From Symptoms to Support: Rethinking Menopause Care in the Workplace

Hello and welcome everyone. Thank you for today joining today's program. My name is Zach Doms, president at a Achieve Engagement as your community lead. I'm excited to learn with you all and dig into this topic that we're gonna jump into in just a minute. But I do wanna thank you all for joining, dedicating some time outta your busy schedules to sharpen your craft, to develop yourselves, to learn new insights, new research, new frameworks that then you can use to build a better world of work. So thank you for doing that. I see all the activity going in the chat right now. If you haven't already, add in there. Where are you calling in from? I know some of us are already debating and seeing like, all right, how cold are you right now, or how much snow you got? And Dawn, we're jealous of you in sunny Florida. I see Laura in Milwaukee. What else? We have Jolyn in Missouri, single digits. Woo. Debbie in Tampa, Florida, Texas currently iced in. We got someone in the Lincoln Park Zoo in Chicago, Toronto's in the house. This is awesome. I mean, I love the, the spread here. I think one of the most powerful aspects of these programs is two parts. One, we get to bring in subject matter experts and people from the field who are doing this work within many organizations, from research, uh, perspective, you know, learning about new frameworks, and we get to learn from them. And that's one piece of today's program. But the other piece is also the peer-to-peer learning, the community learning aspect, and all of you who are joining today's session. So I really encourage you to lean into that. Let's make this the ultimate social learning experience. So as we go through this, I really encourage you to ask questions, share your own point of view, share your own experience in these things. If there's certain ways you've approached it or certain strategies you've implemented, put that in the chat as well so we can learn from each other and just make this a, an incredible collective learning experience. So I'm super pumped to do that with you all. Uh, before I do that, just some quick updates in the community that I would love for you all to be aware of. One, we have a packed calendar coming up, so continue to look on our schedule for some of our upcoming programs. On top of that as well, I just wanted to share some announcements within our ex leadership network. This is more of our deeper dive peer to peer community, where we go a little bit more in depth, into the weeds, into the frameworks, into the research with each other. This is more peer-to-peer coaching and strategy based. So we have our monthly mastermind coming up. We have our first AI innovation for HR mastermind series coming up. We also have a be the People leader that 2026 needs. This is all about developing your skillset sets and competencies as a HR leader. And then on top of that, one of the pieces I'm most excited about is how we're doubling down on these in-person intimate gatherings. We're already releasing some dates with those cities listed on the screen. So if you're in one of those cities and you wanna get together in person, make sure to check out the Ex Leadership Network. We have limited seating for all these programs, so we have to kind of prioritize our members here. So this is all things to be aware of, would love to see you in there if you're looking for that deeper dive network, this is your space. So that being said, I am excited to dig into today's topic. If you know what we're all about at a achieve engagement, we're all about understanding the different frameworks and strategies that can improve the world of work, can enhance the employee experience, and can really make the workplace a place that thrives on fulfillment and joy and purpose and, and impact. So we wanna unpack a lot of these topics, and this is actually a topic that I'm surprised we haven't really unpacked much at all. And I think if you look about the larger world of work and topics that are hit on and thing conversations that are happening within organizations, this is actually one of 'em that seems to get brushed under the rug. Or maybe it is just under the radar for, for, for a lot of organizations. But on the flip side, we know that menopause can affect millions of people each year, especially at pivotal stages in their career. So it's such an important topic that really deserves some bigger spotlight on it. So I'm excited to learn with you all to dig into this topic and to help lead this conversation. I'm excited to welcome and introduce someone that you all have seen in the past with our network lead so many of these conversations with, with our community. Dan Shabel, managing Partner of Workplace Intelligence. Let's give Dan a warm welcome to really kick this off and help facilitate this dialogue. And, uh, we feel very lucky to learn from him and the other speakers that will introduce in a second. But Dan, thank you so much for being here. Lemme stop sharing. Uh, it's great to see you, my friend and I. You Too. Thanks so much for having me, and I'm really looking forward to this discussion. Obviously, as you said, this is a really big topic right now. Uh, it affects millions of employees during a pivotal stage of their career and life, and it's often overlooked, misunderstood, uh, but it's an essential area of workplace health that needs as much attention as possible right now. So in today's discussion, we'll examine the lack of menopause training in traditional primary care, the impact untreated symptoms have on employee wellbeing and performance, and how employees and employers can think about workplace support by leveraging a comprehensive primary care led approach to midlife health. So I'd love to introduce, uh, my panelists today. The first is Josh Duns, be who I've known for several years now. We've done a lot of great research projects together when it comes to primary care, workplace wellness, wellbeing, and, and, uh, now women's health, which is a really great topic. And Josh is the enterprise partnerships, uh, person at Amazon One Medical for business, uh, am uh, I, I remember we were working with, uh, one Medical pre-Amazon and Amazon at the same time, and now they've combined and, and joined forces to create Amazon One Medical. Uh, also Aaron Alde, who's the medical director of Menopause Care at Amazon One Medical. So really excited to have you both on for context. Uh, we recently collaborated on a new white paper, and the topic is obviously