The Health and Economic Impacts of Menopause
Policies and Investments to Advance Care, Opportunity, and Equity
A Special Report from FP Analytics, with support from Bayer
May 2025
Menopause, a biological process that marks the end of a woman’s menstrual cycles and fertility and typically occurs between the ages of 45 and 55, is a universal experience. As life expectancy continues to rise globally, more women are living well beyond menopause, often spending a third of their lives in the postmenopausal stage. There are currently more than one billion women worldwide who are undergoing menopause transition or are postmenopausal. By 2030, the number of women aged between 45 to 55 will reach nearly 500 million, meaning that roughly 6 percent of the world’s population will be in menopause. While most menopausal women will live in low- and middle-income countries (LMICs), they will make up a larger proportion of higher-income countries’ populations. This shift has significant social, economic, and health care implications for women, their families, and their communities.
Yet, menopause remains in the shadows, under-prioritized and under-resourced by policymakers, employers, health care providers, development institutions, and investors alike. Even hallmark global policy agendas such as the UN Decade of Healthy Ageing and the Sustainable Development Goals overlook menopause, despite its relevance to health, education, employment, and demography. The consequences of inadequate menopause support, however, are not limited to those experiencing it but, rather, are collective and cross-generational, with quantitative and qualitative impacts for countries writ large.
FIGURE 1
Projected Menopause Transition by Region, 2000-2050
The number of women entering menopause (aged 45-54) in the coming decades is set to increase significantly, particularly in low- and middle-income countries.
Source: World Population Prospects 2024, Author’s estimates
This special report, produced by FP Analytics with support from Bayer, analyzes the global health and socioeconomic impacts of menopause to demystify and destigmatize this transition and the knock-on health effects later in life. The analysis focuses on the returns on investment from prioritizing menopause care and the need for better resource allocation as well as the costs of inaction, focusing on the United States, the United Kingdom, Canada, and Germany. It highlights relevant national policies, identifies policy gaps, and offers recommendations for the public, private, and nonprofit sectors. This issue brief is accompanied by in-depth country case studies drawing on a range of data and interviews with experts from the public, private, multilateral, and non-profit sectors.
Women’s Health and Menopause
Menopause is diagnosed after a woman has gone 12 consecutive months without a period. It typically occurs between the ages of 45 and 55, with 51 being the median age of natural menopause. But the journey to this point—known as perimenopause—can span several years. Janet Ko, founder of the Menopause Foundation of Canada, noted in an interview with FP Analytics that, “Women now spend up to half their lives in a stage of menopause, each with potential symptoms and long-term health risks that require proactive management. Recognizing it as a critical health transition is essential for effective policy and care.”
During the health transition of menopause, a decline in estrogen and progesterone can lead to a variety of symptoms, which are reported by between 80 and 96 percent of women. The most common physical symptoms are vasomotor, which affect up to 80 percent of women. Vasomotor symptoms can occur during the daytime and at night, consisting of hot flashes and night sweats, and may lead to sleep disturbances while contributing to fatigue and anxiety. Other common physical symptoms include joint or muscle pain as well as sexual dysfunction. Cognitive effects, including memory problems and difficulty concentrating, are also widely reported. The hormonal changes associated with menopause can also trigger mood swings, irritability, and, in some cases, depression and anxiety.
The menopause transition also has lasting effects on women’s health later in life. Specifically, the sudden drop in estrogen associated with menopause has been shown to trigger an inflammatory reaction in some women that leads to a dramatic decrease in bone mass. This condition, osteoporosis, is characterized by the thinning of bones and an increased risk of debilitating fractures. Additionally, the loss of estrogen and vasomotor disturbances, combined with sleep disruption and potential weight gain, increases the risk of cardiovascular disease, which is the leading cause of death among postmenopausal women.
