From Advisory Board, we are bringing you Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. I want to call myself out on something at the beginning of this episode. On Radio Advisory, we've talked about women's health in two ways. We've talked about the dire state of maternal health in America, and we've even talked about what women's health means beyond the bikini or how to comprehensively care for women and even harness their economic power.

(00:39):
But still, so many of women's health programs are primarily focused on pre-menopausal women, which brings me to what we haven't talked about yet, which is menopause, a health event that every woman will experience, and that comes with its own set of health and social challenges. And yet, providers, payers, employers, have largely ignored the specific needs of women in the post-reproductive period. So today I am correcting all of that and I'm bringing back women's health experts, Kara Marlatt and Gaby Marmolejos. Together, they're going to talk about why business leaders should be prioritizing menopause care and the tangible steps that they can take today. Hey, Gaby. Hey, Kara. Welcome back to Radio Advisory.

Gaby Marmolejos (01:27):
Thank you.

Kara Marlatt (01:27):
Thanks for having us.

Rae Woods (01:29):
It hasn't been that long since we last came together and since we last had a conversation, frankly about women's health, and I actually went back to the last conversation that we had when I was prepping for this episode. And in that conversation, we were focused on women's health more broadly. We said the word menopause five times. In a thirty-minute podcast episode, that might be sufficient. It struck me as something that was perhaps too low because we were sitting down and having a dedicated conversation about women's health. I don't know. What do you think of that number?

Gaby Marmolejos (02:03):
I think because it was about women's health broadly, it kind of makes sense since it's a part of women's health. But women's health, there are a lot of other things involved and women do make up 50% of the population. So there's a lot of things, but it certainly is a low number.

Rae Woods (02:21):
It speaks to the fact that we needed to have a follow-up conversation. We needed to have a more dedicated conversation about this event that, like you said, Gaby, 50% of the population is going to go through. Why hasn't the healthcare industry really embraced talking about menopause or even caring for women in midlife and in the post-reproductive years?

Kara Marlatt (02:40):
When you think of some of the numbers of women that go through menopause every year, I think it's over 1 million depending on which city you look at. Over 1 million women in the United States go through menopause every single year. They experience it. And while most women have heard of menopause, I think that a large proportion don't really know all of the symptoms or the physical and the emotional symptoms.

Rae Woods (03:06):
Despite the fact that they're going to go through it.

Kara Marlatt (03:09):
I think that's kind of the first part of the stigma is that women are just not aware of what's going to happen as much as I would like them to be.

Rae Woods (03:18):
Again, which is why we needed to have a dedicated conversation about this topic. And I want to take a moment and repeat the core insight that we shared in our last conversation. Reminder to our listeners, we'll put that in the show notes. But the key thing that we talked about was the fact that the healthcare industry tends to conflate women's health with maternal health. And don't get me wrong, there is clearly need and reason to focus on maternal health, particularly maternal health equity, but investing in women and women's health goes far beyond obstetrics. Can you two name specifically the challenges that women will face in this post reproductive period and perhaps why health leaders should care about this phase in a woman's life?

Kara Marlatt (04:06):
So let me start from the perspective of the woman who's actually going through menopause. I think that there's a confluence of different life events that can happen to women during midlife. And it's not just menopause, but a lot of those things overlap with one another, and it's a lot to manage for each particular woman. And so I think that menopause can happen abruptly with the removal of the ovaries via an oophorectomy, but you can also go through it naturally. So anywhere from one to ten years. And so it can take up a really big part of a woman's life, and there's a lot of different symptoms that they can experience. And this is just a couple of them, but hot flashes and night sweats, really big one. There's sleep disturbances and there's mood challenges and mood swings, anxiety can go along with that. And those are really the big three, but there are a ton more that are happening to women around this period of time.

Rae Woods (05:05):
And happening over what can be a quite long period of time in their health. And I'm thinking with my business leader hat on in a time period in which health leaders tend to really focus on the late forties, the fifties. That's a good age group where you tend to need a lot of healthcare and you tend to be in a good pay or mix. Gaby, why should health leaders care about this phase?

