Andrea M Slominski On How The US Health System Can Improve Medical Care For Women Over Forty

An Interview With Shawna Robins

Published in

Authority Magazine

13 min readAug 30, 2024

Providers should reduce the cost of insurance and medical care and expand benefits coverage to specifically include early testing and treatment options for women’s issues after 40.

Women over forty often face unique health challenges and disparities in the medical care they receive. These women are at a critical stage in life where they may be dealing with menopause, increased risk of chronic diseases, and other age-related health issues. Despite the importance of tailored medical care, many feel underserved by the current health system. How can the US health system improve its medical care for women over forty to ensure they receive the comprehensive, respectful, and effective treatment they deserve? As part of this interview series, we had the pleasure to interview Andrea M. Slominski, Ph.D.

Dr. Slominski is a women’s therapeutic menopause and midlife coach who focuses on helping women navigate the complex years from 45 to 70+. She has named this life stage Regency: Women’s New Power Years. Her research and over ten years in private practice have provided clear insight into the failure of our healthcare system to address the health concerns and needs of women over forty.

Thank you so much for doing this with us! Before we dig in, our readers would like to ‘get to know you’. Can you tell us a bit about your background and your backstory?

Sure! I’m married, with three grown children, two dogs, and a husband of thirty-four years. I live in Southern California though I am originally from the East Coast. I had been teaching as an adjunct college instructor for ten years when I decided to go back to school (at age fifty-five) to earn my M.A. and Ph.D. degrees. My research focused on women’s midlife through the studies of world cultures with an emphasis in depth psychology.

Can you share a story with us about what brought you to your particular career path?

My journeys through menopause and midlife were simultaneous with my study of them. My research ignited my passion to help other women living through this time of change. My doctoral work focused on the physical, psychological, and spiritual transformation women endure from about forty-five to seventy. I discovered that Boomer women and all the women coming up behind them are the first generations of women in the history of humanity to live past menopause as a cohort.

There have always been individual women who lived past menopause but never entire generations living past menopause together. This revealed that a new life stage has emerged for women. In the US, at the turn of the 20th century, statistically, women of color were dead by 43 and white women by 51. Women’s lifespans have doubled for women of color and increased by one-third for white women.

By 2030, there will be over 87 million U.S. women over forty-five. There are no historical models, examples, or maps for women to follow through this new territory. These facts, coupled with the lack of medical research on women ‘s specific health care needs at this time (or any time of life) and the lack of training that physicians receive regarding the perimenopause to post-menopause journey, illustrates how a huge gap developed in women’s health care.

This gap fueled my passion. My goal became to help as many women as I could understand what is happening in their lives, show them how to navigate these tricky waters, and emerge to live their most authentic and fulfilled lives.

Can you share with our readers a bit about why you are an expert on medical care for women over 40?

During the years when I earned my MA and Ph.D. I was journeying through the territory of Regency myself, giving me first-hand knowledge of the impact of the physical, psychological, and spiritual changes that all women who live long enough will face.

I spent four years immersed in in-depth research of medical studies and publications on perimenopause, midlife, menopause, and post-menopause, as well as my therapeutic work and research with women who were also in various stages of these changes. I surveyed hundreds of women about their experience of the Regency years, asking them about their biggest concerns and disappointments with their healthcare.

These women shared their struggles, frustration, and rage with a medical system that habitually ignored, denied, or dismissed their lived experiences.

Validating these concerns, a recent 2023 survey and study by The NIH on women and their healthcare provider’s knowledge of menopause offers, “Women’s lack of education and their healthcare professionals’ lack of adequate training on the menopause (emphasis mine) means that women enter this critical life stage uneducated and unsupported. It is vital that everyone is taught about the menopause and that general practitioners receive proper training. The negative narrative of menopause needs to be re- addressed to normalize the menopause and give postmenopause women hope.” (1)

Unfortunately, physicians, even specialists such as OBGYNs, are given very little or no training in women’s menopausal transition. However, there is hope. In the past few years, a new field has appeared, and some doctors are now specializing in women’s menopause care and treatment.