Menopause Health, uh, how primary Care can Transform Menopause Support at Work. And you can download this right now, you know, you can download it, you know, after this call. Uh, you can see the link that Zach shared to make it even easier on you, uh, which really delves deep into the discussion today, uh, in a very organized, thoughtful way. Uh, Josh Aaron, so happy to have you on this platform to talk about this topic. Thanks for having us, Stan. It's really an honor to get to be with this group, so many folks who are so committed to creating strong and healthy communities in the workplace. And I know Josh and I are just so excited to get to share on this topic and really hear what questions everyone has as well. Absolutely. Yeah. Thanks dad. I can tell it's gonna be fun. There's so many, so much activity in the chat already. So, So we're gonna start off with the poll. Have you or someone you know, sought support from Menopause Care? Yes or no? I'll give it a about a minute and then close the poll. Anyone, you know, could be an employee or a friend or anyone. All right, so 75% say yes and 25% say no. Now, what are your thoughts based on this, Erin and Josh? Is that what you expect? Is it low, high? What do you think? I was kind of thinking we would see closer to a hundred percent, to be honest. But yeah, I think that's great. That's why we wanna have a mix of people here to share their different experiences and we're all coming to the table from different places. So I'm excited to see a blend, Josh. Uh, yeah, We Love you too. Yeah, it shows, um, just different places, the way people are asking about the question. We can tell already people are digging into different parts of the topic and what that means. So I think it's a great jumping off to, um, to get into more detail, uh, about it. Yeah, people being afraid to share that info, even though it's, it's anonymous. I mean, I, I don't see the poll results from an individual standpoint, so, but maybe that's, people are definitely private about it. Um, I'd love to hear more about both your backgrounds and how you, we came together to do this. Uh, can you discuss your backgrounds and why you think employers should consider Menopause care a strategic employee benefit, especially right now? Like, why is this like Josh, like when you came to me with this topic, like you, you said even before the call, you're like, you know, we've heard about this for a few years, but do you think we've reached this like point where it's just such in the spotlight? Like why, why now? Yeah. Thanks Dan. And so, um, maybe just to get us started, I'll, I'll give a quick introduction, let Aaron do that, and then let me come back to that question. So just nice to meet everyone. Josh Sby, I, uh, as Dan said, I lead our enterprise partnerships team with the, the one medical for Business group. So that's focused on largely on sort of our relationships with employers. And I spent, um, a good part of my career working in health benefits consulting and helping employers develop their benefits strategy. So really glad to be able to, to have the opportunity to kind of share that, um, with you guys today. So let me let Erin introduce herself. Sure, thanks Josh. Um, so I'm Erin Aldi, I'm an internist. I'm also a menopause specialist certified with the Menopause Society. And, um, I had a background actually in academic medicine research, trying to understand what were the main gaps in care for women, um, and, uh, and have come to one medical and been here the last three years to actually bring with me menopause care, how to do this well, how to do it evidence-based, how to really bridge an enormous implementation gap. We're gonna talk about this a lot more today, but we have guidelines. We know what we should be doing and how we can help people. And yet there's been a long legacy of misunderstanding, um, based on a, a trial that was totally misinterpreted in the early two thousands and created a lot of unnecessary fear, um, around hormone-based therapies. And, um, and so we have now generations of women who have missed out on having care that could really help them. But we're at a very exciting turning point, which is a real revolution in care for women who are going through perimenopause and menopause. And the time really is now for us to recognize this life experience that affects 85% of people, um, will experience symptoms that last on average four to seven years. Um, and it can be significant impact on quality of life, family dynamics, workplace. Um, and so I came to one medical to train our providers and we've been able to train hundreds, and I'm just so excited to share some of this out. So, um, we, we really hope to make this type of care available to everyone, whether it's with us or elsewhere, wanna help everyone know that care is available and can help people feel their best selves again. Um, yeah, let me, let me add on that and sort of answer a little bit of the question Dan posed, which is sort of the why and the why now, maybe. Um, and I mean, I think, you know, the, the whole, uh, session today is a little bit about the why, but I think the, um, the, you know, for reasons that Aaron's outlined, um, you know, we, we certainly think that employers should be thinking about, you know, menopause and perimenopause as a particular type of benefit, you know, within their healthcare benefits, even as, uh, of course we wanna be considering all, um, all employee health needs. But that's part of why that's part of the why here. As we have moved into kind of benefits strategies that's very attentive to making sure that the, the benefits are inclusive of the entire workforce. This is sort of you, if you will, a bit of a natural progression of that, um, that strategy within the, the benefits professional community. Um, but, and so I think, you know, for, but it's one thing to acknowledge that, and it's one thing to say like, ha have people really kind of dug into what their benefits strategy is around, um, about menopause care? And, and likely a lot of folks in, in the HR world are saying, well, I don't know if we have any strategy whatsoever. Um, or maybe we do and it's not as developed as we'd like. I think, um, I mean, one thing I could share just to kind of put some stats around it, and I saw this just actually the other day in an employee benefit news. They had a survey out on, on specifically on this and saying that, um, you know, I think the, the basic finding there is that, uh, it, it, as a thought of it as a benefit, it's a bit of