Gaby Marmolejos (05:31):
Yeah, no, I mean, I actually recently wrote about this, check out on advisory.com, The Business Case for Investing in Women's Health.

Rae Woods (05:38):
We'll also add that to the show notes for you, Gaby.

Gaby Marmolejos (05:40):
Yes, lovely. But it's one of those things where we always talk about the aging population when it comes to all healthcare patients. But when we think about women's health, we're zeroing in on pregnancy. But guess what? The women population is also aging. You're going to see a lot more women in midlife and 65 plus over the next few years. And they need care. And it's something that health leaders can make this care more accessible. They can make it more streamlined. They can collaborate between service signs. Because we know that in midlife, it's not just menopause symptoms. They also are recommended to receive a lot of different cancer screenings. They're at risk for different cardiovascular conditions. There's metabolism changes. And not to mention that in many cases, these women's also serve as caregivers to children and aging parents. So I think as providers, this is an opportunity for you.

Rae Woods (06:35):
I want to do something risky. I want to actually break the fourth wall for a second here and maybe take a minute and talk to our listeners. Because the purpose of Radio Advisory, the purpose of Advisory Board is to not just answer the questions that our listeners already have. It's actually to tell you the questions that you should be asking. That's precisely how we think about what episodes to bring to all of you every Tuesday. I know that Kara and Gaby and your whole team, you've been focused on the business case for women's health. Really, you've been focusing on that pretty extensively this year. But I have to ask, when it comes to caring for women experiencing menopause, I'm not sure I understand why this should matter financially to industry stakeholders. Why that should be the question that our listeners, that Advisory Board users are asking?

Gaby Marmolejos (07:28):
Yeah, I mean, if you think something that is important is that about 80% of the US healthcare workforce are women. About a third of that is women in midlife. And so these are now some of your most experienced employees, some of your most productive employees, and again, make up a good chunk of the healthcare workforce. So this is important for recruitment and retention.

Rae Woods (07:49):
Those were huge numbers. And I just want to repeat them. You said that 80% of the US healthcare workforce is women, and a third of those are women in midlife?

Gaby Marmolejos (08:01):
Yes.

Rae Woods (08:02):
That's instantaneously gives me a business case. I think you're going to tell me that there's more.

Gaby Marmolejos (08:07):
There's certainly more. I feel like it's one of those commercials when they say, "But wait, there's more." There is more. So I'm thinking you provider or you as an employer, but then also thinking about delivering care. Most hospital systems are seeing a decline in birth rates in their communities and in their system. It's really stressing margins. And so if you're thinking about, "Okay, what does it look like to care for women? How do I grow my service line?" You have to think about who is this population? How can you serve different needs outside of obstetrics and how can you expand your service line to be more comprehensive? And so there's an opportunity there as well.

Rae Woods (08:48):
And it sounds to me that this business case is only going to be more true over time because like you said, that the population is aging, the population of women is aging. But we're also seeing, I think some other momentum around women's health, around attention on menopause specifically, especially since President Biden signed an executive order back in March, establishing the White House initiative on women's health research. What are we seeing from that initiative? And maybe even more broadly, what are the things that are signaling more interest, more investment, more attention, less stigma on menopause?

Gaby Marmolejos (09:28):
I mean, I think Kara can speak a little bit more from the perspective of how things have changed, but in all honesty, I think that there's just been an explosion of interest. The number of times I've been talking to people and they're telling me we should really focus on midlife. And I'm just like, "This is so great to hear." Because for the longest time I was trying to convince people of that fact. And so I think there's just been a big push. Big part of that is probably a lot of the startups, especially FemTech startups that are offering new solutions for employers to offer menopause specific benefits.

Rae Woods (10:00):
Which by the way, they clearly see a business case if we are seeing a rise to the point where we've even named it. I kind of hate this name, FemTech. Named this branch of new startups, new tech companies that are specifically focused on women and women in midlife.

