Menopause is frequently absent from electronic health records (EHRs), according to a large study led by the University of Colorado Anschutz that analysed nearly 396,000 women enrolled in the National Institutes of Health’s All of Us Research Program. The study found menopause was recorded in EHRs for about 7% of women, while survey responses contained roughly 193,000 menopause observations compared with about 28,000 recorded diagnoses in EHRs.
Gaps in routine documentation
Researchers compared participant surveys, which capture self‑reported reproductive histories, with clinical diagnoses or codes in EHRs. Their analysis showed that menopause appeared nearly seven times more often in survey responses than in patients’ electronic records. The disparity, the authors say, limits researchers’ and clinicians’ ability to study how the timing and type of menopause affect long‑term health, including cardiometabolic risk.
The study, published in the journal Menopause, emphasises that large, diverse datasets such as the All of Us programme can advance understanding of reproductive transitions — but only if key reproductive health variables are consistently captured across data sources.
“Ultimately, we cannot study what we do not measure. We cannot treat what we do not know,” said Audrey Hendricks, associate professor of bioinformatics at CU Anschutz and the study’s principal investigator, according to the research team.
Why this matters for health services and research
Menopause is a physiological transition with implications for heart health, metabolic disease and other outcomes. If the timing of menopause, surgical menopause or use of hormone therapy is not routinely documented in clinical records, clinicians and health systems may miss opportunities for targeted screening, prevention and management of risk factors that emerge around mid‑life.
For researchers, incomplete EHR documentation complicates efforts to combine clinical, survey and genomic data to answer questions about how reproductive life course events influence later health. The All of Us programme aims to link diverse data types to support precision medicine, but the study authors caution that reproductive health information must be standardised and recorded to unlock that potential.
Key findings
- Study population: nearly 396,000 women enrolled in the NIH All of Us Research Program.
- Survey observations of menopause: about 193,000.
- EHR menopause diagnoses: roughly 28,000, representing about 7% of women in the dataset.
| Data source | Menopause records |
|---|---|
| Participant surveys | ~193,000 |
| Electronic health records | ~28,000 (~7% of women) |
The authors note that nearly all participants with a menopause diagnosis in their EHR also reported menopause in surveys, suggesting that survey data capture many cases absent from clinical records rather than recording false positives.
Implications for South African practice
Although the study analysed a US research cohort, its findings have practical resonance for South African primary care and health information systems. If menopause and other reproductive milestones are not routinely recorded in EHRs or patient folders, clinicians may lack important context when assessing cardiovascular, metabolic and bone health in mid‑life women.
Health systems, professional bodies and record custodians should consider whether standardised fields for reproductive history — including age at menopause, surgical menopause and current use of hormone therapy — should be incorporated into routine clinical documentation and national health information standards.
For individual patients, the study underlines the importance of discussing menopausal symptoms and reproductive history with a clinician. Women experiencing troubling symptoms or concerned about their risk of chronic disease should consult their doctor or local clinic for assessment and personalised advice rather than self‑diagnose.
Health researchers relying on EHR data are advised to supplement records with carefully collected patient history or survey instruments where possible, and to advocate for improved capture of reproductive health variables in electronic systems to strengthen both clinical care and research.
Accurate, standardised documentation of menopause is a necessary step towards better prevention, diagnosis and management of conditions that disproportionately affect women as they age.