an inconsistent offering, right? So that, um, the, I, I think, so the report there was about six and 10 employers offer, um, hormone replacement therapy as part of the plan probably should be higher than that. It plans vary in a lot of designs and things like that. Aaron will get into much more detail on why that's important, but just sort of as a baseline. And then, uh, it was reported at 39%, um, offered access to in-person menopause specialist care providers. So that's kind of the key thing here. And what Aaron will really dig into is like, it's one thing to sort of have a, a benefit for it, have some insurance coverage for, for menopause care. It's another thing, do you have access to a menopause specialist? So we wanna be able to say what that means and what you should be looking for there. Um, and so, you know, we're definitely at a place where there's a, uh, I would say a med acknowledged coverage gap. And that's part of the, um, the, the momentum that's being created here. 'cause I think the other finding from this particular survey was that, um, it was really about two thirds of the benefit specialists saw menopause care as a benefit, as something that should be a lasting and important benefit to have. So for those who work, you know, very specifically in that area, there's often this idea is like, is it a, is it a must have? Is it a nice to have? Like we're we're moving into, um, it's a, it's a need to have and a need and a need to have at a certain level of quality that's above them, what, what we're typically getting. So I think, um, you know, that's, it's probably a good place to hand over to, to Aaron to talk a little bit about, um, you know, what, what are some of the different approaches and to think about the, you know, as we'll think about the options that employers have for this. Um, and, and what medical stake and it's, you know, has a particular view on of sort of building this into primary care. Um, Yeah, definitely. And actually, and I'm, I'm not gonna totally keep up with the chat, but I am reading some of your comments and, and really appreciate them. And I actually will like to start with maybe just a few definitions for us to, to ground ourselves. So, um, a lot of you already know this, but just in case, so, uh, menopause, we define menopause as, uh, the time when someone has had no more menstrual periods for one year and it's not due to something else like being pregnant or having their uterus removed or an IUD. So, um, you, you get the ideas that the, the ovaries are cycling every month. That's what creates periods and fertility for people. And then menopause is when that time has come too close. Now, perimenopause, peri means around, this is the time around menopause, but really refers to the years leading up to the final menstrual period. And perimenopause actually tends to be the time with the most severe symptoms on average. And it's because it's a major time of transition. I think culturally we have a good understanding that puberty is a time of a lot of changes and it can sometimes help to have that type of a lens. It's not the same thing at all, and every person has a different experience, but for some, there are a lot of hormonal changes during this time. So we can see a lot of different symptoms. And so, um, you know, some of those that, um, you may have heard of and read about in articles or had a family member or an employee talk to you about, um, things like mood changes maybe that hadn't been an issue before or kind of recurring. Um, also sleep difficulties. Uh, some people have these cardinal classic symptoms, which we call hot flashes and night sweats. So temperature dysregulation that's due to fluctuating or low hormones, um, and menstrual symptoms. The list really goes on and on and every person's experience is different and changes over time. So I, yes, I see people talking in the chat, you know, rage is something common I hear from patients. And there are a lot that we think of as impacting the workplace pretty clearly too. Like, I've had a patient before, tell me, I've always been so confident. Um, I've always loved giving presentations to my colleagues, and for the first time ever, I find myself paralyzed with anxiety. Every time I have to give a talk, can you help me? I don't know what's causing this, what can I do? Or, um, I used to be so sharp on my feet, I could, you know, answer questions and now I find I have, you know, foggy brain, maybe it's 'cause I'm not sleeping, I have kids, they're waking me up. I don't know. And so there tends to be this very mixed picture. Um, and it can be hard sometimes to figure out what's going on, but what's important, and this is really going to, you know, what Josh brought up, is how do you find a clinician that can actually help with this? So, um, and we'll, we'll talk about how to find them, but I wanna answer your question, Josh, which is, what are some of the standard pathways of care that some people might take if they're noticing they're not feeling like themselves? Maybe they're having some of these symptoms that are more or less classic to perimenopause or menopause, or they're not sure what's going on. So oftentimes people will first go to their primary care provider or their gynecologist. I'm not feeling like myself. Maybe they'll go to urgent care because we know that there are plenty of environments in which it can be difficult to get into access care, particularly with someone who knows you. There can be long waits, you know, in certain, um, metropolitan areas. It's more than others based on the types of insurance too. And so in that scenario, the odds of landing on somebody who's really trained in menopause care are unfortunately currently low. I hope this changes. I'm optimistic about my colleagues and all of us, you know, wanting to learn and train up. But just simply seeing whoever is available, there's not high likelihood that the person will be met with somebody who's competent in menopause care and can think about, Hey, I need to think of menopause and hormonal contributions as part of this picture that the patient is describing to me. Now, how do we find someone who does know more? So the Menopause Society is a national, actually multinational organization from North America, um, that is considered the most respected governing body setting what is evidence-based care. And they have providers who are members of the society. This is a good shortcut to finding providers who are going to be trained up in the latest evidence, um, and and focused on doing