Each day, an estimated 6,000 women reach menopause—the permanent end of their menstrual cycle.1 Menopause is the endpoint of several years of perimenopause, the period during which the body adjusts to changing hormone levels, and women may experience symptoms such as irregular or heavy bleeding, hot flashes, night sweats, sleep disturbances, and mood changes.
As with any disruption to one’s health and well-being, health changes from perimenopause through postmenopause can shape how women engage in the labor market, resulting in certain workplace supports being especially critical during these times.
While menopause is a nearly universal experience for women, symptoms and severity experienced throughout the transition can vary substantially and, for some women, can be highly disruptive. The entirety of the menopausal transition occurs in three stages:
Menopause occurs at an average age of 52,7 with most women experiencing it between ages 45–55,8 and perimenopause, the years-long transition toward menopause, can start as early as age 35. In 2024, there was an estimated 13.1 percent of women in the United States in the typical age range for menopause.9 The majority of women within the 45–54 age group, 77.3 percent,10 are in the workforce. These ages are typically peak professional and earning years for women—a crucial time for preparing for a secure retirement. The menopausal transition also often coincides with caregiving for children and older adults.11 While the symptoms can be challenging, with the right workplace resources and supports, perimenopause should be a manageable experience, allowing women to stay productive at work without forcing them to sacrifice their employment and economic security.
This brief summarizes existing research on the menopausal transition, including a review of symptoms, the differences in the severity of symptoms by race and ethnicity, and disparities in the ease of managing and addressing symptoms by occupation. It also highlights research on the economic costs of menopause, underscores good workplace policies and practices, and connects the economic impact to women in the workplace.
Of the 90 percent of women in the menopausal transition who experience some symptoms, 39 percent report experiencing between five and nine menopausal symptoms and 13 percent experience ten or more symptoms.12 These include:
Prevalence and intensity of symptoms are not equally distributed across socioeconomic status, race, or ethnicity. Poverty and economic disadvantage have been linked to earlier menopause, more disruptive hot flashes, and more sleep disturbances throughout the transition.19
Factors such as racism, chronic stress, trauma, and growing up in poverty are related to more severe menopause symptoms, and these circumstances often disproportionately impact women of color.20
Indeed, research finds earlier onset and more severe symptoms at higher rates for women of color compared with White women. In a 25-year study analyzing the menopausal transition among women in the United States, Black women experienced hot flashes—the primary menopause symptom—for an average of 10 years compared with 6.5 years for White women.21 Black women also reported the highest rate of hot flashes (46.5 percent) compared with White women (28.9 percent),22 and higher rates of depression than White women, both at the start of the study (27.4 percent and 22.3 percent, respectively) and at the seven-year follow-up (20.0 percent and 13.0 percent, respectively).23
In a separate study of over 68,000 US women, Black, Latina,24 and Indigenous women reported more severe menopause symptoms than White women. These gaps persisted after accounting for socioeconomic status, suggesting that factors beyond income, such as unequal access to medical care, also shape women’s experience of menopause.25
Latinas also report experiencing more symptoms than White women (an average of 5.5 and 5.1, respectively),26 and report higher rates of symptoms such as urine leakage, vaginal dryness, and forgetfulness compared with White women.27 They are also the second most likely group to experience hot flashes and night sweats, behind Black women.28
Research shows that certain subgroups of Asian American women, on the other hand, generally report experiencing fewer symptoms overall, though experiences among subethnic groups vary considerably. Chinese women report hot flashes and night sweats at a rate of 20.5 percent and Japanese women at a rate of 17.6 percent (compared with 31.2 percent for White women),29 and Filipino women report significantly more physical and psychological menopausal symptoms compared with Korean women.30
Symptoms and severity can be compounded by additional barriers such as limited financial resources and less access to medical services. Not only are economically disadvantaged women more likely to be uninsured, but they are also more likely to experience poverty and have less access to resources overall.31 Comprehensive health insurance can provide access to resources such as hormone replacement therapy (HRT), one of the most common treatments to help manage and control symptoms, but a survey conducted by AARP found that just 16 percent of women age 35 and older have access to HRT through the health insurance coverage provided by their employer. While 72 percent of women agree that HRT should be covered through employer-provided health insurance, just 15 percent have tried HRT to manage symptoms,32 likely in part due to accessibility barriers.33
Despite reporting more symptoms and severity, Black and Latina women are less likely to report being treated for menopause compared with White women. Research finds that Black women were about half as likely to use HRT compared with White women, and over 20 percentage points less likely to be treated for mental health issues compared with White women (43 percent and 65 percent, respectively).34 From 2017–2020, an estimated 2.6 percent of postmenopausal Latina women reported using HRT, compared with 5.8 percent of non-Hispanic White women.35
Work environments and job demands vary considerably across different occupations. Menopause symptoms can be more difficult to manage in positions where long periods of standing are required, personal protective equipment or tight-fitting uniforms are needed, time is tightly regulated with set breaks, or there is limited access to clean bathrooms and times when employees can use them. Women in service and construction occupations, for example, are more likely to face difficulty in navigating their symptoms at work. Service sector occupations, such as retail, food service, and hospitality, typically operate with limited break periods, requiring workers to remain on their feet or in customer-facing positions for extended stretches. Workers in construction trades and agriculture often lack adequate restroom facilities and temperature control.
