Why states must focus on women's health

The federal government is no longer a reliable partner in improving and advancing the health of menopausal women.

As the Contrarian rallied and tallied the Trump administration first 100 days scorecard last week, the federal government unceremoniously did a massive flip-flop on women’s health, defunding and then refunding the decades-old Women’s Health Initiative (WHI).

The WHI was created in 1991, the brainchild of Bernadine Healy, appointed by President George H.W. Bush as the first woman to lead the National Institutes of Health (NIH). The WHI set out to focus on cancer, heart disease, and osteoporosis prevention in postmenopausal women, a group historically underserved. To this day, the WHI remains not only the most expansive and expensive interrogation of health outcomes for this demographic but also the largest randomized clinical trial in history to involve only women. (Important sidebar: Medical research did not routinely include women in clinical trials until 1993. As Samantha Bee says in her new menopause monologue, the timeframe for women’s inclusion in medical research equates to a Justin Bieber lifespan.)

Many readers might be familiar with the WHI on account of its notorious 2002 press conference at which it linked usage of menopause hormone therapy (estrogen plus progesterone) to an elevated risk of breast cancer. The finding was quickly debunked, but not before causing a cascade of collateral damage—not the least of which was scaring millions of women from using any form of hormone treatment. Many doctors stopped prescribing it, and related research and education ground to a near halt.

I am among those who have made public demands that the WHI issue a modernized and accurate statement clarifying the safety and efficacy of menopause hormone therapy. Even with its imperfect history, though, the WHI has been a critical engine and aggregator of long-term data: over three decades, scientists at more than 40 affiliated research centers around the country collected detailed information about more than 160,000 women.

That is why the April 21 announcement by the Department of Health and Human Services (HHS) that the Trump administration would eliminate the WHI’s funding and that its regional research centers in California, New York, North Carolina, and Ohio would close in September still felt like a gut punch—yet another blow to women’s health and value.

Days later, the administration did an about-face and promised that the cuts would not happen. It’s hard to say exactly why. It could have been the public outcry, sure—and for that, women’s health advocates are lucky to have a champion like Maria Shriver, who posted on X that she went to the top brass at NIH and HHS (yes, she knows him well) to push back.

But the whiplash of those changes hours and the ongoing decimation of the federal funding landscape across all issue areas makes an adjacent fight even more vital—one I dare say brings some good(ish) news at the moment. That is the role of state legislatures in stepping up to help improve and advance the health of menopausal women.

Thus far, 13 states, a record one in four, have introduced more than 20 bills focused on menopause care, proposing changes that could permanently reshape insurance coverage and educational and health care resources. Public officials in Michigan, Illinois, and West Virginia announced support for menopause reforms. Michigan Gov. Gretchen Whitmer recently hosted a roundtable for leaders and a statewide listening tour.

This is all a relatively new development. Prior, as I wrote with Mary Claire Haver on Katie Couric Media, “three states passed menopause laws over the last two years. As of 2024, California’s various medical boards — including for doctors, nurses, and physicians’ assistants — now can include coursework in menopausal health for continuing professional education requirements. Illinois (in 2023) and Louisiana (in 2024) mandated insurance coverage for some or all menopause treatments. (A bill to require insurance coverage for menopause treatment also passed in California last year, only for Governor Newsom to veto it.)”

The latest slate of bills—introduced in red and blue states alike—would do all of the above and more, including bolstering workplace supports and dedicating resources to public education. In fact, the bills are being proposed at such a fast clip that menopause was named on a “Ones To Watch: Legislation Landscape for 2025” list.

Though this does not resolve the many deficits in menopause care, especially the ongoing investment needed for research—federal dollars dedicated to women’s health have never added up to even 10% of the NIH budget, with menopause-related spending just over 0.1%—it is nonetheless an opportunity to advance women’s health when promise of progress on other fronts is in short supply.

Back in January, I wrote for the Contrarian about my optimism there could still be feasible federal action. Now, with my eyes on the states, I stand by what I wrote about staying the course: “All of this is hardly a niche interest or weak consolation prize. Menopausal women are a contingent 75 million strong in the U.S. and entitled to accessible, competent care and treatment. We have every right to demand lawmakers and political leaders invest in our well-being, our dignity, our humanity. And we know that when we fight for ourselves, we also fight for our daughters.”

Jennifer Weiss-Wolf is executive director of the Birnbaum Women’s Leadership Center at NYU School of Law.

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