On my website, women can find PDFs of medical research studies from 2018 to 2024 covering many issues that affect women in their Regency years, from 45–70+. In my practice, I offer group and private coaching that focuses on each woman’s lived experience during this transformational time. The education I offer to my clients includes what to expect during perimenopause, midlife, menopause, and post-menopause, which covers a significantly broad array of indicators and issues, as each woman’s lived experience of this time is as individual as she is. This explains why the standardization of menopause and midlife treatment is impossible at best and ineffective at worst.

What are some common health concerns for women over forty, and how can the healthcare system be more responsive to these needs?

Until recently, the subject of menopause was considered taboo. Generations of women entered the menopause transition without having been told anything about it by their family members or their doctors. In a culture that is youth-obsessed and dismissive of older women, discussing the end of fertility, the onset of aging, and all the changes that come with it is often seen as embarrassing, sometimes shameful, and usually painful.

Now, women over forty are talking more about the journey toward and through menopause and have more access to information on the changes ahead than any generation before them. Women want to know what to expect as they live into perimenopause. Some of the frequently asked questions and concerns are, “How will I know if I am in perimenopause? What age does perimenopause start? I’m feeling different, and my doctor won’t order hormone testing; they say I’m too young. What can I do to get the testing I want? What are the physical and psychological indicators that I’m starting perimenopause? Is HRT safe? How can I get rid of this excess weight I am gaining?”

In my research with hundreds of women, each of their experiences was unique; though many of them experienced some of the same indicators, they were usually in different combinations, at different times, and for different durations. What follows is a list of the most frequent symptoms women report during the perimenopause to menopause to post-menopause transition. Women are concerned with their changing bodies, their slowing metabolism, a loss of bladder control, any accompanying issues with the thyroid, changes in their skin, muscle tone, thinning hair, the loss of libido, painful sex, and irregular periods. The list continues; some women suffer the onset of mood swings, anxiety, panic attacks, and depression, the uprising of anger and resentment, hot flashes, night sweats, insomnia, weight gain, the development of migraines, full body joint and muscle pain (the musculoskeletal syndrome of menopause) deep fatigue, heavy periods, vertigo, brain fog, memory issues, trouble focusing and concentrating, stress, a loss of self-confidence, and sadness. These are not the complete list, but they are the most common indicators my clients have experienced.

Additional health concerns that women face from the loss of estrogen in perimenopause and menopause include an increased risk of cardiovascular disease, osteoporosis, cancer, obesity, diabetes, psychiatric symptoms, and cognitive decline.

The first change that needs to happen in our healthcare system is that doctors need to listen to women.

For too long, women have been dismissed as overreactive and hysterical, even when it comes to their health. Women live through hundreds of cycles in their lifetimes and can often tell when something is changing or feels different in their bodies.

For too long, women have been told, “You are too young to be in perimenopause. It’s all in your head. It’s not that bad; just tough it out; it will all be over soon.” Primary Care Physicians, Endocrinologists, and OBGYNs need more training in this important time of women’s lives. Physicians who treat women over forty must keep up with the latest research and analysis of effective therapies for all the healthcare issues that may present themselves. As time-consuming as it may be, individual treatment plans must address each woman’s indicators, needs, health challenges, and risks.

What changes would you like to see in the way routine check-ups and screenings are conducted for women over forty?

Just as women are recommended to have regular pap smears and breast cancer screenings, detailed hormone and thyroid blood panel tests and Dexa scans should be a part of every woman’s annual health exam starting at age 40. These tests and subsequent treatment plans could prevent millions of women from unnecessarily failing health and disease.

Over twenty different bodily systems have estrogen receptors in the female body. (2) If women and their physicians were better educated about women’s bodies, menopause, midlife, and the changes that they bring, women would be better prepared to start protecting their bones, cardiovascular systems, minds, happiness, psychological endurance, overall health, and strength — decades earlier — with better outcomes.

