VA Falls Short on Menopause Care for 300,000+ Female Veterans

Why It Matters

More than 300,000 women veterans using VA health care are at the age when menopause is most likely to occur, and a new federal watchdog report finds the VA is falling short on both the clinical guidance and patient education needed to serve them. A report published June 12 by the Government Accountability Office found that VA menopause care lacks a completed clinical practice guideline, has no finalized performance measures, and has no systematic strategy to inform women veterans that menopause treatment is even available to them.

The consequences are measurable. In a GAO questionnaire of 348 women veterans aged 35–64, 60 percent said they had never encountered any VA menopause resources. Among those who did not receive care from any provider in the past five years, 41 percent said they simply did not know they could get menopause care through the VA.

A Growing Patient Population

Women are the fastest-growing group of veterans receiving VA health care. Between fiscal years 2019 and 2024, the number of women veterans receiving care from the Veterans Health Administration grew 31 percent, from approximately 524,300 to nearly 687,000. Almost half (about 45 percent) of those women are between the ages of 45 and 64, the window when menopause symptoms are most likely to emerge.

Those symptoms are not trivial. VA menopause care addresses hot flashes, sleep disruption, mood changes, memory issues, urologic concerns, and vulvovaginal health, among others. Hormone therapy is one of the primary treatments, and the VA's clinical pharmacy network and gynecology workforce have grown to meet demand. Full-time equivalent gynecology providers increased 56 percent between FY 2019 and FY 2024, from 142 to 220. Women's health primary care providers rose 43 percent, from 2,688 to 3,832.

But the data also reveal wide variation in how care is actually delivered. Across VA medical facilities in FY 2024, the share of women veterans aged 45–64 with a menopause-related diagnosis in their charts ranged from six percent to 20 percent. The share who filled a prescription for hormone therapy ranged from three percent to 35 percent. That 32-percentage-point spread suggests something other than patient need is driving the difference.

The Unfinished Guideline

At the center of the GAO's findings is a clinical practice guideline for menopause care that the VHA began developing jointly with the Department of Defense in February 2025. As of April 2026, a draft was still under workgroup review, with completion anticipated by mid-August 2026.

The workgroup had not yet begun drafting performance measures as of April 2026, though officials anticipated starting that process in late May 2026. More significantly, officials from the Office of Women's Health, the sponsoring office, told GAO they could not confirm whether or how they plan to monitor those performance measures once they exist.

Without a completed guideline and without a monitoring plan, the VA has no systematic way to know whether its clinicians are providing consistent, evidence-based menopause treatment recommendations across its 139 medical facilities.

GAO made two recommendations to the VA's Undersecretary for Health. The first: use performance measures tied to the clinical practice guideline to monitor implementation across facilities. The second: develop and implement a strategy to ensure women approaching or experiencing menopause are proactively provided with educational information about their symptoms and available care options. The VA did not provide comments on the report.

What Veterans Said

The GAO conducted a questionnaire of 348 women veterans aged 35–64 between April and June 2025, drawing respondents from 48 states, Washington, D.C., and Puerto Rico.

The responses paint a picture of a patient population that is largely unaware of what the VA offers. Of the 108 respondents who had received VA menopause care in the past five years, 68 percent saw a primary care provider and 55 percent saw a gynecologist. But 54 percent of all respondents (189 out of 348) had not received menopause care from any provider, VA or otherwise, in that period.

Of 30 dissatisfied respondents, 70 percent felt their VA provider did not take their symptoms seriously, and an equal share felt their provider did not take their concerns about treatment options seriously. Sixty percent said their provider was not open to discussing all available options.

Access gaps also showed up in wait times. One facility reported that a referral to a community care gynecologist could take as long as 97 days, compared to as few as 5 days for a VHA women's health primary care provider.

Racial Disparities

The report also surfaced a disparity in how menopause care is delivered across racial lines. VHA research cited in the report found that Black women were less likely than White women to have documented menopause symptoms in their charts, despite evidence suggesting Black women carry a higher symptom burden. Both Black women and Hispanic women were less likely to be prescribed systemic hormone therapy than White women.

The incomplete clinical guideline makes it harder to address those disparities systematically. Without standardized recommendations and performance monitoring, individual provider discretion fills the gap, and the data suggest that discretion does not produce equitable results.

Provider Training

As of March 2026, VHA offered 36 menopause-related trainings. A four-hour session on menopause and hormone therapy in November 2025 drew more than 1,100 VHA providers. And a 2024 national needs assessment of primary care providers found that menopause was the single most requested area for additional education among the 3,217 respondents.

That demand for training came shortly after a significant regulatory shift. In November 2025, the Food and Drug Administration removed "black box" warnings about the risks associated with hormone therapy, noting that women may be under-utilizing approved therapies. The change reflects an evolution in the clinical evidence on hormone therapy, one that the VA's still-unfinished guideline will need to incorporate.

The Bottom Line

The report was requested by three Democratic members of Congress: Sen. Kirsten Gillibrand (D-NY), Ranking Member of the Senate Special Committee on Aging; Rep. Julia Brownley (D-CA), Ranking Member of the House Veterans' Affairs Subcommittee on Health; and Rep. Kelly Morrison (D-MN).

All three serve in minority roles on committees with jurisdiction over veterans' health and aging policy, meaning the request came from lawmakers without subpoena power or the ability to compel hearings. Commissioning a GAO review is one of the principal tools available to minority members who want to put pressure on an agency without majority backing. The VA's silence in response to the report leaves the two GAO recommendations without a public agency commitment to act.

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