evidence-based care. I wanna also actually talk about what is evidence-based care, because there's so many ideas, you know, out there and over the years we've seen this evolve. So for many people experiencing menopause symptoms, modifying their hormones will help them feel better. That can take a lot of different forms. So what's right for the person does require a really strong clinical relationship and sometimes some trial and error. And doing evidence-based care is in perimenopause, oftentimes we're looking towards hormone modulation. This can be using birth control pills are one form that can be right for some people in certain situations. There's also using menopausal hormone therapy or estrogen progesterone and helping people using those hormones in different combinations and different frequencies and ratios. And then we also use non-hormonal treatments as well. Some of them are pharmaceutical prescription treatments and some are lifestyle focus. And so it's taking that holistic perspective of what are the different levers we can pull to try to help this person feel better. Um, and I wanna also talk about what is bioidentical hormone therapy? 'cause I've seen that in the chat and it's such a good question that comes up. So, um, bioidentical hormone therapy is actually a marketing term that came about a number of years ago. And the idea is that it's hormones that are the same as the exact hormones you make in your own body. There are many FDA approved pharmaceutical grade bioidentical, or we'll say the same molecules as your body makes hormone therapies available. Um, there's a misconception because certain groups marketed this historically that bioidentical hormone therapy is only available through compounding, which is pharmacies that will mix up, um, batches of hormones for you, um, and therefore is not covered by insurance because it's a bespoke, um, handcrafted cocktail. Um, while there are certain scenarios where that is the best thing for the patient, in the vast majority of cases, people who are recommended to take hormone therapies can get pharmaceutical grade FDA approved hormone therapies. Most of them are available in generic. Um, but Josh, it sounds like you had some statistics for us on the coverage of hormone therapy, and I think what we're talking about here is those FDA approved versions of hormone therapy because compounded hormone therapy is not gonna be covered. But it's also fortunately not required most of the time. I know I've been talking a lot, but I really like to give us some of those kind of definitions so that we can be having the same conversation Yeah, I'm seeing in the thread. Exactly. You know, each person's individual and, and yeah, compounding can be really variable. Yeah. Thank, thanks all for engaging in the chat. Yeah, Erin, that that's super informative. I, I already picked up a few things, but I thought just to what you were talking about there, so I think you, um, were outlining quite a bit just on the clinical side, there's different clinical pathways. I'll, I'll sort of speak on the benefit side that, um, you, I think one thing, um, that we're seeing in terms of, you know, solutions for employers that are thinking about this is like, uh, you know, the, there's a way in which it's, uh, starts to look like a pharmacy benefit. And, um, and so we wanna be careful about that. So I, I think I might use that as a way to kind of tee up again, this kind of topic of, um, what for employers, there's different options and, and there's a lot of standalone solutions out there for, for menopause care. That's great. We, we want everybody to be getting, um, the care, there's just a, a deficit of opportunity and access right now. Um, but I think the, you know, the way that one medical can approach this, and obviously we, we feel like this is a great way to do it, but what are some of the advantages of, you know, really integrating that in with primary care? Like what does that mean? And I think, you know, Aaron probably even, you know, starting with what, what are people's sense of primary care? Why would they or, or not come to a primary care provider for this type of, um, uh, uh, you know, type of care to begin with? Yeah, so I, I really think the goal we, we need to work toward as an entire medical community, and I feel proud that we're leading this at one medical, is that menopause care is primary care. This is care that is best done in the context of someone's overall health and the relationship they have with a continuous provider who knows them over time. A continuous health team that knows what's important to them, that understands some of the challenges they've been through, that knows any past medical history that could interact with how we would advise the person. Um, and so I think we're in a really exciting time where there are a lot of, um, actually menopause, entirely menopause focused, um, clinic, sometimes telehealth services to really increase access for everybody. Um, and I, but I think the ideal is not just to have menopause aware care, but whole person aware menopause aware care. That's the whole package. That's what really helps people because there, there are plenty of cases I can tell you that I've had with patients and my colleagues that I've trained have where, um, you know, on the very first go, we start a treatment, the person feels a lot better, um, and we're really off to the races. It's also common that, um, it requires working together and tinkering. The body keeps changing over time, things are changing. And so, you know, I can't even tell you how many times someone has come in for menopause concerns and we've found something else that needs attention. And so how often do we say, you know what, let's start this treatment. And gosh, it looks like there's pre-diabetes as well. How can I help you with a lifestyle program that works for you so that now you're feeling a bit better, we're treating your hot flashes, you're sleeping better, but also, hey, let's get you, you know, back into that healthier eating you were doing before or the activities you enjoy. So we're able to look at this as part of the whole person. And what's interesting is more and more research continues to come out saying menopause is actually a transitional time that we start to see new cardiovascular risks come up. I bet if you talk to people who've gone through this life experience, you'll hear things like, I never had high blood pressure before. I never had a problem with my blood sugars before. I am now having more