Why nobody warned you: perimenopause research and training, by the numbers

Part one: how little doctors are taught

The single most cited piece of evidence here is a cross-sectional survey published in Mayo Clinic Proceedings in 2019 by Kling and colleagues. Researchers surveyed 183 residents in family medicine, internal medicine, and obstetrics and gynecology across 20 US training programs. These are precisely the clinicians a woman with new night sweats, broken sleep, and a shortening cycle is going to see.

• 6.8 percent (12 of 177) felt adequately prepared to manage menopausal patients.
• 20.3 percent (36 of 177) reported receiving no menopause lectures at all during residency.
• 93.8 percent (165 of 176) said training in menopause management was important or very important. They knew the gap was there. Nobody filled it.
• 34.4 percent (63 of 183) said they would not offer hormone therapy to a symptomatic, newly menopausal woman with no contraindications.
• Only 38.7 percent (71 of 183) would prescribe hormone therapy until the natural age of menopause for a woman who reached menopause prematurely, which is what guidelines recommend.

Read that fourth bullet again. Roughly a third of the next generation of primary care and women's health doctors would decline hormone therapy for the exact textbook candidate. Not because of a contraindication. Because of what they absorbed instead of a curriculum.

The UK picture is not better, it is just documented differently. A 2025 Freedom of Information response from the University of East Anglia medical school put its total menopause teaching at one 1-hour seminar across the entire medical course, with an optional clinic placement on top. Menopause education is still not universally mandatory across UK medical schools, which is why advocacy groups and the Senedd have been pushing the General Medical Council on it.

One hour. For a life stage that affects half the population for an average of four to eight years, and for some women well over a decade.

Part two: how little money goes into the research

NIH publishes what it spends per research category. Menopause research received approximately 56 million dollars in fiscal 2023 and approximately 59 million dollars in fiscal 2024. The total NIH budget over those years ran roughly 47 to 48 billion dollars annually.

Put the last three rows side by side and the whole thing stops being abstract. The measured economic cost of untreated menopause symptoms in the US, from the 2023 Mayo Clinic Proceedings workplace study of 4,440 women, is 26.6 billion dollars a year. The research spend aimed at fixing it is under 60 million. That is roughly one research dollar for every 450 dollars of cost.

An independent analysis of NIH funding data from 2007 through 2024 found menopause research funding has stayed broadly flat, not scaled with the burden. In January 2025, Nature ran a news feature describing menopause research as globally underfunded, and traced part of the lag to the collapse in dedicated funding streams after 2002.

Part three: 2002, and the twenty years of silence after it

In July 2002, the Women's Health Initiative trial results hit the news cycle. The nuance, which was about age at initiation, formulation, and absolute rather than relative risk, did not travel. The headline did. Analyses of prescribing data from 2001 to 2003 show hormone therapy use fell about 66 percent within roughly a year.

Then came the cost of the overcorrection. A 2013 analysis in the American Journal of Public Health by Sarrel and colleagues estimated that estrogen avoidance among women aged 50 to 59 who had had a hysterectomy was associated with 18,601 to 91,610 excess deaths over the decade from 2002 to 2011, depending on the assumptions used. That is a wide range, because modelling always is. Even the bottom of the range is a number that should have changed how this is taught.

Instead, an entire cohort of clinicians completed training in a period when the safest professional move was to not raise the subject. Which loops directly back to the 2019 residency survey. The 6.8 percent figure is not a coincidence. It is downstream of 2002.

Part four: what that does to you, specifically

The education gap and the funding gap converge in one exam room, in a 15-minute appointment, with you in it. The survey data on what women experience lines up with what the training data would predict.

• 69 percent of women did not recognize the initial symptoms of menopause, per Bonafide's 2023 State of Menopause survey.
• 79 percent said self-education was the best way to navigate menopause. Not their doctor. Themselves.
• 73 percent of women were not treating their menopause symptoms at all, in Bonafide's earlier survey of over 1,000 US women.
• Menopause symptoms cost US women 1.8 billion dollars a year in lost work time, and 26.6 billion including medical costs, per Mayo Clinic Proceedings 2023.

This is why the first symptom is so often a shock rather than a signal. Nobody handed you a list. The frozen shoulder, the itchy ears, the 3 a.m. wake-up, the rage in the car park, the joints that ache in the rain now: individually they look like unrelated bad luck. Nobody taught the person across the desk to see them as a cluster either.

Part five: what is actually changing

• February 2024. ARPA-H announced a 100 million dollar Sprint for Women's Health, the first deliverable of the White House Initiative on Women's Health Research.
• March 2024. An executive order and budget request pledged an additional 200 million dollars for NIH women's health research, with menopause named among the priority areas.
• Fiscal 2024. NIH updated its women's health research spending category to track the money more accurately, which matters because you cannot argue about a gap you cannot measure.
• Market pressure. The global menopause market was valued around 17.8 billion dollars in 2024 and is projected to reach roughly 24 billion by 2030. Commercial interest arrived well before public research funding did, which is its own commentary.

Real progress. Also, 300 million dollars spread across all of women's health is not a correction for two decades of a 0.1 percent research share.

What to do with these numbers

• Stop treating the gap as a verdict on you. A clinician who is vague about perimenopause is far more likely to be undertrained than to be right that nothing is happening.
• Bring data, not adjectives. In a short appointment with a thin training base, a tracked symptom log with dates, frequencies, and cycle timing does more work than any description of how bad it has been.
• Ask for a menopause-trained clinician by name. In the US, the Menopause Society maintains a certified practitioner directory. Given a 6.8 percent preparedness rate, filtering for training is not fussy. It is efficient.
• Know what the guidelines actually say before you accept a no. Diagnosis in perimenopause is largely clinical, and normal bloodwork does not rule it out.
• Count yourself in the data. Every woman who names this, tracks it, and pushes for care is part of why the funding lines are finally moving at all.

The bottom line

6.8 percent of residents feel prepared. One in five got zero lectures. Roughly 0.1 percent of the NIH budget goes to menopause research, against a 26.6 billion dollar annual cost in the US alone. You were not warned because the system that was supposed to warn you was never funded or taught to. That is not a reason to give up on care. It is a reason to walk in with receipts.

Where PeriSlayer fits

If the system will not connect your dots, you get to. PeriSlayer logs symptoms in a few taps and looks for the patterns across them, so what you take into an appointment is a timeline rather than a memory. Receipts instead of vibes.