Women of color, and particularly Black and Latina women, are overrepresented in the lower-paid occupations where workplace accommodations are often the sparsest. Black and Latina women are much more likely to work in service occupations compared with White women (26.8 percent, 29.7 percent, and 19.3 percent, respectively).36 Such jobs are also less likely to offer access to quality health care or other benefits like paid time off, which can make managing symptoms a bit easier.37 Nationally, almost one-fifth (19 percent) of workers lack access to a single paid sick day, rising to over one-third (33 percent) of workers in service occupations in the private sector and over one-fourth (26 percent) of workers in sales occupations.38
Compared with White women, women of color are more likely to work nonstandard schedules and less likely to have access to remote work or flextime. Nearly one-third (32.8 percent) of White women reported having access to remote work in 2018, compared with 18.8 percent of Black women and 18.1 percent of Latinas.39 Black and Latina women’s lower earnings40 and access to economic resources, combined with their greater likelihood of working in jobs that tend to provide fewer accommodations, can be compounding factors contributing to the greater severity of symptoms experienced by them throughout the menopausal transition.
Menopause—and specifically perimenopause—symptoms can be more manageable with supportive and flexible workplace accommodations. An office job with flexibility for bathroom breaks, the ability to work remotely (even occasionally), and negotiated workplace supports such as office fans and extra breaks can make it much easier to cope with symptoms. Office-based professional and administrative work is also more likely to include benefits such as paid sick time, flextime or remote accommodations, and more comprehensive health care insurance.41
The economic consequences of the menopausal transition can range from costly out-of-pocket expenses, reduced work hours, and overall lost earnings. Women who report the highest symptoms are over 15 times more likely to report experiencing adverse work outcomes, such as missing days from work, reducing work hours, being laid off or fired, quitting, retiring, or changing jobs.42 One estimate based on a survey of over 4,000 women found that the economic costs of menopause amount to a conservative estimate of $1.8 billion in lost workdays per year, with another $24.8 billion related to direct medical expenses.43
Another survey conducted by AARP found that women workers are estimated to spend over $13 billion each year on nonmedical treatments, copays, and HRT. Results from this same survey found that over one-third (34 percent) of female workers reported missing 11 or more workdays due to menopause symptoms, but few reported considering leaving or leaving their job altogether (4 percent and 3 percent, respectively).44
Although the majority (70 percent) of women report not making any changes to their work due to menopause,45 it is essential to ensure that women have access to the right workplace supports, especially for those experiencing multiple and/or severe symptoms. Just under one-quarter (22 percent) of employers offer any specific menopause-related benefits, but 73 percent of employers agree that US employers need to do more to support employees in menopause.46
Good workplace practices can ease some of the burden felt during the menopause transition and ultimately keep valuable workers in the labor force. Many of the practices that would benefit women experiencing symptoms associated with menopause are good workplace supports for all employees, regardless of circumstance or gender. These include:
Perimenopause can bring symptoms that may make work impossible on certain days. With nationally mandated paid leave policies, women could manage symptoms without risking their health, income, or job security.47
Adequate temperature control, including desk fans and access to windows, can make working through hot flashes more feasible in the workplace. Cold drinking water and rest areas mitigate symptoms without hindering productivity. Additionally, working in a confined position or prolonged periods of standing may exacerbate symptoms, so providing more space or places to sit can help. Providing additional breaks can lessen the burden of symptoms as well.48 Workplace accommodations are particularly important for women in occupations that involve extreme temperatures, long periods of standing, or a set number of breaks and limited control over when they can take them.
Perimenopause can include symptoms such as urinary urgency and heavy menstrual bleeding. Clean, accessible restrooms, toilets, flexible break policies, and unscheduled access to facilities are simple accommodations that can help women focus on their work rather than symptom management.
Working from home, even if occasionally, can vastly help women manage severe symptoms. When possible, allowing flexibility in working hours can also ease the stress of managing symptoms while working.
Health care insurance is important for all workers, including women transitioning into and after menopause. Coverage for relevant medications and treatments can make symptoms more manageable.49 Eighty-eight percent of workers in management, professional, and related occupations have access to medical benefits through their employer, compared with 52 percent of workers in service occupations.50
Without adequate education, menopause remains a taboo topic in most workplaces, and managers and colleagues may dismiss symptoms as personal problems and attribute performance changes to gaps in capability or productivity. Educating managers and staff about menopause can build awareness, normalize the transition, and equip workplaces to offer supports that allow women to manage their symptoms and remain in jobs where they thrive.
Unions can help reduce employees’ risk of retaliation.51 Negotiating protections is a secure way to not feel pressure to disclose symptoms one-on-one.
Menopause impacts almost all women, yet—as is the case with women’s health overall—its causes, symptoms, and treatments are underfunded and under-researched. Investing in research and supports that meet the needs of women throughout the menopausal transition will help ensure women in the workforce can stay productive and healthy, which will benefit them, employers, and the overall economy.
This brief was prepared by Miranda Peterson, with additional support from Ariane Hegewisch, Dr. Kate Bahn, and Emily Maistrellis.
