Philanthropist Melinda French Gates is expanding her women's health work with significant new funding for midlife and menopause care. Her total investment will exceed $600 million over two years, addressing a healthcare system that has long neglected women's midlife needs. Gates compares current menopause care to the outdated "twilight sleep" approach used in early 20th century childbirth.

The US healthcare system fails women experiencing menopause at alarming rates. Only 25% of women in menopause receive treatment, despite symptoms that can severely disrupt daily life. These issues cost the nation $26 billion annually in medical expenses and lost work time. Hormone therapy use has plummeted to less than 5% among postmenopausal women.

Systemic change requires addressing deep flaws in medical education and treatment. Less than one-third of OB-GYN residency programs offer menopause curriculum, leaving doctors unprepared to help patients through this universal biological experience. Gates calls for better training, expanded insurance coverage, workplace protections, and increased research funding.