difficulty with, um, weight than I ever was before. Something is different. This is not a failure of willpower. It's, that's not what's going on. We have real body changes that are happening. Primary care is the place where we really focus on these types of things and how to improve them. So I like to bring this up because the treatments for menopause sometimes also involve treating the other things going on with someone and finding that source also of motivation and partnership to do good care. Um, who is, yeah, yeah, go ahead Dan. No, I was gonna say that I just, I know it's big. We've had, we've had a great conversation so far and a lot of interaction. I just wanna make sure we get to Jessica Lungs, uh, you know, a question, it might be useful to share, uh, useful to share the importance of allyship and also that lived experiences, um, even just through identity are not the only way for people to get knowledgeable on this topic and to advance care and options for employees. Any thoughts on allyship? Yeah, I, I guess I, I saw that, and I also saw another chat or que comment there about sort of communication within the workplace about that. I, I take that as kind of a form of how do you build allyship, um, uh, and, you know, build a sort of business case for, you know, a, a meno menopause care benefit and expanded benefit. Um, I, I think the, you, as we we've said already, but I think it, it bears repeating that, um, I think the strategy here, the kind of communication strategy is not to be treating this as something as like kind of special or niche benefit, but like, let's acknowledge that this is something that, you know, affects 50% of the population, um, that it is an absolutely normal and predictable part of, of aging process. Um, also acknowledging, you know, HR professionals are highly sensitive to, uh, things that are related to age and to gender, right? And, and so communications around that are, are, you know, need to be treated with, you know, appropriate sensitivity. You layer on top of that health issues and privacy. Like this is a topic that's a little tricky to, to navigate in the workplace. Um, but I think the, uh, the, the starting point is to say like, this is absolutely a normal part, and so we need, this should be a core part of our benefit. And, and, um, in terms of health benefits, the, the underlying point there is always to make sure that you're, you're meeting everybody's needs. And so I think that's kind of the, the starting place. I think, um, the, you know, and I think within, as I mentioned before, like within sort of benefits strategy, there's been a movement just to make sure that there, there's sort of an inventory and assessment of like, are we meeting everybody's needs? Are we meeting them at different life stages? And so this becomes a natural part and of that, you know, strategic conversation and sort of review of benefits, um, as you're looking at other things as well, it's no, um, you know, it, it's the same type of conversation when you're trying to identify gaps as if you're talking about cancer coverage or something else. Um, I think the, it, it's also, um, you know, important then to, you know, if you're, particularly if you're managing a health plan and not just the sort of workforce, but that you're thinking about dependence as well. And so maybe you have a predominantly male workforce, but there's a lot of, uh, dependence on there and, and making sure, you know, what are your strategies for, for, for that. These are, you know, pretty common things within, um, the, the, the, uh, the HR teams to be thinking about. But I think also, you know, this is also a great, and I love the kind of allyship part of it. 'cause it, another part of it is, and, and Aaron's hit upon this, like there's just some of the symptoms and things and, and experiences of having menopause that then to impact other parts of the workplace. And so, you know, having the conversations with, with the facilities people about the temperature of rooms, I, I know that has, uh, come up numerous times in my own experience with colleagues and things like that. Um, like this is a great opportunity to sort of expand out the conversation. Uh, similarly with things just, you know, occupational health services as you get into the nitty gritty of like, what are, what's dress codes, what's uniforms, um, all of those things, you know, are, are part of a, a, an important conversation to build a great workplace experience. Tie that in specifically to your, you know, your health plans and the benefits that are being offered there. I think, you know, there's, there's varying degrees of creating sort of champions, um, manager trainings, but I think all of, all of that underlying that is just sort of normalizing the, the conversation about it and, uh, and, and ultimately sort of just making it a, um, you know, a topic that always flies within, uh, you know, the, the workforce, which is just like, how, how are we addressing employees' needs? How are we making sure that they're fully present and, you know, as productive as they can be. And there's some really great questions. I'm like, which one to tackle? Right? I mean, I like the, I building off of what you just said about, you know, earlier about communicating these benefits and positioning and how it's, you know, part of the larger package of bene of, uh, healthcare benefits. Um, what do you do if you're mostly in a male only workplace environment? You know, how do you, how do you, uh, how do you, how do you get people to kind of listen to you and understand what you're going through when there's no other women? Let's say. Uh, and then I think this one's pretty interesting just in general, like advocacy. Advocacy, you know, how do you advocate yourself as a patient when you feel like you're not being heard? And this sort of like an intersection there too. It's, what do you say? How do you speak up, especially in certain circumstances, like you're surrounded by men. Yeah, well, I mean, I, I I can definitely speak to, um, strategies that should hopefully help when interacting with clinicians or a clinical team and feeling like you're not being heard or understood that they're kind of missing, um, what might be going on for you. So, um, you know, first and foremost, anytime we can get this care from someone that already knows the swallow, particularly if we otherwise have a good relationship with them, it is the case that these days, not all providers have yet pursued extra training. And I hope all will, uh, certainly at