One of the most read articles in The New York Times Magazine this year was one that the writer, Susan Dominus, almost didn’t think worth a story because, she said later, it wasn’t something she thought people really cared about.
Titled “Women Have Been Misled About Menopause,” the piece was a thoughtful, expansive piece on the medical and cultural misinformation about what euphemistically used to be called “that time of life.” In it, Dominus lays out the poor science and poorer communication that led doctors to stop prescribing life-preserving hormone therapy to women in the late 1990s — despite the fact that most women under 60 are helped, not hurt, by taking a combination of estrogen and progesterone every day.
As Dominus wrote:
It is painful to contemplate the sheer number of indignities unnecessarily endured over the past 20 years: the embarrassing flights to the bathroom, the loss of precious sleep, the promotions that seemed no longer in reach, the changing of all those drenched sheets in the early morning, the depression that fell like a dark curtain over so many women’s days.
The story was like a collective scream for millions of older American women who have felt ignored over the last 25 years. For women of my generation, it was like a collective sigh of relief. Oh, wait: There is something that can be done for this weird, annoying conglomeration of symptoms that are plaguing our days and keeping us up at night? Huzzah! That the story garnered more than 3,000 comments is one of many signs that, weirdly, menopause is having a moment. (Just ask Gwyneth. Drew. Gillian. And any number of fab celebrities.)
And yet. If you look up menopause research on the National Institutes of Health website dedicated to aging, this is the first thing you’ll read: “More than 1 million women in the United States experience menopause each year. Still, little is known about the health effects of this natural biological occurrence.” (Emphasis my own.)
Menopause at work
That is baffling enough, given that half the human population of the world has been experiencing menopause for(checks calendar)ever. But that ignorance has consequences beyond physical and emotional suffering. According to women’s healthcare platform Maven, an astonishing one in four women leave their jobs because of menopause symptoms, including brain fog and lack of sleep. A Mayo Clinic study published earlier this year found that more than 10 percent of menopausal women surveyed between ages 45 and 60 had missed some work in the past year.
Rebecca Thurston, a University of Pittsburgh psychiatrist, put it this way in Dominus’s New York Times piece: The lack of care “suggests that we have a high cultural tolerance for women’s suffering. It’s not regarded as important.”
This is because the symptoms of menopause are often incompatible with — not to mention embarrassing at — work. Women as young as their mid-30s may experience any of several dozen ailments associated with menopause, including the best known — hot flashes and night sweats — which are not even the most common. Sheila Shanmugan, a reproductive psychiatrist at the Penn Center for Women’s Behavioral Wellness, says her patients often find themselves zoning out in meetings, losing keys, having trouble staying organized, mixing up schedules, running out of energy, struggling to maintain work-life balance and making “silly mistakes.”
“These are generally very high-functioning women, so they really notice this,” Shanmugan says, “and it really interferes with their work.”
That puts women at an economic disadvantage — but also affects the bottom line for businesses. The Mayo Clinic study found lost time due to menopause costs $1.8 billion a year and $26.6 billion in medical expenses. Research has repeatedly shown that having women in executive roles makes companies more profitable, socially responsible, and responsive to customers, as well as more hospitable places to work. Replacing workers who leave a job, meanwhile, can be far more expensive than retaining workers, both in terms of salary and training.
And from a broader perspective, women leaving the workforce runs counter to any efforts to increase the minuscule numbers of women who lead large companies or sit on corporate boards. (To wit: Fortune recently celebrated that just over 10 percent of the top 500 highest-grossing companies are run by women.) It also means fewer high-level women to mentor younger women in the workplace.
All of which is to say: we should be doing better for menopausal (and perimenopausal and postmenopausal) women in the office (and outside of it). “Supporting this population that is experiencing menopausal symptoms has very clear consequences,” says Maven VP of Employer Growth Isha Vij, “especially given all the initiatives companies have towards achieving gender equity and helping women achieve the most senior positions.”
The menopausal revolution
Fortunately, this support is finally — hopefully! — on its way. In mid-November, the Biden Administration announced the country’s first-ever White House Initiative on Women’s Health Research, to be led by First Lady Jill Biden, to close the research gap in women’s health. (That points to another problem: Until this initiative, only just under 11 percent of NIH research funding has gone toward women’s health.) In particular, the project will target reproductive health, including the under-researched areas of menopause and perimenopause.
That initiative comes several months after New York City Mayor Eric Adams announced his city’s Department of Women’s Health at a press conference in which he talked about watching his mother “unable to get the care she needed when she was going through menopause,” including in the workplace. His women’s health department is specifically tasked with creating better access to menopause treatments, and more menopause-friendly workplaces.
If you look up menopause research on the National Institutes of Health website dedicated to aging, this is the first thing you’ll read: “More than 1 million women in the United States experience menopause each year. Still, little is known about the health effects of this natural biological occurrence.”
On that, Adams is following the example of Great Britain, where Parliament held two years of hearings about menopause at work, a consequence of a study that found menopause-aged women are the fastest-growing demographic in the British workforce. Companies throughout Britain have now begun enacting menopause-friendly policies — which include training workers about symptoms, providing physical accommodations like desk fans and modified uniforms, and offering more flexible schedules. And some have received an informal accreditation from training firm Henpicked.
In the U.S., Vij says Maven’s menopause service is the company’s fastest-growing program, with several hundred companies signed on to offer female employees help with everything from finding a doctor, to connecting women with psychologists, fitness and nutrition experts, holistic medicine practitioners and more. They even have career coaches to help women talk to their employers about menopause and how it’s affecting them in their jobs.
The biggest innovation for menopausal women is a result of our post-pandemic workplace. Working from home has allowed those experiencing menopause to create their own comfortable work spaces and dress codes, and allowed for more flexibility in when the day starts and ends, and when breaks happen. That, of course, is not applicable to people in the service industry or healthcare or any number of jobs that require in-person work — which is why Maven, and other women’s health tech companies, also provide services to businesses to help managers understand the complexities of menopause and how they can talk to their employees, and accommodate them.
All of this requires an attention to the problem, and an increased awareness from women of what they are experiencing and how they might get help — something Shanmugan says has gotten better, but is still not where it needs to be. Rebecca Thurston, a University of Pittsburgh psychiatrist, put it this way in Dominus’s New York Times piece: The lack of care “suggests that we have a high cultural tolerance for women’s suffering. It’s not regarded as important.”
What has helped is the weird cultural moment that menopause is experiencing — and the leadership of women (and men) who are finally recognizing that it is worthwhile doing something to help the half of our population who experiences it. Will that include Mayor-elect Cherelle Parker, our city’s first female mayor, who could look to New York City for a model of how to make menopause not just acceptable, but accommodated in workplaces in Philadelphia, starting with City offices?
Adams made clear an intention we would all benefit from observing: “We are going to change the stigma around menopause in this city. Historically, it’s been taboo to talk about this issue. Not anymore.”
This piece is part of a year-long editorial series looking at innovations to address inequities in women’s healthcare, sponsored by Independence Blue Cross.
MORE ON WOMEN’S HEALTH FROM THE CITIZENPhoto by Siniz Kim for Unsplash.