INTRODUCTION: Menopause is a natural part of aging and greatly affects the demographic cohort seen by urogynecologists. While menopause consists of a wide range of symptoms, current studies indicate that many Ob/Gyn physicians feel unprepared to discuss or treat these symptoms. Urogynecologists are uniquely positioned to address menopausal symptoms and treatments given their specialized training with this patient population. However, limited research exists on whether urogynecology fellows feel adequately prepared to take on this role. OBJECTIVE: To assess whether urogynecology fellows feel adequately trained and comfortable discussing menopausal symptoms and managing these conditions. METHODS: This survey was sent to 56 urogynecology programs across the United States with 12 responses completed (approximately 8% response rate). Using a 5-point Likert scale, participants were surveyed regarding their training, comfort, and practice in speaking about and managing menopausal symptoms. RESULTS: Participants ranged from first- to third-year fellows, with even geographic distribution. Forty-one percent felt comfortable managing a new patient with menopausal concerns, and 50% reported feeling adequately trained to diagnose and treat these symptoms. Participants reported their training was absent or self-directed when addressing symptoms regarding vasomotor symptoms (58%), osteopenia/osteoporosis (67%), psychologic/mood disruptions (67%), metabolic dysfunction (92%), musculoskeletal changes (75%), neurologic sequelae (67%), dermatologic conditions (75%), and sleep/energy changes (65%). Comfort in treatment varied by symptom. Participants felt very comfortable treating urinary urgency (92%), recurrent UTIs (92%), and vaginal dryness (83%). However, many were uncomfortable or very uncomfortable with sleep disturbance (58%), weight gain (67%), fatigue (58%), memory changes (67%), joint pain (58%), and headaches/migraines (58%) (Table 1). Regarding treatment, most participants were comfortable or very comfortable recommending lubricants (100%), vaginal moisturizers (91%), vaginal estrogen cream (92%), vaginal estrogen rings (100%), transdermal estrogen (75%), SSRIs (75%), behavioral modification (75%), sleep hygiene (75%), exercise techniques (75%), and masturbation/sex toy use (67%). Discomfort was highest with SERM use (58%), fezolinetant (75%), osteoporosis/osteopenia treatment (67%), hypoactive sexual desire disorder medications (67%), testosterone (75%), clitoral pearl removal (67%), alternative therapies (58%), and DHEA creams (67%) (Table 2). Referral to another provider rather than prescribing was common for transdermal estrogen (50%), oral HRT (58%), SERMs (75%), fezolinetant (58%), SSRIs (67%), vaginal/vulvar laser therapy (67%), bone health screening (67%), bone health preventative care (67%), osteopenia/osteoporosis treatment (75%), hypoactive sexual desire disorder (67%), and testosterone (67%). The main reason for not offering these services was lack of knowledge (50%). Training types associated with physician comfort included: clinical guidelines (83%), completion of formal training (75%), mentorship (67%), patient experiences (75%), peer-reviewed articles (58%), and peer discussions (50%). Fellows seeking more comfort identified interest in using: clinical guidelines (75%), mentorship (75%), peer discussions (67%), formal training (58%), and peer-reviewed articles (50%). CONCLUSIONS: While urogynecology fellows report confidence in managing certain menopausal symptoms and treatments, significant gaps in education and training remain; particularly with vasomotor, metabolic, musculoskeletal, and sexual health concerns. The variability in comfort levels and reliance on referral for many therapies underscores the need for more structured, targeted training and education in menopause management to better prepare fellows to address this need in their patient population.Table 1Table 2
Raman et al. (Fri,) studied this question.