The quality of menopause research and clinical management depends entirely on whether health systems are reliably capturing what women actually experience — and a sweeping review of electronic health records suggests that foundation is far shakier than widely assumed. For the roughly 1.3 million women entering menopause annually in the United States, inconsistent documentation has downstream consequences for care accuracy, treatment decisions, and the validity of population-level studies.
This scoping review, drawing on four major databases covering 2004 through March 2026, identified only 19 studies meeting inclusion criteria — itself a telling signal of how sparse rigorous EHR-based menopause research remains. Across those studies, sample sizes ranged from 45 to over 307,000 women, with most conducted in US health systems using retrospective or cross-sectional designs. Thirteen of the 19 studies leaned on ICD-9 or ICD-10 billing codes as proxies for menopause status, yet fewer than half reported precisely which codes they used, raising serious questions about reproducibility. Three recurring themes emerged from synthesis: structural limitations in how reproductive stage is recorded, inconsistent capture of vasomotor symptoms like hot flashes, and a lack of standardized terminology that would allow meaningful data aggregation across systems.
This review lands at an important inflection point. The menopause field is experiencing renewed clinical and public interest following updated hormone therapy guidance, yet the data infrastructure supporting that care has not kept pace. Relying on billing codes to classify perimenopause or menopause is methodologically fragile — codes are designed for reimbursement, not longitudinal health tracking. The absence of structured reproductive stage fields means clinicians frequently lack temporal context when interpreting labs, symptoms, or cardiovascular risk markers. The review's limitation is its scoping design: it maps the landscape without quantifying effect sizes or producing pooled estimates. Still, the finding that documentation gaps are pervasive, not peripheral, positions this as a systems-level problem requiring standardized EHR data models — an incremental but foundational contribution to women's health informatics.