Video Transcript - Women's Health Panel: Menopause
[INTRO MUSIC]
[Text On Screen – A panel discussion on women’s health. Part 3: Menopause]
[STEPHANIE FEHR AND A PANEL OF SPEAKERS SITTING ON A STUDIO SOUND STAGE, SPEAKING TO THE CAMERA, WITH A WHITE SCREEN DISPLAYING: WOMEN’S HEALTH]
STEPHANIE FEHR: Welcome. We're so excited to be here with you talking about women's health. This is a topic we are all so excited about and passionate about.
[Text On Screen – Stephanie Fehr, Chief People Officer, UnitedHealthcare]
I am Stephanie Fehr, and I am privileged to lead the people teams at UnitedHealthcare and serve as their chief people officer. I'm also so fortunate to work with an esteemed panel today, people who care deeply about this topic and are really experts. So why are we talking about women's health and, really, what is our objective? We have the good fortune of having a lot of data around women's health, and that informs the trends that we see over the course of a woman's health journey. That also informs the type of products and services that will help women navigate their health journeys. As we've gone through the last year and a half, I know it's been incredibly rewarding for me, and I think all of you, and we've had some incredible discussions and dialogue that, honestly, have really informed how we want to service our customers and our own employees. And that's what we're going to talk to you about today. Let's talk about menopause. This topic is so important, and we don't talk about it enough. So we're going to start with Craig and some data, and we're going to come back and have a dialogue about it. So Craig, take it away.
CRAIG KURTZWEIL: Thank you, Stephanie.
[Text On Screen – Craig Kurtzweil, Chief Data & Analytics Officer UnitedHealthcare Employer & Individual]
It definitely doesn't get talked about enough. When you think about women's health, we oftentimes focus on maternity or infertility-based services, but menopause, in particular, has a wide impact across the female population in our book of business.
[Text On Screen – (Slide 27) Menopause impacts women’s midlife health
- Stages of menopause
o Pre-menopause
§ No menopausal symptoms
§ Still have periods
o Perimenopause
§ Symptoms of hormonal changes
§ Can still become pregnant
§ Lasts about 4 years
o Menopause Onset
§ No period for 12 consecutive months
§ Ovaries stop producing eggs
o Post-menopause
§ Time after menopause onset
Physician changes and symptoms that occur across the menopause transition (and beyond)
- Sleep disturbances, Mood swings/irritability, Weight gain, Reduced libido/sex drive, Urinary tract infections, Hot flashes/night sweats
DATA SPOTLIGHT: 84% of U.S. women ages 50-80 experienced menopause-related symptoms in 2022
*Sources: Morgan, “Women’s Health, Sex, Intimacy, and Menopause, University of Michigan’s Institute for Healthcare Policy and Innovation, “Menopause basics” U.S. Office of Women’s Health, Advisory Board, ©2024 Advisory Board, All rights reserved, advisory.com]
First of all, as you look at this slide, obviously, menopause has a wide ranging impact on our adult female population, ranging from weight gain to hot flashes, to having trouble sleep. In general, about 84 percent of women ages 50 to 80 will have an issue associated with menopause during their lifetime.
[Text On Screen – (Slide 28) Perimenopause, menopause and insomnia claims
- Menopause and insomnia-related claims begin to increase in the 40s; average age of menopause is 51
- Most women seeking treatment for menopause symptoms and/or insomnia visit their OB/GYN provider
Claimants per 1,000 (graph)
Distribution of Menopause/Insomnia Claimants by Physician Type (pie chart)
- Primary Care 24%
- Specialist 29%, OB/GYN 47%
*Source: UnitedHealthcare book of business. Based on claims incurred Oct. 1, 2022, and paid through Nov. 30, 2022. ©2024 United HealthCare Services, Inc. All rights reserved]
Keep in mind that 84 percent because we look into our data and we start to look to see who is actually going to their doctor to be treated for menopause-related issues59, and you see the numbers are very different. In this bucket, if we even look at the 50 to population or the 60 plus population, we're talking about 20 to 25 percent of those females being diagnosed, seeing a doctor for menopause related conditions. So there's obviously a wide gap from people that are struggling with this issue versus those that are seeking treatment for the issue. And you can see that in this view.
