SUN-146 - Symptomatic Menopause in Endocrinology Practice: Missed Opportunities for Care

Objective: To characterize Endocrinology encounters with midlife women experiencing symptomatic menopause and evaluate potential gaps in the management of menopausal symptoms.

Design: Manual chart extraction was performed on women aged 40–59 seen at Endocrinology clinics within a tertiary academic health system between 2018-2023 with ≥1 encounter diagnosis codes suggestive of symptomatic menopause (N95.1, N95.2, N95.8, N95.9, and R23.2). Only the first encounter for each unique patient was included. Patients were classified as having ‘symptomatic’ or ‘unclear’ menopause based upon information available at the first encounter. Symptomatic menopause was defined as: a) symptoms attributed to menopause b) receipt of menopause treatment, or c) referral for menopausal symptom evaluation. In the absence of documented symptoms, or when menopause was noted as a differential (but not definitive) diagnosis, patients were classified as having unclear menopause. Asymptomatic, premature, and iatrogenic menopause were excluded. Each record was reviewed up to six months after the initial encounter to assess prescriptions and referrals. Descriptive analyses were performed.

Results: In our cohort of 286 women, 68% (n=195/286) were of ages 45-55, 72% (n=207/286) were of White race, 92% (n=263/286) were non-Hispanic and 80% (n=229/286) had commercial insurance. One-fifth of the patients (21%, n=61/286) had symptomatic menopause while the remaining (79%, n=225/286) had unclear menopause. Most frequently used ICD-10 codes were R23.2 (flushing) and N95.1 (menopause and female climacteric states), at 49% (n=141/286) and 43% (n=122/286) respectively. Vasomotor symptoms were the most frequently reported symptoms for both symptomatic and unclear menopause, at 77% (n=47/61) and 73% (n=164/225), respectively. Menopause-related ICD-10 codes were primary diagnoses in 12% (n=33/286) of encounters, while the most common primary diagnosis was thyroid disease at 52% (n=148/286). About 20% (n=12/61) received treatment among those with symptomatic menopause, compared to 4% (n=9/225) of those with unclear menopause. Among encounters in which a menopause-related ICD-10 code was the primary diagnosis (n=33), only 9% (n=3) received treatment. Referrals were provided for 33% (n=20/61) of those with symptomatic menopause and 21% (n=48/225) with unclear menopause.

Conclusion: Despite its clear hormonal and metabolic relevance for midlife women, there are substantial missed opportunities for menopause care in Endocrinology practice, as reflected by only a minority of those with symptomatic menopause receiving targeted therapy. Most encounters considered menopause in midlife as a differential for presenting symptoms, with vasomotor symptoms being most common. Limited specificity of ICD-10 coding necessitates detailed chart review and impedes large-scale data analyses.

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