Middle-aged women now represent a record share of the global workforce, owing to gains in female labour-force participation and demographic shifts. Moreover, many will have already absorbed or moved past the “child penalty,” the well-documented career disruption and loss of earnings caused by the transition into motherhood.
There is a big, unaddressed problem, though. Far from leveling out, the playing field remains tilted. As women reach middle age, they face yet another biological hurdle: menopause.
Beyond hot flashes and mood changes, the hormonal fluctuations associated with menopause produce a cascade of physical, emotional, and cognitive symptoms that can span several years and affect a woman’s work performance and overall quality of life – even increasing lifelong health risks such as bone loss and cardiovascular disease.
While overall aging unfolds gradually, menopause triggers a sharp health decline, and unlike many health conditions, it is certain and inevitable.
Yet until recently, menopause remained rarely discussed and markedly understudied. With medical professionals receiving little training on menopause management, women have long lacked adequate support to navigate the transition, and our knowledge of the economic and social costs has been limited.
Fortunately, this is beginning to change. Menopause has finally become a part of the conversation on social media, in academic fields, within workplaces, and in policy circles.
For example, in 2024, US senators proposed the Advancing Menopause Care and Mid-Life Women’s Health Act to fund menopause research, medical training, and public-awareness efforts.
There is growing evidence that the costs of menopause extend well beyond its better-known effects on middle-aged women’s health and well-being. Data from the United States, the United Kingdom, and Scandinavia show that women’s employment, work hours, and earnings decrease with menopause, while part-time work, sick leave, and reliance on transfer income (social security disability benefits or other public transfers) increase.
Marriage rates also fall sharply during this transition, and health deteriorates – particularly bone health, owing to the higher risk of osteoporosis and fractures.
These costs are not borne individually; they imply productivity losses, higher health-care costs, and greater gender inequality. Over the long term, women’s economic and physical dependency in old age puts pressure on families and social security, health, and welfare systems. As populations age globally, ignoring these costs is not only unwise but unsustainable.
The good news is that providing access to specialized medical care can mitigate the costs of menopause, particularly for the most vulnerable women and those experiencing the most severe symptoms. Women who receive hormone replacement therapy (HRT), for example, experience smaller disruptions in employment and better bone health.
Yes, HRT has been controversial since the publication of the 2002 Women’s Health Initiative Study, which linked it to serious health risks. Yet those findings have been called into question, so much so that the FDA removed its “black-box” warning from HRT labels.
It remains to be seen whether this move will mark a turning point. Access to health information and care tends to be unequal along the lines of education, income, and race.
Addressing these disparities and expanding specialised health care remains imperative to mitigate the economic costs of menopause.
To that end, policymakers could mandate comprehensive insurance coverage for menopause-related care, including HRT and other therapeutic treatments, and push for more menopause-related training in medical schools and residency programmes.
At the same time, employers could implement workplace accommodations – flexible schedules, temperature controls, supportive leave policies – that recognise menopause as a legitimate health condition requiring support.
Many societies have long embraced policies such as maternity leave, midwifery models of care, and breastfeeding-friendly practices to meet the needs of mothers, and many of these measures have led to increased productivity and talent retention. It stands to reason that menopause-friendly policies would do the same.
To be sure, although menopause affects women everywhere, our evidence is confined to a few developed countries. Owing to the interaction between biological and social factors, the costs of menopause are likely to be context-specific. That means we still know very little about how menopause affects women in less developed regions, where they face even greater challenges in accessing health care.
A major obstacle is the lack of high-quality data on menopause and labour and health outcomes. Most labour-force surveys – and even many health surveys – do not systematically collect information on women’s menstrual cycles or their cessation.
Even health, labour, and administrative data are often not suitable for analysis, because doctors might not ask or record women’s menopausal status routinely, and sick-leave or disease codes might capture only symptoms, rather than menopause itself.
These data gaps ultimately reflect a lack of public interest in the issue, and it is this complacency that must be addressed. Measuring the costs of menopause is a necessary first step toward improving advocacy and outcomes. As the Nobel laureate economist Angus Deaton argues, “Measurement, even without understanding of mechanisms, can be of great importance in and of itself – policy change is frequently based on it.”
As the global workforce ages, the number of women experiencing menopause while working will only grow, and the long-term costs of higher economic and physical dependency will accumulate. The longer we wait to address the social and economic toll of menopause, the more it will cost us.
(Laura Juárez is Associate Professor of Economics at El Colegio de México. Fernanda Márquez-Padilla is Associate Professor of Economics at El Colegio de México and a visiting professor (2025-26) at the University of Zurich)
Project Syndicate