[Text On Screen – (Slide 29) Sleep disturbances and slow metabolism most common
- Proportion of U.S. women ages 50-80 experiencing menopause symptoms in 2022 National Poll on Healthy Aging report, ,University of Michigan’s Institute for Healthcare Policy and Innovation
Least common to most common
- Menstrual changes, n=85m 7%
- Pelvic/bladder pain, n=159 13%
- Urinary tract infections n=196 16%
- Mood swings/irritability n=465 38%
- Hot flashes/night sweats n=502 41%
- Reduced libido/sexual drive n=672 55%
- Sleep disturbances n=686 56%
56% of women did not discuss potential menopause symptom treatments with their healthcare provider
*Sources: Morgan, “Women’s Health, Sex, Intimacy, and Menopause, University of Michigan’s Institute for Healthcare Policy and Innovation, “Menopause basics” U.S. Office of Women’s Health, Advisory Board, ©2024 Advisory Board, All rights reserved, advisory.com]
Fifty-six percent of women are not seeking treatment for menopause. And as you can see on the left hand side, a wide ranging impact on medical issues, from sleep issues to weight gain and so on. So lots of issues, lots of impact, but not a lot of treatment and support for the female population as they take on the menopause challenge.
[Text On Screen – (Slide 30) Women do not feel prepared for menopause
- Shortcomings in care delivery contribute to women’s feelings of uncertainty around menopause
o Inadequate attention,
o Lack of information
o Disregarded symptoms
o Insufficient resources
Providers are falling short
- In a 2021 qualitative study on Black women’s experiences with menopause, participants reported…
o Their health concerns were overlooked or not believed by providers because of their race
o Their ob-gyn didn’t believe the severity of their symptoms or didn’t know how to support them
o They were not provided with the information they were hoping to receive about menopause
o They felt unprepared for the changes they experienced during menopause
- Note: of the women involved in the study reported a positive experience with talking to medical professionals about menopause.
*Sources: Morgan, “Women’s Health, Sex, Intimacy, and Menopause, University of Michigan’s Institute for Healthcare Policy and Innovation, “Menopause basics” U.S. Office of Women’s Health, Advisory Board, ©2024 Advisory Board, All rights reserved, advisory.com]
As we dive into what women are experiencing, and obviously I'm not one to speak, but what the data tells us, is women don't feel like they're getting the support that they would like. They're not seeking treatment. They're not comfortable seeking treatment. They're not getting the treatment they would like from the healthcare system, and leaving with a lot of questions unanswered, and having to deal with this experience. They feel like they're on their own through this journey.
[Text On Screen – (Slide 31) Lack of menopause support costs U.S. billions annually
- $24.8B lost in direct medical expenditures related to menopause symptoms
- $26.6B lost in direct and indirect U.S. health care costs related to menopause symptoms
- $1.8B lost as a result of workdays missed due to menopause symptoms
*Source: 2023 “Impact of Menopause Symptoms in Women in the Workplace” Mayo Clinic Proceedings. Advisory Board, ©2024 Advisory Board, All rights reserved, advisory.com]
If you think about the full impact of menopause, it obviously impacts medical claims, not just the treatment, the experience of menopause, but all of the comorbid conditions that come with it, and all of the other health issues that come with that as well. But don't forget that this has a big impact on productivity as well. Women that are struggling with all of these conditions and all of the side effects associated with menopause, it's hard to be productive on your job when you're experiencing those types of significant conditions. All in all, we look at about almost $27 billion in expense associated with the lack of support that we see from menopause annually.
[Text On Screen – (Slide 32) Employees are demanding menopause-specific benefits
- Employers offering menopause support
o 4% offered menopause support benefits in 2022 or plan to offer in 2023
o 15% offer or plan to offer menopause support benefits in 2024
- Top benefits among employers offering menopause-specific benefits
o 40% offer access to menopause health professionals
o 38% offer menopause policies such as time off or flexible work arrangements
o 38% offer menopausal hormone therapy coverage by health insurance plans
DATA SPOTLIGHT: 58% of women offered menopause-specific benefits report they had a positive impact on their work. Advisory Board, ©2024 Advisory Board, All rights reserved, advisory.com]
As you think about what employers are doing in this space, most employers don't offer a benefit or support in this space. When they do, it's really focused on education and access to care. At the end of the day, when employers do take advantage of some of those solutions that are available, on the far right you can see 58 percent of women will engage. So there's an appetite for it, there's a demand for it, but currently there's not a lot of employers that are going on the path of offering support into this area, again, because menopause doesn't get talked about as much as it probably should.