What specific policy changes would you propose to enhance preventative care services for women over forty in the US healthcare system?

First Lady Jill Biden announced the White House initiative for Women’s Health research this year. The funds are meant to close the big gaps in medical research on diseases and conditions that affect women, such as menopause, endometriosis, and reproductive cancers, as well as women’s experience of Alzheimer’s and heart disease, which can differ from men’s. This is a $100 billion initiative to help play catch up on the enormous gaps in Women’s Health research. Hopefully, this will be the first of many policy directives to improve women’s healthcare. New research will lead to new testing and treatment protocols for women’s health. The First Lady notes, “Together, we will build a health care system that puts women and their lived experiences at its center. Where no woman or girl has to hear that “it’s all in your head,” or, “it’s just stress.” Where women aren’t just an after-thought, but a first-thought. Where women don’t just survive with chronic conditions, but lead long and healthy lives.” (3)

The US is the only nation in the global north that doesn’t offer universal healthcare for its citizens. It is beyond time for lawmakers, physicians, and patients to design a healthcare system that works for all its citizens, including women over forty — many lawmakers in the US point to the problems with other nations’ healthcare systems as a reason to block universal healthcare. If the US, with all its bright minds and innovators, can put humanity on the moon, we can design a healthcare system that we can afford and that works for everyone. We may have to change the structure of health insurance companies to be not-for-profit; it is ultimately a question of our values as a nation.

In its report on Nationalized Healthcare VS. Privatized Healthcare, the Harvard University International Socioeconomics Laboratory writes, “ Nationalized healthcare under a single Medicare system would save 68 thousand lives a year. In fact, nationalized healthcare would impact the working class in two ways: small businesses and job opportunities. The average American family would see positive annual savings of about 2400 dollars which means that they are now pocketing dollars that would have previously gone to their treatment. Every extra dollar going into the pockets of low-wage workers adds about 1.2 dollars to the national economy. This becomes largely significant when looking to the 53 million low-wage workers in America who would, therefore, add trillions of dollars to the national economy annually.” (4)

As I mentioned above, in addition to the standard tests performed at an annual physical, the addition of early hormone and thyroid testing, annual pap smears, Dexa scans, and breast cancer screenings, the offering of cancer blood tests such as the CA-125, and internal ultrasounds would detect more uterine and ovarian disease with more time to save lives.

How can the integration of technology and telemedicine be optimized to better serve the healthcare needs of women over forty?

Initial physical exams should be offered in person for every woman who can visit her physician’s office. The thorough, caring, and communicative visit should give women and their physicians time to discuss the many changes that may be or will be, occurring during this time of their lives. Education is the key for both the woman and her physician. Women must be encouraged to ask questions, and physicians must have the training and information to answer them. Once a relationship has been established between a woman and her doctor, follow-up visits or further consultation could include telehealth options.

For women in rural communities, telehealth may need to serve as a point of contact and ongoing treatment, but ultimately, it should not replace annual one-to-one care. There are many challenges to delivering healthcare to rural America. Healthaffairs.org notes, “Recent closures of rural obstetric units and entire hospitals have exacerbated concerns about access to care for more than eighteen million women of reproductive age living in rural America.” (5) These are large systemic problems that can only be solved by placing a priority of women’s health nationally and rising to the challenge of developing a nationalized healthcare system that is not run as a for-profit business.

In what ways can healthcare providers be trained to better address the unique health concerns of women over forty, particularly in underserved communities?

As I mentioned earlier, physicians who treat women over forty, such as primary care providers, endocrinologists, OBGYNs, Neurologists, Psychologists, Psychiatrists, etc., need to receive more in-depth training on women’s embodied experience of the years of perimenopause, midlife, menopause through the post-menopause years. Physicians and patients alike would be well served if physicians working in underserved communities prioritized understanding the culture of the women they serve. This includes the norms and taboos around how women think about their bodies, talk about them, care for them, and share their female wisdom traditions from generation to generation. Barriers to participation in medical services in underserved communities can be environmental, interpersonal, and internal.

