Rethinking menopause care for midlife women

Rebecca Sauer, MD, associate professor of obstetrics and gynecology at UCI Health, joins Physician Huddle to discuss the evolving field of menopause and midlife care.

Sauer reflects on her path from medical school at UC Irvine to her current focus on perimenopause, menopause, and women’s health. She explains that menopause care historically has received limited attention in medical training, despite the wide range of symptoms and health concerns that can arise during this stage of life.

The conversation covers common symptoms of perimenopause and menopause, including hot flashes, night sweats, sleep disturbances, mood changes, urogenital symptoms, and cognitive concerns. Sauer also discusses emerging associations with joint issues, tinnitus, cardiovascular changes, and broader health implications.

She outlines how clinicians can approach evaluation, including when to consider thyroid, rheumatologic, autoimmune, nutritional or mood-related conditions before attributing symptoms to perimenopause. The discussion also explores hormone therapy, nonhormonal options, osteoporosis prevention, resistance training, and the importance of setting realistic expectations for treatment.

Sauer also illustrates UCI Health leadership in developing a comprehensive menopause program, built around certified menopause providers, multidisciplinary collaboration and evidence-based guidance for women navigating midlife health.

Topics discussed: 

• Sauer emphasizes that listening, validation, and individualized care can significantly improve quality of life.
• Nonhormonal therapies may be appropriate for patients who are not candidates for hormone therapy or have targeted symptoms. 
• Menopause and perimenopause have historically been underrepresented in medical education, even within OB-GYN training. 
• Common symptoms include hot flashes, night sweats, sleep disturbances, mood changes, urinary symptoms and vaginal dryness. 
• Midlife care may also involve cognitive symptoms, joint concerns, cardiovascular risk, bone health, mood disorders and metabolic changes. 
• Perimenopausal symptoms are often a diagnosis of exclusion; clinicians should evaluate for thyroid disease, autoimmune conditions, nutritional deficiencies and other possible causes when indicated. 
• Hormone therapy remains a standard-of-care option for vasomotor symptoms and may help prevent osteoporosis in appropriate patients. 
• UCI Health progress toward a comprehensive, evidence-based menopause care model across OB-GYN, primary care, and other key subspecialties. 

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