[Text On Screen – (Slide 33) Concerns among senior women
Claimants per 1,000 (graph)
- Insights
o Prevalence of injury claims (fractures, sprains, etc.) increase as women age, likely a result of falls
o While incontinence diagnosis begin to be identified in women as young as 30, the prevalence continues to increase with age
o Dementia is extremely rare in women. Under 65, but prevalence begins to increase after age 65 and is 12 times higher in women 75+ compared to women 60-64
*Source: UnitedHealthcare book of business. Based on claims incurred Oct. 1, 2022, and paid through Nov. 30, 2022. ©2024 United HealthCare Services, Inc. All rights reserved]
We know that conditions in senior women go beyond menopause, and in this slide you can see, in particular, injuries, and that goes hand in hand with some of the conditions we were talking about. As women start to age, we start to see a rapid escalation associated with injuries. Some of that could be connected, some of that's outside of what we see across the menopause concerns. With that, Stephanie, I'll kick it back to you.
STEPHANIE FEHR: All right, Craig, thank you so much. It’s a really good precursor to our conversation. This is a topic that we just don't talk very much about, especially in the U.S. I think Europe has been ahead of us, actually. Dr. Saul, I'd love to start with you, Lisa. Women just don't feel prepared to go through menopause. They just don't feel like they have enough information, myself included, but the research is really clear that Black women go through it and they're feeling even like it's a bigger issue for them. What's being done to help educate women to go through this more effectively?
[Text On Screen – Dr. Lisa Saul, Chief Medical Officer, Women’s Health UnitedHealthcare]
DR. LISA SAUL: I think it starts with the care that we're getting during the course of our lifespan, and we really rely on our doctors to help us and prepare us for this particular phase in life. The fact of the matter is that almost 70 percent of currently practicing physicians, OBGYNs, have said that they did not receive any specific training on menopause during their residency. So you have a population of physicians that aren't really equipped to educate their patients on menopause. But that's changing, as we see the field changing, that the field of OBGYN is changing for people to focus on obstetrics, focus on gynecology, and you find more and more are beginning to focus on menopause.
STEPHANIE FEHR: Which is a great shift.
DR. LISA SAUL: Which is a great shift and very important. And to your point, people aren't prepared, and they're fighting it, kicking and screaming.
STEPHANIE FEHR: Right, exactly.
DR. LISA SAUL: I had two conversations with, two, this week with friends, who one said she was offended that she was going through this and feeling hot flashes and things like that. And another, because menopause is always, is also a chameleon, of sorts, who had seen three different sub-specialists, due to symptoms that she was having, only to ultimately be told, actually, this is perimenopause that you're going through and all the things you've been dealing with for the past many months. So I think we're getting there, but it is a slower journey to marrying those two together.
STEPHANIE FEHR: I understand her point about it's offensive because it feels intrusive. It feels like it's attacking you.
DR. LISA SAUL: Exactly. I think that's a paradigm shift that we need to make.
STEPHANIE FEHR: I completely agree.
DR. LISA SAUL: Exactly Because all women will go through it, you've said that, a hundred percent of us. And so I think that's the paradigm shift that needs to happen and I think it will happen as we educate ourselves more, but also as the medical community embraces it more and makes it part of the discussion.
STEPHANIE FEHR: You kind of answered my next question, but are providers starting to specialize in menopause or have we not gotten that far?
DR. LISA SAUL: We are seeing that shift, particularly as many OBGYNs are now choosing the path of gynecology only, that we're seeing more of a focus on subspecialty certifications in menopausal medicine that I think will help as we go down the path.
STEPHANIE FEHR: That's fantastic. Good news, good news. Will, the cost from lack of menopause, which Craig put up on the slide, it's staggering, at $26.6 billion. What can employers do to better support women and employees during this journey?
[Text On Screen – Will Porteous, Chief Growth Officer, Maven]
WILL PORTEOUS: I know you never argue with a data scientist, but I actually think that's probably underestimated. Because if you think about when menopause hits, it's typically for working women. So I think a lot of the audience is employers. It's typically the height of their career as well.
STEPHANIE FEHR: It happened to me then, yeah, for sure.
WILL PORTEOUS: And if you think about the value that those women are providing to our economy and your own companies, it's pretty meaningful. Because we also see in our data, Maven has a menopause product that we launched two years ago. It's been our fastest growing product of all time.
STEPHANIE FEHR: It's fantastic.
WILL PORTEOUS: The UHG employees are phenomenal users of it.
STEPHANIE FEHR: It's been adopted very quickly. It’s great.
WILL PORTEOUS: It's clear, from that alone, that there's been such a need for it. But then when you think about from what we see in our data, of our members, 98 percent of them are experiencing symptoms, 98 percent of them. So a hundred percent of them will go through it, 98 percent are experiencing symptoms.
STEPHANIE FEHR: But no surprise, I don't think, right?