one medical, we, we feel that we're ahead of the curve here, but, um, I think what can help is, um, I saw in the chat someone actually put one idea that I think works well, um, which is, uh, giving a heads up in advance of a visit of what you wanna talk about. Sometimes that gives providers a chance to say, oh, I actually maybe don't know as much about this. I'm gonna quickly try to read a little bit and educate myself. Sometimes if I know someone's coming in with something that maybe I haven't seen in many years or is really complicated, I could take the opportunity to try to read up a little bit or ask a colleague. That might create a little opportunity there. I would also say, um, stick to how you feel. You know, if you feel like it's not clicking with the person, I would express it and say, I feel like there's something more here. I wouldn't be afraid to say. I'm wondering if, um, perimenopause or menopause is playing a role here, how can we assess that? And I think that's important. I will comment on, 'cause there, there's questions and, and I get these all the time. Um, can we use labs to help guide us in medicine? We use lab testing, imaging all the time to help us with our investigations in menopause care. There are, uh, fewer scenarios where labs are helpful. They definitely are helpful. If someone is, um, having these symptoms earlier than 40, we'll get them as many times as we need to to see if something's abnormal there. Um, they can be useful if we're trying to, you know, differentiate between a couple of different diagnoses we have in mind, and some of those have specific tests for them, or there, maybe there's some hormonal patterns we do or don't see. Um, but when it comes to, uh, more standard perimenopause in the late forties, early fifties, the labs don't usually help us choose a treatment. I think the diagnosis is much easier then. Um, and the labs, unfortunately, providers who are unacquainted could say labs are in normal range, therefore nothing to do here. Um, I think those of us who are experts know that labs vary quite widely. Um, and so just because they're falling somewhere in the normal range doesn't mean that, um, hormones are not a contributor to what's going on. So unfortunately, I, I actually sometimes see labs used in the wrong direction by mistake, which is to withhold care, um, because they haven't really been designed to answer the exact questions we need these days. And, and I am hopeful and have heard of research happening now to try to make more precise types of labs that can help us guide treatments. Um, but Josh, do you wanna maybe comment a little more on, um, for folks who are in the workplace and, um, looking for some guidance or some understanding, um, you know, strategies around that or, or maybe being on the receiving end as HR professionals, how can we create that environment that helps people? Um, yeah, and I, I think that's sort of moving the, the conversation forward to saying like, okay, you've made, made a case for, um, you know, a particular benefit to how that is one go about kind of communicating that. I think, um, you know, there's different, uh, you know, the, the strategies there are to sort of, you know, I would say kind of fold this into the, the general health communication strategies. Um, and, you know, uh, it's, it's often there's a place now, you know, for women's health is often pulled out as a particular topic. So obviously this kind of fits naturally into that. Um, you know, and I think that if there's not sort of a, an existing benefit, that also becomes a way of sort of highlighting the topic and the need for the topic. Um, so I, I think those are, you know, that that's, that's one way of, um, again, the communications like that, that, that are going out to the entire workforce. It gets them familiar with the topic and, and allows that kind of conversation to open up as well. Just, uh, to, you know, to, to be able to see it in those communications is just, you know, next to the make sure you're eating right and exercising and those typical kind of health promotion activities that everyone recognizes, you know, are, are, are for everybody. Um, to, to put that in there is a, is a good strategy, I think. Um, yeah, I mean, there, there's so many great questions. I, I know we're all sort of reading through them here. Um, I think Aaron, maybe I, I might ask you just 'cause I saw it fly by and just wanna make sure we address it as just the, um, you know, I think there was a question or sort of like, how does One medical refer out to, um, to specialists in menopause care? So, uh, there's one thing I wanna make sure that everyone gets the takeaway, just at least about us at One Medical is how, uh, a clear understanding of how we are delivering that. So Aaron May give you the opportunity just to outline what this incredible program that you've, you've built at One Medical Yeah. And, and thanks for the question. So, um, what we do actually is we have more than a third of our providers who have undergone advanced training in menopause care. So we are not referring out almost at all for menopause care, um, at this point. And I do track those things, and it used to happen, um, before we got started and we, we really aren't referring people for menopause care now, which we're really proud of. Um, one of the reasons that we felt strongly that we wanted to do this care is, you know, when you feel good about a referral, like we have great cardiologists we refer to in all the cities we work in, we didn't feel like we necessarily had a place that had good access to care. Oftentimes there's one amazing provider at an institution, but nine month waiting list, one year waiting list not taking patients. We said, we can't in good conscience be referring people to get this care, and then they just wait and don't get it. This is within our realm to learn this and do this well. And like I said, do it integrated with your overall care. Um, and so what we're doing is menopause care within primary care, and to be specific, um, we offer these visit types that are called the peri slash menopause visit. So we're welcoming people who may be experiencing perimenopause, menopause, not sure, but want to look into it and talk to someone who knows more about the topic. And so patients can book that directly through our app, um, or by calling in if that's their preferred method for booking. Um, and only providers who have undergone this training, who are passionate about this care are the ones who offer those visits. All of our