Why We Need to Talk More About Menopause (and What I Wish I Knew Sooner)

By Rachel Query, Family Nurse Practitioner with Mosaic Community Health.

A few years ago, I started noticing a pattern. More and more women in their 40s and 50s were coming to me with questions about perimenopause, menopause and hormone therapy. They were tired, frustrated and not feeling like themselves—and they wanted answers. They asked what I could do to help them feel better, manage their symptoms and reclaim their lives.

I did everything I could to support them: rule out other conditions, offer symptom management and listen closely. But the truth is, I often felt like I didn’t have much to offer. In graduate school, menopause was barely mentioned—maybe one lecture, at best. The dominant narrative I was taught? Hormones were dangerous and largely unnecessary. That was it.

It was frustrating for me, and even more so for the women sitting across from me, desperate to feel heard and helped. I wish I knew then what I know now.

The Menopause Gap in Healthcare

These women were speaking up, asking for support and trying to advocate for themselves in a healthcare system that often overlooks their needs. They didn’t feel right, and no one was truly listening. Unfortunately, that’s not surprising—women’s health has long been under-researched and undervalued.

But something is shifting.

In today’s information age, the conversation around menopause, perimenopause and hormone therapy is finally gaining traction. While it’s critical to stay vigilant about misinformation, the availability of credible resources has empowered women to ask better questions, seek real solutions and demand to be heard.

A powerful example of this shift: the Gates Foundation recently committed $2.5 billion to address historically ignored areas of women’s health. That includes funding much-needed research on menopause—an area where data has been sorely lacking for far too long.

What We Know About Menopause Symptoms and Risks

Menopause isn’t just a life stage—it’s a medical transition with real health implications.

• Vasomotor symptoms like hot flashes and night sweats affect sleep quality, mood and self-confidence.
• Genitourinary syndrome of menopause (GSM) includes chronic changes to the bladder, vulva and vagina, causing changes to urinary frequency, UTIs, vaginal dryness and pain—significantly impacting quality of life.
• Long-term risks include increased chances of osteoporosis, cardiovascular disease, cognitive decline and mood disorders.

These aren’t just inconvenient symptoms, but real health risks that deserve serious attention.

Hormone Therapy: Safe, Effective and Underused

The good news? When carefully prescribed and paired with a healthy lifestyle, both hormone therapy and non-hormonal therapies can be safe and effective options for many women.

New research presented at the 2025 Annual Meeting of The Menopause Society, shows that starting estrogen therapy during perimenopause may offer better long-term protection against conditions like heart disease, stroke and breast cancer. While it may not consistently reduce anxiety, it can significantly improve sleep, mood and quality of life. As always, treatment should be personalized, and women deserve clear, evidence-based guidance to make informed choices.

Despite its proven effectiveness, only 3.8% of women between the ages of 45 and 59 in the U.S. currently use hormone therapy to manage menopause symptoms—a sharp decline from 27% in 1999, according to a 2023 study presented by The Menopause Society. This drop is largely due to lingering fears from the 2002 Women’s Health Initiative study, which raised concerns about breast cancer and heart disease.

Newer research has clarified that hormone therapy is safe for most healthy women under 60, with emerging evidence supporting the need to be more inclusive of women over 60 or those starting hormone therapy more than 10 years post-menopause. But confusion and outdated perceptions continue to limit access and use. According to The Menopause Society, lack of standardized provider education is a major factor contributing to this underutilization.

Our Commitment at Mosaic Community Health

At Mosaic Community Health, our providers are taking midlife women’s health—and especially perimenopause and menopause—seriously. We’ve pursued extra training to better understand this important stage of life and how to care for it in a safe, effective way. Our goal is to truly listen to women and make sure more people have access to the care they need during this time.

For me personally, this work is deeply meaningful. I recently became certified by the Menopause Society, as well as through the Heather Hirsch Academy, to specialize in treating symptoms of perimenopause and menopause. I chose to go through this additional education because I wanted to make sure I was offering the safest, most up-to-date care possible.

Navigating Menopause with Confidence

There’s so much information out there about perimenopause and menopause—some of it helpful, and some of it confusing or even harmful. It can be overwhelming to know what’s true, what’s safe, and what works.

With this extra training, I feel more prepared than ever to support women through this phase of life. Whether you’re just starting to notice changes or you’re well into menopause, you deserve care that is informed, respectful and focused on your unique needs.

Let’s Talk About It

It’s time to give menopause the attention it deserves. That means:

• Better education for healthcare providers
• More research funding
• Open, honest conversations with the women experiencing it

If you’re navigating perimenopause or menopause, know this: you’re not alone, and you don’t have to settle.

~

Rachel Etter Query, DNP, FNP, MPH, MSCP, is a family nurse practitioner at Mosaic with over a decade of experience in community health. She is passionate about expanding equitable access to care and has a particular focus on women’s health during perimenopause and menopause. Rachel is certified by the Menopause Society (2025) and in hormone prescribing through the Heather Hirsch Academy.