WHEP Scholar Nimerta Sandhu
Drexel University College of Medicine, Class of 2021

For patients: The menopausal years can be a challenging time due to changing health needs, apprehension to discuss such personal health changes, and conflicting information from family, friends and providers. The years leading up to menopause are characterized by menstrual irregularity and hormonal fluctuations often first marked by lengthening of the intermenstrual interval. Many known symptoms of menopause are manageable and deserve attention. They include hot flashes, sleep disturbance, depression, vaginal dryness, sexual function, cognitive changes and joint pain. There are also many long-term consequences of estrogen deficiency including bone loss, cardiovascular disease, dementia, osteoarthritis, altered body composition, skin changes and balance difficulties. 

For physicians: Reproductive hormones influence most health conditions to a varying extent, and it is critical for physicians to understand the endocrinology and reproductive changes occurring during menopause and aging. An in-depth understanding of reproductive endocrinology helps physicians better understand a patient's health, the role of prevention, differences in disease presentation and progression, and opportunities for therapeutic intervention. The menopausal years are a critical time period for continued screening and patient engagement. 

For public health: Treating patients, not just managing menopause, requires insight into the context of other medical and sociocultural factors. Understanding the context in which patients seek or avoid care demands an understanding of their complex environment. Additionally, there is an increasing demand for care for individuals past their reproductive life. Symptomatic menopausal patients have 121% higher health care resource utilization and 60% greater loss of work productivity days compared to those without symptoms. This adds to more than $2,100 per patient per year in costs to an already overburdened health care system. 

To understand the public health benefit of robust menopausal care, offer more holistic resources for patients, and support efforts to improve patient care and well-being, my research focuses on understanding the barriers to menopausal care. The research addresses the historical approach to menopausal care, scientific and medical advancements, stigma surrounding these health needs, the current state of patient education, and cultural disparities to care. I also propose solutions for patients, clinicians and the greater health care community to advance the current state of menopausal care and support individuals to receive proactive and needed care.