Poor hot flash documentation in primary care setting leaves many midlife women untreated

Key takeaways:

• Less than 23% of postmenopausal women reporting bothersome hot flashes had their symptoms documented in electronic health records.
• Few women reported using hormone therapy to alleviate vasomotor symptoms.

Many postmenopausal women self-reported moderate or higher vasomotor symptoms in the primary care setting but remained untreated due to lack of electronic health record documentation, researchers reported.

“We had a sense — and I know from experience in the clinic — that these [menopause] symptoms are common, but they are not showing up in the medical record,” Stephanie S. Faubion, MD, MBA, MSCP, NCMP, IF, director of the Mayo Clinic Center for Women’s Health and medical director of The Menopause Society, told Healio. “Women are undertreated, so we were trying to figure out where the gaps are. Is it a lack of identification of symptoms? Is it a lack of documentation? How do we ultimately go about addressing these gaps?”

Faubion and colleagues conducted a retrospective study, published in Menopause, with 229 postmenopausal women (mean age, 55.1 years) from the Mayo Clinic Health System Northwest Wisconsin Region who self-reported moderate or higher vasomotor symptoms on a Mayo Clinic survey conducted from March 2021 to June 2021. The survey was administered via email as an online questionnaire to assess menopause symptoms, health history and whether symptom care was received. All participants attended a primary care visit during the survey period. Researchers evaluated menopause symptom documentation sufficiency in all participants’ EHR.

Despite 57.6% of women having moderate to very severe vasomotor symptoms documented in clinic notes from primary care visits, only 22.7% of women had vasomotor symptoms documented in the EHR clinical problem lists.

Stephanie S. Faubion

Regarding treatment, 6.1% of women reported systemic hormone therapy use for menopause symptom management. However, nonhormone prescription therapy use for moderate to very severe vasomotor symptoms was higher, with 14.8% of women reporting use.

According to Faubion, women who self-reported menopause status sometimes do not accurately identify their menopause stage and diagnoses do not appear in health records, which is a bigger issue than previously hypothesized.

“We are not identifying menopause in the record. It is not making it to a ‘problem’ list and then women are not treated appropriately. So, what is the way to address this?” Faubion told Healio. “I do not think identifying it and pushing it to the physicians is the way to do this. Menopausal women are going to have to activate, similar to the way women activated to push for breast cancer screenings. This will not be driven by getting a better ‘cue’ in the medical record, because clearly, the cues do not matter. This will have to come from the other direction. This will have to come from women saying, ‘Here is what I am documenting in my app and here are the guidelines. Can you help me with this?”

For more information:

Stephanie S. Faubion, MD, MBA, MSCP, NCMP, IF, can be reached at faubion.stephanie@mayo.edu.