Gaby Marmolejos (10:17):
Yeah, no, a hundred percent. And they're focusing on a lot of the areas and not to mention just new clinical solutions. And there's been new non-hormonal menopause symptom treatments that are available now. Whereas before it was mostly hormone replacement therapy. So it's nice that there are new options for if someone is experiencing symptoms, they can help treat them. But Kara, I'm curious how you've seen the explosion on your end.

Kara Marlatt (10:41):
Well, it's interesting because I remember talking about this FemTech boom like back in 2018, 2019, and I remember physicians saying, "Well, I think menopause is really having this moment." But this moment has really continued to grow. And I love to see that. But the reason why these FemTech companies have boomed is because consumers are looking for different solutions. Many are going into their providers, and it's not that their providers aren't trying to provide the best possible care. It's just that with all of the different symptoms that women experience and all the different things that you have to cover, how can you possibly cover that in a 15-minute appointment? It's really challenging. And so that's where FemTech has really popped into the mix because it's another avenue to fill that demand gap.

Rae Woods (11:34):
So there are new companies entering the space that are trying to help women better deal with menopause. Like you said, outside of the traditional kind of structures of care delivery, there are new clinical solutions coming out there. And it seems like there is a new push for better research. At least that's what I'm tracking from what the administration is trying to do. Can you share a little bit more about that?

Gaby Marmolejos (11:57):
Yeah. I've sat in on a few of the different meetings of the White House initiative. There's honestly a lot of different components to the White House initiative, so I'm not going to bore you breaking that down. But it's interesting because a mix of investment from the NIH, which is more lab science research. I'm very hopeful that we will see research across menstrual cycles and in different parts of midlife, which will be really interesting. And there's also just the Sprint for Women's Health, which is an initiative where they're focusing on research and development, and it's primarily with private companies. And what's cool is that there's a lot of focus on remote patient monitoring and using different devices to be able to capture different symptoms that women might experience, especially since at this point, most of the time you just have to kind of record it yourself on maybe a notepad. And so it'd be really nice to track symptoms in a digital way that might be more accurate.

Kara Marlatt (12:49):
And we had talked about this in our previous discussion on the business case for investing in women's health, but I think too that this surge in investment, specifically in midlife and the menopause space, it's trying to fill the gap of years of this lack of investment. And we don't know as much about women's health across the lifespan, and it's because the menstrual cycle is very hard to study. And so this is push for this increased understanding of this time period, because I always think back, women can spend up to 40% of their lives in a state of estrogen deficiency. So it's essentially when their ovaries cease to work and they go through menopause. So up to 40%, and just like Gaby had said, with all the improvements in treatment and the increased life expectancy, that 40% is probably going to get bigger.

Rae Woods (14:44):
Honestly, I'm reflecting on our conversation thus far, and there are actually a of reasons why our listeners should be focused on menopause. There should be a focus because we are talking about half the population. We're talking about a clinical event that half the population will go through. We are talking about the overwhelming majority of the healthcare workforce. We are talking about needing better research, better clinical products. We're talking about new competition in this space, new legislation in this space. There are a lot of reasons why we should focus on menopause, but simply understanding that even having the new information isn't enough, especially when you have to actually deploy or act against some of these challenges. So my question is, what would it look like for provider organizations to really harness this opportunity and deliver more comprehensive midlife and menopause care?

Kara Marlatt (15:46):
I mean, I think one of the first things that comes to mind is just being aware of what the menopause transition looks like in practice.

Rae Woods (15:57):
So education on the provider side?

Kara Marlatt (15:59):
Yes, absolutely. And so what I was going to say is that when providers go through training, they receive very little training specifically on menopause. Yet so many of the symptoms that arise during midlife, they don't have to just be related to menopause, but a lot of them overlap with menopause. And so it'd be really important for providers to be able to identify what those things are. Like if a woman is dealing with hair loss or a skin condition of some kind or body aches or joint pain, they're not just passed off and said like, "Hey, just take a leave or just take an ibuprofen." Maybe this is actually because of something else you're experiencing, and that might be because of menopause. So being able to diagnose that. A lot of women go in and they don't know and they rely on a provider of some kind to help them identify it. But if a doctor doesn't know those confluences of different symptoms, they might not recognize that as being menopause related symptoms.