providers are aware and can help people navigate. So if their regular primary care with us doesn't have that advanced level of training, they may be able to start some of the investigation, start some basic therapies, but they may say, you know what, for your care, it's a little more complicated. I want you to see my colleague, Dr. Aldi or whoever. Um, and so we stay within the system of care, we stay within one medical, the place that knows you, that has your records. So, um, that's something that we're really, really proud of and happy about. And we have been hearing from our patients that they're grateful to be able to get this care quickly, to get it with people they already know within their system of care. That's really important to us. I know somebody in, in the channel mentioned earlier that, um, a great gynecologist can do this too. Absolutely, absolutely. There are wonderful gynecologists out there that do this type of care too. Um, we're just so happy that we can do this at the scale that we're able to do this offering in, you know, more than 20 metropolitan areas, um, doing virtual and in-person care so we can fit it to whatever's clinically appropriate, whatever's preferred, um, for the person that's the, the care that we're doing. Excellent. I mean, this a it's a great conversation going on. Uh, one of the questions that I saw was, what are your thoughts on the Dutch test? Yes, Aaron, do you know that one? Yes. Uh, Dutch testing is, um, uh, test usually about $250. Um, providers, uh, sign up with the Dutch company and sell that. Um, it's usually like private practice type providers. Um, there's really been no strong trial data to show that it helps get people on the right treatments. And to my mind, I wanna use a test that's gonna help me elucidate diagnosis and a treatment pathway. The whole point here is to get someone from feeling not good to feeling good. So since the Dutch test has not been shown to be beneficial in that, that we can do this without it, I don't recommend it, we don't do it at one medical, we feel that that is, um, an unnecessary expenditure on the patient's part. Um, uh, that said, there are gonna be practitioners out there that really swear by this method. There's always a great range in how people practice. Um, but the, the evidence and the menopause society is very clear on this is not strong for Dutch testing, but I don't wanna negate anyone's experience who felt like that really unlocked the key for them, even though if on average it's not great, it could be wonderful for some people, but again, we don't, we don't use that. We use, um, blood-based testing when appropriate. Um, and, and I also think it's worth emphasizing because we are generalists. We are family practitioners and internists, and we, we are focused on, on, um, cardiometabolic health to a large degree. We don't let lab tests start or stop at hormones. We're thinking about your long term heart health. We are looking for how our blood sugars, um, we do advanced cholesterol testing with a OB and lipoprotein A, these are things that people should be asking their providers for, um, these days. But we we're trying to stay, you know, on the cutting edge of that as well. And consider the menopause transition actually a particularly important time for doing this type of investigation. Um, just to answer Susan's question, do you designate your PCPs on the website as having additional training? Um, we have individual provider bio pages, and this information would be on each provider's bio, but for somebody, um, who just wants to go in the app and book and ensure that they see someone, um, that is, has the additional training, if they select that peri slash menopause visit type, they will only be able to book the visit with people who had the additional training. So they don't need to, uh, go searching and, you know, find a list over here. Um, it's directly in that booking experience. This is another question from Andrea. Does anyone consider offering quiet space for those who have extra care needs, nap, regroup, let out the emotion, get, get away from overstimulation? Any Thoughts I get? I can take that. I mean, I, I've, I've seen a lot of organizations add, you know, whether it be called a wellness room. I think it probably one of the first motivations was for lactation. Often that's, um, gotten pulled off as a separate space to, to do that. Um, but yeah, I think it's a very reasonable thing for, uh, employees to ask, you know, their, their workplace to provide some sort of, um, you know, quiet space, uh, essentially kind of a little bit of a retreat within the workplace to, to, um, you know, regroup themselves and, uh, rebalance themselves. So I, I at least I, I think it varies greatly on terms of size of the, the employer and types of benefits that they already offer. But I can say that, you know, in, in the large employer space, um, where I have gone through, uh, a lot, a lot of, uh, visits, um, it, it's really become a norm that that kind of space is available. Excellent. Um, I'd love to make this a little bit, uh, also, you know, more future looking, uh, from your perspective, Josh, how do you envision the relationship between employers, employees, and primary care providers evolving over the next few years, and what do you think will define success? Yeah, I, I think, um, I mean, starting with primary care, I, I, I, I think this topic has helped highlight that primary care is very broad and can meet a lot of people's needs and really should be thought of as the, the first place to start care. And not just for something that like a kind of urgent care, we are, we are trying to make sure that primary care is something that's understood as the place to, you know, have a longitudinal relationship, having a trusting relationship with your, your provider and, you know, a, a, a group a a care team that can really help you navigate a lot of different things. Um, so I think that that's kind of the starting point. And my particular, you know, passion here is to make sure that, um, there's so many things that, that, uh, a, a good primary care provider can address. I think Aaron's made a very good point that even then just above and beyond sort of standard training for that, um, something like menopause is an area that needs additional, um, or, you know, the, the patients benefit from that additional training. And then there's historic reasons there that, you know, Aaron hit on just in terms of evidence in the, the, the clinical education and sort of comfort levels