Menopause Education in Plastic Surgery Residency Training: A Competency-Based Framework

Menopause is a major yet underrecognized determinant of plastic surgery outcomes and patient concerns. Women now spend more than 40% of their lives in menopause, and peri‑ and postmenopausal women represent a substantial and growing proportion of patients seeking cosmetic and reconstructive procedures. Estrogen loss affects many tissues central to plastic surgery practice, including skin, adipose tissue, breast tissue, hair, and vulvovaginal structures, influencing both patient presentation and procedural outcomes. Menopause-related conditions such as genitourinary syndrome of menopause may also drive demand for interventions offered by plastic surgeons. Despite the relevance of menopause to surgical decision-making, patient counseling, and perioperative management, formal menopause education is absent from plastic surgery residency training. We propose a competency-based framework to integrate menopause education into plastic surgery graduate medical education. Building upon Accreditation Council for Graduate Medical Education competency domains and contemporary competency-based education principles, we developed 4 menopause-focused entrustable professional activities (EPAs): (1) screening for menopause during preoperative consultation, (2) referral for evidence-based medical management before procedural intervention when appropriate, (3) counseling patients on hormone-related changes relevant to surgical outcomes and expectations, and (4) providing menopause-informed breast health counseling. We describe implementation strategies including Menopause Education Teams composed of menopause specialists and plastic surgery faculty, incorporation of menopause-focused didactics into existing curricula, EPA-based assessment, and electronic health record prompts to facilitate clinical learning opportunities. Importantly, our proposal is grounded in prior successful educational innovations, including women's health EPAs, menopause-focused residency curricula, and the Geriatrics-for-Specialists initiative, which collectively demonstrate that competency-based, specialty-specific educational interventions can successfully address longstanding gaps in clinician preparedness and patient care. This framework provides a scalable model for incorporating menopause education into plastic surgery training and may serve as a template for other surgical specialties.