Rae Woods (17:02):
Gaby, what do you want to see providers do?

Gaby Marmolejos (17:05):
I think Kara's first point is first and foremost is just about education, but it's also just about thinking about women's health holistically. Knowing when you need to refer a patient to other providers for different symptoms they might be experiencing and taking their symptoms seriously is also really important. But not to mention just because women in this age, and I'm going to say also people as well since they're non-binary folk-

Rae Woods (17:30):
Yes, that's a good point.

Gaby Marmolejos (17:31):
... that also experience menopause. Many times, they need a lot of different services. It's not just menopause symptom treatments. The mammogram screening recommendation from the USPSTF is now starting at age 40, and so now we're seeing more patients who would be coming in for cancer screenings, breast cancer screenings. What would it look like for a provider to organize all of these preventive services for these patients to make sure that you're offering comprehensive care, thinking about all the different services they need in that time period and addressing them?

Rae Woods (18:07):
I want us to get to solutions. I get worried that often when we talk about challenges like this one, which does have a long history of stigma, has a long history of prejudice that the problem often feels too big to start. I want to focus on the tangible, maybe even the attainable steps that stakeholders can take to advance to this shared goal of better care for women throughout their life, particularly in menopause. What are some of those tangible steps?

Kara Marlatt (18:36):
Again, providers get less than one day of training on how to care for women. I mean, I talked to many provider friends that I know of. There's this many books that are coming out that are from physicians that are authoring these books that are citing kind of the same thing. So this isn't just in one state or in one medical program. This is kind of across the board. So increasing education just more than just one day.

Rae Woods (19:05):
And importantly, it not being on the individual physician or provider, but it being something that the enterprise offers, supports, creates, fills the gap of.

Kara Marlatt (19:12):
I would absolutely encourage provider organizations to look at different menopause society certifications, and so the Menopause Society, it's just menopause.org. You can go there and actually get a certification. So it's a certified menopause practitioner. It's easy to do, and I think if organizations did just a provider audit to see who's trained in different things, it'd be great to have a couple of providers be certified in this so that they could flag patients coming in with these sort of symptoms. So that's just one tangible thing that they could do.

Gaby Marmolejos (19:48):
Along sort of the flagging piece of what you were saying is there's a lot of clinical decision support tools. I've heard of the Mayo Clinic specifically uses artificial intelligence to enable evidence-based menopause symptom management. So it might flag the EHR dependent on the symptoms presented to say maybe this patient might have menopause or maybe would need menopause treatment. But I think there's a lot of interesting ways where you can use technology, you can use EHR systems to be able to support providers in recognizing and addressing menopause symptoms.

Rae Woods (20:23):
I love that example because that's about creating a stronger system and not about relying on just individual people. But if I'm honest, the provider-direct patient care angle of this is not the thing that has blown my mind in this conversation. It's actually the stats that Gaby shared at the top of this conversation. 80% of the healthcare workforce is women. A third of them are in midlife. That's only if we account for healthcare providers as employers, let alone if we talk about employers in general. So I want to talk about the employer's role in this. Gaby, can you share more about that?

Gaby Marmolejos (21:00):
Me and Kara actually wrote an article about five ways employers can support women in midlife. We tried to lay out in that article big and small steps you can take as an employer to support women in midlife and specifically menopause so it can be as simple as thinking about the workplace. How can you make the workplace more suitable for the different symptoms women might be experiencing? And so you might be able to allow for temperature setting controls or maybe having face heaters if that's allowed in your workplace or something to be able to control the temperature.

Rae Woods (21:36):
We love an easy solution.

