国会最近首次就更年期问题举行了听证会。立法者花了这么长时间才着手解决这一重要问题，这反映了我们整个国家在公开讨论、深入研究以及为解决女性健康中的这一常见问题提供充足资金方面所存在的不足。
Congress recently convened a first-ever hearing on menopause. That it took this long for lawmakers to address this important issue mirrors how we as a nation have failed to publicly confront, thoughtfully study and allocate meaningful federal funding to address this predictable stage of women’s health.
上个月，参议员柯尔斯滕·吉利布兰德（D-纽约州）和里克·斯科特（R-佛罗里达州）邀请医生和专家到国会作证，讨论更年期的相关培训、研究及医疗护理现状。他们的评估结果令人沮丧：医生短缺、医疗资源获取困难、保险问题以及医学教育不足等问题都被认为是导致进展缓慢的主要原因。
Last month, Sens. Kirsten Gillibrand (D-N.Y.) and Rick Scott (R-Fla.) invited physicians and experts to testify before Congress on the current state of menopause training, research and care. Their collective assessment was discouraging — physician shortages, inadequate access to care, insurance challenges and a lack of medical education were cited among many reasons why there’s been little progress.
两位参议员还要求政府问责办公室调查联邦政府在更年期研究方面的资金投入情况，以找出培训、治疗和监管方面的不足之处。
The senators also asked the Government Accountability Office to examine how the federal government has funded menopause research to identify gaps in training, treatment and oversight.
更年期是女性衰老过程中的一个自然现象，标志着她生育能力的终结。这一阶段会伴随重大的荷尔蒙变化，常常引发潮热、夜间盗汗、睡眠障碍、情绪波动、泌尿系统问题、注意力下降、体重增加等症状。如果这些症状得不到及时治疗，将对女性及其家庭造成巨大困扰。
Menopause is the normal part of a woman’s aging process that marks the end of her reproductive years. A major hormonal shift takes place, often triggering hot flashes, night sweats, sleep interruption, emotional swings, urinary changes, concentration loss, weight gain and headaches. These symptoms, if left untreated, can be enormously challenging for women and their families.
更年期是一个生物学上的现实现象——大约一半的美国女性都会经历这一阶段。这些女性在围绝经期和更年期期间会花费其生命周期的三分之一时间。然而，几个世纪以来，这一话题在我们的文化中一直被视为禁忌。
Menopause is a biological reality that roughly half of the U.S. population will experience. These women will spend as much as one-third of their lives in perimenopause and menopause. Yet, for generations, it has occupied a taboo place in our culture.
问题的根源部分在于医学教育和培训体系：更年期并未被妇产科医生视为重要的研究领域。一项针对美国妇产科住院医师培训项目的调查显示，仅有30%的培训项目包含更年期相关的教学内容。
Because it’s a topic no one wants to talk about. The problem begins, in part, with medical training and education. Menopause isn’t prioritized as a field of study among obstetricians and gynecologists.
根据《研究生医学教育认证委员会》（Accreditation Council for Graduate Medical Education）的规定，接受妇产科培训的医生必须完成至少360例分娩手术。然而，目前对于治疗更年期症状的医生来说，并没有类似的培训要求或工作标准。
One survey of U.S. OB-GYN residency programs found that just over 30 percent had a menopause curriculum. The Accreditation Council for Graduate Medical Education requires that an OB-GYN in training must log a minimum of 360 direct deliveries. Today, there is no such standard required for doctors treating menopause.
当女性出现围绝经期症状时，她们通常会咨询初级保健医生；但在从事内科工作的临床医生中，对更年期相关知识的了解存在显著不足。缺乏相关培训是全球范围内导致更年期护理质量低下的主要原因之一。
Women often consult primary care physicians as perimenopausal symptoms develop, and there are significant gaps in menopause knowledge among clinicians who practice internal medicine. A lack of training is among the most frequently cited barriers to providing quality menopause care globally.
处于更年期的女性如果出现失眠、思维模糊或潮热等症状，可能会面临极大的困境。她们正在经历一个正常的生理变化过程，但由于性别刻板印象的存在，如果公开谈论这些症状，她们的职场地位可能会受到威胁。
A woman in menopause experiencing insomnia, brain fog or hot flashes, or any one of a myriad of normal menopausal symptoms, can find herself in an extremely difficult situation. She is going through a normal transition, yet because of unfair gender stereotypes, she can jeopardize her standing in the workplace if she talks about it openly.