One proposal for rural communities that have lost hospitals and the associated OBGYN services would be the establishment of government-funded community health clinics specializing in women’s care. The clinics, in partnership with churches, civic groups, and schools, could promote healthcare education and their services through these trusted community organizations.

How can the US healthcare system address and reduce the disparities in access to specialized care for women over forty, such as menopause management and osteoporosis treatment?

This problem is two-fold: access and affordability. The only way to address this problem is to change the parameters of standardized and recommended annual medical testing and care for all women, including women 40 and over. A woman can’t be treated for a health problem that has gone unrecognized, undiagnosed, or ignored. Furthermore, as long as there are two healthcare systems, one for those who can pay for insurance and less care or no care for those who can’t, women’s healthcare treatment will remain woefully unequal.

What role should insurance companies play in improving the affordability and accessibility of comprehensive healthcare services for women over forty?

Until we have a national healthcare system, insurance companies should work with physicians to include expanded free education and low-cost or no-cost annual screenings for women over 40, as mentioned above. Ultimately, this would, I believe, result in cost savings for the insurance companies. We know early testing can prevent diseases and illnesses that may develop in women after 40, such as gynecologic and urinary issues, cancers, cardiovascular disease, bone density problems resulting in joint replacement surgeries, fragility, and more.

Can you please share “5 Ways The US Health System Can Improve Medical Care For Women Over Forty”?

1. Listen to women. Physicians need to listen to women and answer their questions.

2. Improve women’s education on the changes of perimenopause, midlife, menopause, and post-menopause and inform them of all available treatment options.

3. Improve education and training for physicians who treat women over 40 on the changes of perimenopause, midlife, menopause, and post-menopause.

4. Expand recommended annual testing for women over 40.

5. Design and launch a national healthcare system that includes a focus on women’s health after 40.

In what ways can the healthcare system encourage women over forty to prioritize their health and seek regular medical care?

Insurance companies can encourage providers to speak with their patients about the changes ahead after 40. Additionally, Insurance providers can develop initiatives to Increase education, offer outreach programs for women over 40 through schools, churches, and places of employment, and host free online telehealth presentations and Q&A sessions with their customers.

Providers should reduce the cost of insurance and medical care and expand benefits coverage to specifically include early testing and treatment options for women’s issues after 40.

Wonderful. We are nearly done. Is there a person in the world, or in the US, with whom you would like to have a private breakfast or lunch, and why? He or she might just see this, especially if we tag them. :-)

Maria Shriver, she is a leader in promoting women’s health and well-being.

How can our readers further follow your work online?

https://www.drandreaslominski.com

This was very meaningful, thank you so much. We wish you only continued success on your great work!

Citations

About the Interviewer: Shawna Robins is an international best-selling author of two books — Powerful Sleep — Rest Deeply, Repair Your Brain and Restore Your Life, and Irresistibly Healthy — Simple Strategies to Feel Vibrant, Alive, Healthy and Full of Energy Again. Shawna is the founder and CEO of Third Spark, an online wellness hub for women over 40 who want to reignite their sleep, reset healthier habits and respark their lives. Shawna is a sleep expert, hormone health expert, and a National Board-Certified Health and Wellness Coach (NBHWC). She has been featured on many podcasts including Dr. Mindy Pelz’s “The Resetter Podcast” and in Authority Magazine, Thrive Global, and The Huffington Post. A free download of her latest book can be found at www.thirdsparkhealth.com/powerful-sleep/ You can follow her on YouTube, Facebook, Instagram and LinkedIn.

Andrea M Slominski On How The US Health System Can Improve Medical Care For Women Over Forty

An Interview With Shawna Robins

Written by Shawna Robins