WILL PORTEOUS: No, I don't think so either. But 17 percent of them say they feel equipped to manage it. And only one in five providers, which is getting better, but only one in five have any training in how to manage these symptoms. If you look at the treatments, I was staggered, I was pretty shocked when I learned how it's even treated. Until recently, it's really not been meaningfully supported from HRT, hormone replacement therapies, or non Rx. There's a lot of non Rx related treatments as well. There's also things like gabapentin, which is a nerve agent, or selective serotonin reuptake inhibitors, which is an antidepressant. There's just still so much to learn about the space. It’s something that impacts everybody. So as an employer, I think it's taking all that in. Because of that, you need to have a holistic support system because every single person is also going to go through different elements of it. So the 98 percent experiencing symptoms, number one, is actually anxiety and depression. We’ve seen some other data from Craig that actually you see a drop in claims as someone ages in that space. You're actually seeing a rise in the need for it and oftentimes because there is a stigma around it. So having a solution on your phone to be able to connect with a behavioral health specialist, it's our number one most utilized provider. So that's one. And then two, there's a lot of physical elements to this as well, weight gain being one, libido, sleep. There's so many different types of providers you'd need to meet with. If you had to go do that, for all, in person, you'd never be able to do it. So providing that wraparound support, with a digital solution, I think is a really meaningful addition.
STEPHANIE FEHR: So valuable. And a good use of a digital resource too.
WILL PORTEOUS: For sure.
STEPHANIE FEHR: Such a great point. Very good. Thank you. Alison, and this is scary because I hadn't heard this before, but menopause can impact your teeth and your eyesight. Can you talk a little bit about this?
[Text On Screen – Alison Richards, Chief Executive Officer, Surest]
ALISON RICHARDS: I know it might be a surprise, as you hear about those different types of things. And as we're sitting here, talking about this conversation, I can relate to most of these symptoms that are out there today and wish we had a lot more tools early on, but so happy that it's out there today. I went to the dentist a couple of years ago, and you're going through, your hygienist is going through the stuff that's going on. And she said, hey, are you going through menopause? And I said, yeah. She goes, we need to make sure that you need to realize that your need to start flossing a little bit differently, making sure you're doing, are you using this mouthwash? That was like the first conversation I would have had about what was going on with me, personally.
STEPHANIE FEHR: Going back to education.
ALISON RICHARDS: Right, on education. Now, think about that. You don't think about the declining estrogen levels that are happening in your body that really take away from the teeth and the gums and everything that are going on, and it had tooth decay and gum disease. That all, on top of everything we've all just talked about on the medical side, it's a whole body thing. We have to really think about it that way, from our mental health to our physical health, to our eyes, our ears, and our teeth. It is something that we have to understand what we're doing, holistically, with our bodies. So I found it very interesting when we think about what's going on out there, that it's not just – you have to start asking those questions and making sure we're educated around the whole thing.
STEPHANIE FEHR: I do think awareness is such a key thing, and education, and giving people tools so they can help themselves. Our employees, when we introduced the benefit a year ago, I think, the engagement level I think was the best we've ever seen, and it does speak to the need. I'm really thankful that we can offer our employees that benefit. Again, you guys are great. Thank you so much. This has been such a joy and a pleasure. So we will wrap up with a fire round of advice. So maybe I'll start with you, Alison, this time. For our listeners today, as it relates to this topic, what would be your advice?
ALISON RICHARDS: What I would say is stay current on health care, stay current. Use the tools and the assets that we have around us to continue down this path and be educated. Don't be afraid to ask questions. Don't be afraid to ask questions of your provider or your dentist.
STEPHANIE FEHR: That's right. Timely advice. Thank you.
WILL PORTEOUS: I would say with all of the different experiences you might have, it could feel overwhelming to figure out how you're going to hit all of them, and all of this is new. But if you actually look at Maven and our UHG partnership, 50 percent of our clients through UHG now have the menopause product. So there's a lot of opportunity to actually put something in place that's holistic. It's rapidly increasing. Check it out. There's a lot you can do, more than you might think.
STEPHANIE FEHR: That's great. Thank you, Will. That's great.
DR. LISA SAUL: I would just add, normalize this. This is a stage of life that is a stage, and nothing more. So I think the more we normalize it, the more we will talk about it, and the more we will inform others and inform ourselves.
STEPHANIE FEHR: And people can feel comfortable talking about it.
DR. LISA SAUL: Absolutely.
[OUTRO MUSIC]
STEPHANIE FEHR: Love that. Thank you. You guys are awesome. All right, thanks so much. We'll talk again soon.
[LOGO: UNITEDHEALTHCARE]
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