New Jersey lawmaker wants insurance companies to cover menopause treatments

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In New Jersey, an effort is underway to raise awareness about menopause and ensure that women get the care they need when experiencing symptoms.

Assemblywoman Heather Simmons introduced a bill that would require insurance companies to cover all medically necessary treatments for perimenopause and menopause, including non-hormonal treatments, behavioral health care services, pelvic-floor physical therapy, bone health treatments and preventative services and menopause management counseling. A companion bill would require doctors to be trained and educated about menopause.

In the United States, approximately 6,000 women reach menopause every day, according to the Society of Women’s Health Research. Yet there is not much conversation or support around it, Simmons said.

Kisha Jones, who lives in Somerset County, said insurance companies should cover treating symptoms, including hot flashes.

“It’s like burning from the inside out, so there’s nothing that can cool you down, absolutely nothing,” said Jones, who is experiencing menopause. “I’m usually a very positive person, but in certain instances I just dismissed things and people and my attitude was just kind of negative, I really thought I was going out of my mind. My husband would look at our kids and say, ‘Just leave mommy alone.’”

For most women, the symptoms start early in a stage called perimenopause, characterized by irregular periods, hot flashes and hormonal imbalances.

Lisa Schaeffer, of Gloucester County and who is now experiencing perimenopause, said it hasn’t been easy.

“My life is about compensating for the sweating, basically; my husband, he’s very supportive, even in the car when it’s cold outside, sometimes I’ll turn the air conditioning on,” she said. “Sometimes I might forget names, like I might forget certain things. I’m not exactly sure if that means my memory sucks or if that is due to the perimenopause, or if it’s just a little bit of both.”

What are perimenopause and menopause?

Dr. Monica Christmas, associate medical director of the Menopause Society, said menopause is part of the natural aging process for women, a stage in life after periods stop and ovaries no longer make reproductive hormones. She said it is called perimenopause when this change begins.

“So one might still be getting a menstrual cycle every month but it’s starting to become irregular,” she said. “[One] may have some mood-related symptoms, hot flashes or night sweats, cognitive decline, people talk a lot about brain fog.”

She said some women experience very few symptoms, but about 80% of women experience hot flashes and night sweats. Other symptoms can include vaginal dryness, urinary symptoms and infections, joint pain and weight gain.

“They can last for many years, they often start a couple of years before the final menstrual period,” Dr. Christmas said. “On average, they can last for about four and a half to five years after that final menstrual period.”

She said Black women often have symptoms for a longer duration, sometimes 10 years or more.

What are some ways to treat menopausal and perimenopausal symptoms?

Dr. Christmas said hormone replacement therapy is one category of treatment for night sweats, genitourinary symptoms or early onset of menopause, before the age of 40, because this increases the risk of cardiovascular disease, cognitive decline and osteoporosis.

“Notice I didn’t say for weight, for mood, for sleep, although some of those things can improve with hormone therapy because the hot flashes are gone,” she said. “Hot flashes can create a lot of turmoil.”

She said hormone therapy is available and can come in the form of a pill, patch, cream or gel to treat different conditions. Dr. Christmas said the U.S. Food and Drug Administration has also approved a newer medication, Veozah, for hot flashes that does not contain hormones. She noted this can be beneficial for individuals who cannot be on hormone therapy because they are cancer survivors or have cardiovascular problems.

“Other options include certain antidepressants that have been shown to be highly efficacious in reducing hot flashes and night sweats,” she said. “Only one has FDA approval, however there are others with good clinical data behind them that show that they work as well.”

Weight loss, hypnosis and cognitive behavioral therapy can also provide some relief for some women, according to Dr. Christmas. She noted that a number of herbal and vitamin supplements claim to help minimize menopausal symptoms, but that many randomized control trials have not shown them to have a better efficacy than placebo.

What inspired Simmons to work on a bill about menopause?

Simmons said she herself has struggled to find information about menopause, prompting her to work on the two pieces of legislation that address providing care and educating doctors about menopause. Both bills are being considered in the Assembly Insurance and Financial Institutions committee.

“When I speak to my physicians, there has been very little knowledge on their behalf and some dismissal for the symptoms that I have been experiencing,” she said. “Some statistics say that as few as 30% of physicians in any field have any training at all in menopause, so we can say broadly that menopause care has been overlooked in medical education.”

Simmons said many men and women don’t really understand that menopause involves a major biological transition.

She said people need to understand that menopause is a natural change that all women experience, and that it can affect nearly every aspect of a woman’s life: physically, mentally and emotionally.

“This matters because if menopause isn’t properly managed, it can really significantly reduce a woman’s ability to enjoy life, to stay productive and to really feel like herself,” Simmons said. “That’s why access to treatment options, workplace accommodations and social support are essential. It’s not really just about getting older, it’s about maintaining a high quality of life.”

A Mayo Clinic study found that menopause is responsible for an estimated $1.8 billion in lost work time per year for women. That number increases to $26.6 billion when medical expenses are included.

Support and empathy

Dr. Gloria Bachmann, a professor of obstetrics, gynecology and medicine and co-director of the Women’s Health Institute at Rutgers University’s Robert Wood Johnson Medical School, said it’s important for men and women to have empathy for women struggling with menopause and understand how difficult this phase of life may be.

Jones, from Somerset County, said she would feel supported if friends and family acknowledged what she is going through.

“I’m learning how to regulate my tone with my children, but there needs to be some give and take, some grace given to the moms and the wives, the women that are going through menopause,” she said.

Jones agrees that insurance companies should pay for menopausal treatment. She has been reluctant to try medications because she is not sure if her insurance would cover them; instead, she’s opted for yoga, deep breathing and therapy.

Schaeffer said she worries about her symptoms getting worse when menopause starts and, like Jones, believes all women should have access to affordable treatments.

“Women and their systems are very misunderstood, and women aren’t always listened to with perimenopause and menopause, and even with just regular periods,” she said.

There are several menopause support groups in New Jersey and across the region, including the Menopause Mojo Society, Not Your Mother’s Menopause NJ and the Red Hot Mamas Menopause Education and Support Program.