虽然大多数公司都制定了关于怀孕、残疾及其他健康问题的相关政策，但在美国，更年期问题仍基本未被纳入职场管理计划之中。事实上，睡眠障碍和注意力不集中等症状确实会影响员工的工作效率、留任率以及职业发展机会。
Most companies have policies addressing pregnancy, disability and other health conditions. But in the U.S., menopause remains largely absent from workplace planning, even though symptoms such as sleep disruption and concentration loss can affect productivity, retention and advancement.
相比之下，英国的规定更为严格：员工人数超过250的公司必须每年发布《更年期行动计划》，以营造公平、高效的工作环境。对于许多女性来说，围绝经期往往发生在她们收入最高的阶段，此时她们拥有更多的经验和时间来发展自己的职业生涯。有研究表明，更年期给美国经济带来的年度损失接近270亿美元。
That stands in stark contrast to the United Kingdom, where companies that employ over 250 people are legally required to publish annual Menopause Action Plans for the purpose of “building equitable, productive workplaces.”For many women, perimenopause occurs during high earning years at a time when women have more experience and time to give to their careers. One study put menopause’s total annual cost to the U.S. economy at nearly $27 billion.
此外，对于那些曾经患过癌症的女性来说，情况更加复杂。激素替代疗法对某些更年期症状患者确实有一定帮助，但由于可能增加癌症复发的风险，这种疗法通常不被推荐给乳腺癌患者。这一现象尤其令人担忧——因为在美国，每8名女性中就有1人会患上乳腺癌。
And there are added complications for women who have survived cancer. Hormone replacement therapy can be a helpful treatment for some women experiencing menopausal symptoms but is often not recommended for breast cancer survivors as it may heighten the risk of recurrence. This is especially alarming as 1 in 8 women in America will develop breast cancer.
正因为如此，国会呼吁加强相关研究并提高医疗人员的培训水平才显得尤为重要。女性理应获得基于科学证据的治疗方案，而不是医生们的主观猜测或臆断。
That’s why congressional calls for more research and training matter. Women deserve treatment options based on evidence — not guesswork from physicians.
医学界正在积极回应人们对更年期问题的日益关注。几天前，美国妇产科医师学会更新了其关于更年期治疗的建议；据悉，该学会上次更新相关指南已经是12年前的事了。
The medical community is responding to the heightened interest in menopause. Days ago, the American College of Obstetricians and Gynecologists refreshed its recommendations on menopause treatment options.
提高公众的认知度也同样重要。今年4月，喜剧演员艾米·舒默（Amy Schumer）成为了Midi Health公司全国性宣传活动的代言人，她通过幽默的方式公开讨论了更年期的各种症状，包括潮热和情绪变化等问题。
Its last update was reportedly 12 years ago. Awareness is also critical. In April, comedian Amy Schumer became the face of Midi Health’s national “Midlife Back in Session” campaign, using humor to talk openly about menopause symptoms ranging from hot flashes to mood changes.
此外，改善联邦政府对更年期相关医疗服务的资助的立法工作也正在推进中。今年春天，参议员帕蒂·默里（Patty Murray，民主党，华盛顿州）和丽莎·默尔科夫斯基（Lisa Murkowski，共和党，阿拉斯加州）共同提出了《推进护理与中年女性健康法案》（Advancing Care and Midlife Women’s Health Act），该法案计划拨款2.75亿美元用于相关培训、教育及研究工作。这些努力共同将更年期问题从美国女性健康政策的边缘地位，推向医疗教育、研究资金分配以及职场实践的核心领域。
And legislation to improve federal funding for menopause is underway. This spring, Sens. Patty Murray (D-Wash.) and Lisa Murkowski (R-Alaska) introduced the Advancing Care and Mid-life Women’s Health Act, which would authorize $275 million for training, education and research. Combined, these efforts can move menopause from the sidelines of U.S. women’s health policy to the mainstream of medical education, research funding and workplace practice.
这种转变迫在眉睫。因为每一位女性都理应能够在进入更年期时获得准确的信息，并由受过专业培训的医疗人员提供帮助；她们也应该能够坦诚地讨论自己的身体状况，而无需担心受到他人的评判，或因不必要的羞耻感而感到困扰。
This shift is urgently needed. Because every woman deserves to enter menopause equipped with accurate information, delivered by trained medical professionals and have the ability to talk about it openly, without fear of being judged or burdened by misguided feelings of shame or embarrassment.
林登·哈维兰德（Lyndon Haviland）博士（DrPH, MPH）是纽约市立大学（CUNY）公共卫生与卫生政策学院的杰出学者。
Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.