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Menopause may be underdocumented in EHRs
Surveys captured nearly 7 times as many menopause observations as structured clinical records, with high agreement when both sources identified menopause.
To analyze the documentation of menopause in self-reported surveys compared to structured electronic health records (EHRs) in the All of Us Research Program.
Approach:
Data Analysis: Investigators analyzed menopause-related survey responses, EHR diagnosis codes, and genomic data from approximately 396,000 participants recorded as female at birth.
Survey Measures: Included questions on permanent cessation of menstrual periods, reasons for cessation, hysterectomy history, and ovary removal.
EHR Measures: Included structured diagnostic codes for menopause, premature menopause, and related conditions.
Key Findings:
192,655 participants reported permanent cessation of menstrual periods, while only 27,975 had an EHR diagnosis code for menopause.
Surveys identified nearly 7 times as many menopause observations compared to structured EHR data.
Among participants with an EHR menopause diagnosis, over 99% reported that their periods had permanently stopped.
18% of participants with natural and surgical menopause had an EHR menopause diagnosis.
EHR data showed limited documentation of menopause-related symptoms.
Interpretation:
The findings indicate substantial underreporting of menopause in structured EHRs compared to self-reported surveys.
Limitations:
Menopause status was not clinically confirmed.
Survey and EHR data did not provide age at natural menopause.
Response and recall bias may affect survey results.
Small sample sizes in some sociodemographic groups limit interpretation.
Conclusion:
Survey data provided greater ascertainment of menopause than structured EHR diagnoses.
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