navigating that. So that, that would be one thing. I think, um, that said though, like the, the, our, our goal, what I think everybody should be looking for from community primary care is the a an ever growing kinda stronger training. Um, and that it's, it's not just, uh, kind of an annual exam and sort of an urgent visit, but that the standard is that you're have, you know, open communication with a provider and have means to do that. Um, and that if they don't have a particular specialty training, they have an ability to consult for that or refer out if needed. Um, I think then, you know, from the employer's perspective, you know, as a kind of major purchaser of healthcare services, you know, making sure that you are getting the data, uh, that you need to show clinical effectiveness to show. So I think, um, you know, lots of, uh, uh, I would love to see sort of the data and analytics around this to be much better, um, in terms of, you know, clinical outcomes, but access, um, and mostly because I think that it, it, it's that type of conversation that moves, um, moves the conversation forward in a business environment, you need, you need data, you need things to, to, to ground yourself in. Um, and when, when of, when none of that's really happening, then it becomes a much more sort of, um, unstructured conversation and it's harder to get results there. So I think those are, um, you know, the, that's sort of broadly what I would love to see in terms of success. Um, and you know, I mean, it just really getting into the, the details on that, I mean, I, I, I want every, you know, employer to be able to say that with confidence that, you know, every employee's getting the care that they need. And, you know, and specifically, um, you know, the around menopause care, I'll, I'll just sort of add in, like again, there's a, a very strong argument in the workplace around productivity. We're talking about often taking, um, you know, uh, women being impacted, I would say not just women, but really in this age group is like their prime earning years as well. Um, then you think about it that way, it's just like, this is not part of the workforce that you want to, um, you know, to, to be short changing in any way. It's, it's a really important piece and there's a really important business argument to, to be made here. That's so true, Josh, because so many of my patients are, you know, in, can be in upper management or have been at a company they love working at for so many years, but now because of feeling poorly for some time are saying, I'm sober out. I, I feel lost. I, I don't know how to feel better. I've been trying to get care. I can't find it, you know, when they finally arrive with us. And so I think, um, helping people really get to that care and, and normalizing these conversations, and I mean, Josh, you paint such a wonderful picture of, of a workplace that would really, really support people in getting, um, the care navigation they need early and, and the resources they need to really feel their best and keep being an amazing part of, of their team and leading their teams. That is so many, so many good comments and questions. I wanna wrap it up. I also, I do wanna get to this question because I'm, I'm even curious, I'm really curious about this too, just from your, all, both of your experiences is, is, is there an organization that you consider a gold standard for menopause benefits? Is there one that you're like, yeah, that company, you know, their offering looks good, the communication access to care, just kind of check, you know, primary care is embedded, like checks all the boxes. Do you see any company that really stands out or are we, are we too early? Josh, isn't there an award for this? I think I, but I don't know what the criteria are there though, so I don't know if I should celebrate the winner of it because I don't really know. But there, there is some sort of award for both menopause aware workplace and that exists. Okay. I, I, I think, um, yeah, I, I think, uh, Dan, I, I think what, yeah, what Erin's putting, there's lots of, um, awards and sort of recognition. This is a topic that's really gotten folded into there. So, um, but in terms of standard, um, I, I mean I, I, I think really, I, I think there's so much more, I, I don't mean to sound sort of, you know, Pollyanna about, but I do think there's so much more space to grow here that no one's totally achieved what they could achieve. Um, I think it tends, you know, what phrased that way, it tends to favor some of the companies that are early adopters have richer benefits and are able to kind of pull in some solutions and, and do things. Um, so I think, uh, I'll, I'll leave it at that. I'll, we'll, we'll find that for another day. Excellent. Before, before I wrap up, any additional comments, anything that we didn't cover that you think is really important to raise to this group? Erin, Josh, I, I, I think we covered a lot. I, um, yeah. So Aaron, is there any clinical information that you feel like you wanna address or clarify? I Think that the main thing is to actually feel hopeful at this time and, um, uh, and to keep searching for the right provider to help. And if this is, you know, advice for individuals, but also for HR professionals who may be helping people navigate their care benefits, um, I would say keep at it because they're very much are people who are qualified to help with this. And I would use the listings on the Menopause Society website as a guide, um, look to organizations like One Medical and other orgs that, um, really are demonstrating good outcomes in menopause care, um, because a lot of people can do a lot better. Excellent. Well, that's a great way to end it. I just added the link to, so for everyone could download the report where you can hear a lot more from Josh and Aaron on this topic and you know, it's a white paper you can send your colleagues, anyone you think would benefit from it. I think they, that would be a really great thing as kind of a, uh, you know, next steps. And, you know, it was a great conversation. I mean, I learned a lot. I'm sure everyone else felt, you know, almost like this was like a support group a little bit, you know, with the conversation that people have had, um, definitely down the white paper and continue the conversation because as, as Josh had pointed out, this is just getting started and you know, it's gonna continue to be something that is really important to women in the workplace moving forward. Thanks everyone. Thanks. Thanks all.