Who Actually Has Access to Good Menopause Care?

My best friend, my sister and I were having a conversation about our menopause care when we realized something: All three of us are on some form of Hormone Replacement Therapy. None of us has a gynecologist.

We have Primary Care Physicians and telehealth providers prescribing and managing our hormones. But as three women in their late 40s to mid-50s, we started wondering, shouldn't we have an actual gynecologist on our medical teams? We had no idea how complicated that question was about to become.

Like a lot of women navigating menopause right now, we follow popular menopause specialists online. We wanted doctors knowledgeable about the type of treatment we were already receiving, so we started looking for referrals and found Menopause Society Certified Practitioners, healthcare professionals who have demonstrated expertise in menopause care.

The fees

My best friend needed to see someone quickly, so she found a practice and made an appointment. Then came the email. "Oh, and by the way, in addition to your insurance, we charge a $1,000 annual concierge fee." Excuse me?

The fee, she was told, allowed the practice to provide a higher level of specialized care than the traditional insurance model typically supports. Longer appointments. More access to your doctor. More time to navigate the complexities of menopause. Basically, if you want that level of time and attention, you may have to pay for it out of pocket, on top of the health insurance you're already paying for.

And this is where the conversation about access changes

Let's imagine three women:

Woman #1 is married with a seven-figure household income, excellent insurance and plenty of disposable income.

Woman #2 is a single mother with a solid middle-class salary and employer-sponsored insurance. Her bills are paid, but an unexpected $1,000 healthcare expense requires planning or sacrificing something else.

Woman #3 is a single entrepreneur who pays for her own health insurance and already spends significant money out of pocket on healthcare.

All three women are 49. All three are experiencing the same perimenopause symptoms. All three want knowledgeable, evidence-based care. But do all three actually have access to the same level of care? In THIS economy? An extra $1,000 isn't exactly sitting in the "menopause concierge" section of the monthly budget.

And $1,000 isn't necessarily the cost of your menopause care. It's the cost of accessing the doctor. You may still have insurance premiums, copays, bloodwork, imaging, prescriptions and other out-of-pocket costs. Suddenly, specialized menopause care isn't just healthcare. It's a financial decision. And when specialized care becomes a financial decision, privilege enters the examination room before the patient does.

My friend paid the fee. When she arrived for her appointment, she noticed something else. She was the only Black woman in the office. One doctor's waiting room is certainly not a scientific study, but it made us ask another question: Where are we?

What research shows

Research tells us Black women aren't somehow skipping menopause. Studies have found that Black women can experience hot flashes and night sweats for longer than White women, yet research has also found racial differences in the use of menopausal hormone therapy.¹ So why aren't more of us sitting in specialized menopause practices?
Maybe we don't know these specialists exist.

Maybe we don't trust the medical system, our insurance doesn't provide access, or we simply can't afford an additional $1,000 to walk through the door. We tell women to advocate for themselves, ask questions, get second opinions and find better providers. But advocacy requires access. You can't choose a better doctor if the better doctor is behind a paywall.

So what can we actually do?

• Find out what your insurance already gives you. Ask whether your plan covers menopause specialists, gynecologists with menopause expertise or telehealth menopause care before assuming concierge care is your only option.
• Ask about the entire cost of care before booking. Concierge fees are only one piece. Ask about insurance, testing, prescriptions and follow-up appointments so you know what the care will actually cost.
• Share the information. If you find a knowledgeable provider, affordable telehealth option or resource that helped you, tell another woman. Access starts with knowing the option exists.

My best friend, my sister and I thought adding a gynecologist to our medical teams was simply the responsible thing to do as we got older. Instead, we stumbled into a much bigger question: Who actually gets access to good menopause care?

My hormones don't know my household income. Perimenopause doesn't care whether I'm married, single, salaried or self-employed. Our bodies can be going through the exact same transition. Our bank accounts shouldn't determine how well we're allowed to navigate it.