Menopause is a universal physiological transition associated with vasomotor symptoms (VMS), mood and sleep disturbances, and increased chronic disease risk. Although menopausal hormone therapy (MHT) is the first-line treatment for VMS, its use in the United States remains low. Previous studies have shown geographical regions called "provider deserts" with a severe lack of menopause specialists. Additionally, this access to menopause care is especially limited for publicly insured and Black patients, yet the mechanisms underlying these disparities are unclear.

This study evaluates how insurance type influences access to Menopause Society Certified Practitioners (MSCPs) in the United States. Using a cross-sectional, secret shopper telephone audit, trained research assistants will call randomly selected MSCP-certified offices across diverse geographic regions. Standardized patient profiles will vary by insurance type (Medicaid vs. private) and zip code. Outcomes include appointment wait times, telehealth availability, and pre-appointment barriers such as referral or payment requirements. Calls comparing insurance types will be placed on the same day to reduce temporal variation. Results will be analyzed according to the state's Medicaid reimbursement strategy and the physician's administrative burden.

Findings will quantify disparities in realized access to menopause specialists and illuminate provider behaviors that contribute to unequal care, informing policies to expand equitable menopause care delivery.