Gaby Marmolejos (21:38):
Easy, simple, although I'm assuming so many providers are like, "Actually, that's really hard to get a space heater." But it also can be just flexible scheduling. COVID has shown us that there are a lot of things we can do virtually. For a lot of positions in a lot of roles, even in healthcare, there's an opportunity for a hybrid environment. And so that's something that you might want to look into to be able to retain folks, especially people who are caregivers or experiencing menopause symptoms and maybe would be better for them to work from home.

Rae Woods (22:11):
What about some of the harder changes?

Gaby Marmolejos (22:15):
A lot of it is just providing different benefits, whether that's paid leave in the form of sick leave. We know that there's a lot of preventive services recommended for women in midlife and for just treating menopause symptoms. You might have to see a few different providers before you get a solution that works best for you. So sick leave is really important, but also just from the mental health aspect is having different caregiver supports, child care support, elder care assistance. There are different ways that employers can ease some of the burdens that people are experiencing in this phase of life.

Kara Marlatt (22:50):
I still always like to go back to it as well. If you want to know what you can do to help out your employees, the first thing you can do is just ask them. I guarantee you if you ask them what would help them, they will give you their opinion, if you give them an opportunity to. So asking them is kind of first and foremost. Another one is that like Gaby had said, if you increase different health benefits for them and encourage them to take PTO or things like that. Gaby and I were just talking this morning that 40% of women that experience menopause symptoms or some sort of immense sort of pain, they work through it. That just wears away at them. And so encouraging them to take that time and using the resources would be a great start.

Rae Woods (23:40):
I'm going to break the fourth wall again here and put on my podcast host hat. I'm aware of the fact that listeners who have clicked into this episode, who've shared this episode, who've listened up to this point are here because they're not the ones who need convincing that we should be focused on this particular challenge in healthcare and healthcare business. I want to help those people go out into the world and talk to their friends, their peers, their colleagues, their bosses about why the healthcare industry needs to focus on women's health, needs to focus on menopause specifically. What advice would you give to them as they have hard conversations with other folks in healthcare?

Gaby Marmolejos (24:21):
It's definitely recognizing what your organizational goals are. I think I always come back to that. If you want to make the case for anything, go to the organizational goals and show them how this aligns with your organization's goals. That will always help make the case because that's part of the strategy. You're showing how women's health fits into the strategy, advances the strategy, and is good for patients. It's good for the workforce, and yeah, it's good for the community as well.

Rae Woods (24:50):
What about advice for our listeners who may actually need to do some self-advocacy and may need to identify symptoms in themselves and ultimately advocate for their own healthcare?

Kara Marlatt (25:03):
Always speak up for yourself and tell your providers what you're experiencing. And if they don't listen to you, then that might not be the right provider. What I would specifically tell women if they are going into an appointment, I would say to do kind of a laundry list of things. At first, know the symptoms of menopause or write down the symptoms that you are experiencing and make sure that you bring those into your provider. So almost like a symptom log of sorts. And so I don't care if it sounds weird or not, they might be related to changes that are happening in midlife. So always write that down. Second thing is come in with a set of questions. I think that I'm notorious for having a list of things in my head that I want to ask a provider, but then when I get in there, I ask maybe just 20% of those questions. And so it's knowing the questions that you have and make sure you get all the answers.

Rae Woods (26:05):
Well, Gaby, Kara, keep doing the research, keep writing, and thank you so much for coming on Radio Advisory.

(26:19):
The biggest thing that I want you to hear from this episode is that focusing on women's health, focusing on equitable practices in general, even focusing on menopause specifically, is not just a feel-good strategy. It's not just about doing the right thing for a large group of our population. There is a very real business case here. And frankly, there is an opportunity that may be fleeting. So I want you to get involved in women's health. I want you to start having conversations about menopause with your peers, with your colleagues, with your employees. And remember, as always, we are here to help.

(27:26):
If you like Radio Advisory, please share it with your networks. Subscribe wherever you get your podcasts and leave a rating and a review. Radio advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Abby Burns, Kristin Myers, Chloe Bakst, and Atticus Raasch. The episode was edited by Katy Anderson. With technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Carson Sisk, Leanne Elston, and Erin Collins. We'll see you next week.