This story is part of a series produced for the USC Annenberg Center for Health Journalism’s 2025 California Health Equity Fellowship.
Denise Pines was sitting at her desk at work when she felt a pounding sensation in her chest and thought she was having a heart attack.
“By the fourth one of these things, which was happening every hour, I finally realized, oh my god, I’m having hot flashes,” she said.
Pines used to be president of the Medical Board of California. She not only has access to great health care, but knows a lot of doctors. Yet, she was surprised by how little she knew about menopause.
Many people at that stage of life find it hard to get information. That’s partly because it has been routinely overlooked in clinical research, which limits what doctors can do for patients experiencing symptoms.
Pines has since pushed for more research and even made a PBS documentary about issues in menopause treatment and research. She said there’s a huge knowledge gap, especially about how it affects women of color, like herself.
“To me, this is a reflection of how people care about women,” she said. “They don’t care about women, and they really don’t care about women as you get older.”
Today, many doctors are still relying on old information. For example — one of the biggest studies on menopause warned against prescribing hormone replacement therapy, which can help with many symptoms, like hot flashes, vaginal dryness and bone loss. It suggested that the treatment would increase cancer risk very broadly across patients who received it.
That was over 20 years ago. Pines said it took too long for the medical field to acknowledge that the methodology in that study doesn’t hold up: The participants were past menopause, and the findings were overblown in communication about the study through press conferences and interviews, among other issues.
“That has been totally rebuked. And of course, now there are so many different hormone replacement therapies, even now non-hormonal replacement therapies,” she said.
But confusion persists. Many doctors are still wary of hormone replacement therapy, as are some patients who continue to read about the study in the news.
And little new research has taken that study’s place.
“I can count on two hands the number of big projects that have been done,” said Dr. Emily Jacobs, an associate professor of psychological and brain sciences at UC Santa Barbara. “It’s not that there has been nothing, but relative to other questions, there’s such a dearth.”
Historically, medical research has focused on white men. It wasn’t until 1993 that Congress mandated women and minority groups be included.
And even though menopause has a big impact on the brain — hot flashes, for example, start there — it gets almost no attention in neurological research.
Jacobs said even clinical research that uses animals, like mice, rarely studies female subjects.
“We are bearing the brunt of this collective ignorance,” Jacobs said.
She said interest in menopause has picked up in recent years, but the primary funder of all medical research — the federal government — has become a less stable source since President Donald Trump took office.
It cut back billions of dollars on research spending, and its proposed budget bill would eliminate another $18 million.
Then in April, one of the largest studies on women, including those experiencing menopause — the Women’s Health Initiative — lost its funding, only to get back days later.
“All of a sudden we’ve gone from kind of celebrating and recognizing this need to invest in women’s health to us having the Scarlet Letter sewn back on,” Jacobs said.
She and other researchers who study menopause say they are concerned this administration will turn down study applications that would have previously won approval.
They also say the uncertainty — even when funds are restored — can damage work that relies on consistency.
In an office park in Pleasanton, California, Elaine Chung sifts through gifts, greeting cards and newsletters she sends to participants in the Study of Women’s Health Across the Nation, or SWAN.
“We have many different items that we give them: aprons, umbrellas, things that we thought are practical, and something to remember us each year,” she said.
Chung, is a program manager with the Kaiser Permanente Division of Research. Her role in SWAN is essential — she keeps in contact with more than 300 of the study’s volunteers who identify as white or Chinese, and her job is to make sure they keep coming back for regular appointments with researchers.
SWAN is one of the biggest and longest studies on menopause in the U.S. It began 30 years ago and runs out of hospitals and universities in seven cities, with cohorts representing five racial groups. Participants have completed nearly 20 visits through it. In its current grant cycle, which started in 2020 and ends early next year, it has a $43-million budget.
Researchers tap the pool of participants to study myriad topics, including the impact of menopause symptoms on long-term health, and have published over 500 manuscripts so far.
That work has helped show that menopause affects many parts of the body, and expanded how providers think about treatment options. It has also shown that patients tend to have better outcomes if they are in regular contact with their doctor about symptoms.
Chung keeps participants engaged by speaking to them in their native language and making sure they know they’re contributing something special.
“Each one of them are very unique and important to the project, you know, because it’s a longitudinal study, and we can’t replace them,” she said. “We want to follow them, from the beginning to whenever, to the very end.”
And Chung tells study participants they’re making this stage of life better for the next generation.
Megan Myscofski is a statehouse/politics reporter at CapRadio. CapRadio is a partner of The Intersection and CVJC.
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