The onset, intensity, and duration of menopause symptoms can vary widely among women, influenced by factors such as diet, exercise levels, smoking status, body mass index, socioeconomic status, ethnicity, and concurrent health issues. Research indicates that Black and Hispanic women, for example, tend to report more vasomotor symptoms, such as intense and more frequent hot flashes, than their white counterparts. The Study of Women’s Health Across the Nation (SWAN) further highlights that Black women in the U.S. tend to reach menopause a year earlier than white women or women of East Asian descent, and experience symptoms for up to 10 years—three years longer than the national average. Similar trends have been reported among women of South Asian and African descent living in the U.K. but, as multiple interviewees pointed out, there are very few studies outside the United States that examine how race and ethnicity interact with women’s experiences of menopause. According to Nina Kuypers, the founder of the U.K.-based community platform Black Women in Menopause, this dearth of research means there is an over-reliance on a limited number of studies from the U.S. to understand potential physical, economic, and social impacts of menopause among women of color and other underserved groups.
The earlier onset of menopause, as well as its longer duration, reported by Black and other minority women in the U.S., the U.K., and elsewhere may be linked to a phenomenon known as “weathering,” a term used to describe the cumulative toll that social, economic, and environmental stressors have on the rate of aging and overall health of marginalized groups over time. The earlier and more intense menopausal experience among these women may thus be seen as a reflection of broader systemic inequalities, which not only impact the timing of menopause but also contribute to worse health outcomes later in life, including higher risks of cardiovascular disease and osteoporosis. Kuypers and other interviewees called for increased funding for research into the roles of race, ethnicity, and other characteristics in the U.K., Canada, and other countries to better understand and serve the needs of marginalized groups. Without this evidence base, policy and health care solutions risk being ineffective or exclusionary.
The Inadequate Prioritization of Menopause in Health Care
Menopause care remains a significant gap in health care systems worldwide, with women often facing inconsistent care, delays in diagnosis, and a lack of individualized treatment. Although menopause affects half the world’s population, many health care providers lack the necessary expertise to effectively diagnose and manage menopausal symptoms. A 2024 survey of 157 British Menopause Society members found that 72 percent of respondents “believe newly qualified health care professionals have not been given enough education about menopause,” and 55 percent of respondents “believe there is insufficient evidence-based education training for qualified health care professionals.” In the U.S., only one-fifth of obstetrician-gynecologists report formal training related to menopause. Meanwhile, a global analysis of medical textbooks found that 58 percent contained no mention of menopause. This lack of focus on menopause in both medical education and clinical resources leaves many health care professionals underprepared to manage the condition effectively.
Indeed, across all four country case studies in this report, interviewees consistently noted the absence of medical training among primary care and gynecological health care providers as a driver for the underdiagnosis of menopause and undertreatment of its symptoms. Interviewees emphasized the need for expanded menopause-related training of health care practitioners. They also called for greater dissemination and awareness of menopause research, particularly among primary health care workers, to enable faster treatment of menopausal women without referral to specialist or secondary care. To this end, NGOs such as the British Menopause Society and the Canadian Menopause Society offer menopause training and accreditation to primary care providers, but much more funding is needed to scale up programming for medical professionals and end unmet need among patients.
The lack of expertise among doctors and health care workers is compounded by the broader social stigma surrounding menopause. Negative attitudes around aging and embarrassment to discuss vasomotor, cognitive, sexual, or emotional symptoms discourage women from seeking out treatment for their menopause. A lack of information about menopause and available evidence-based treatments alongside stigma may be responsible. A global survey of women found that only 20 percent of women feel well-informed about menopause, while 73 percent of women reported not seeking treatment for menopause symptoms despite the availability of hormone-based and non-hormonal treatments.
Menopause hormone therapy (MHT) covers a range of hormonal treatments that can reduce symptoms of menopause. Although it is considered the most effective treatment to manage menopause, its use has declined since the release of a 2002 Women’s Health Initiative (WHI) study that found the treatment increased the risk of cardiovascular disease in older women. Often misinterpreted, the findings of this study primarily applied to postmenopausal women over age 60 who were provided one type of MHT and contributed to an ongoing reluctance to use MHT despite evidence suggesting that it is safe and effective when initiated near the onset of menopause. Since the study’s release, MHT use in the U.S. dropped from around 40 percent to just 4 percent between 1999 and 2010. The decline in MHT use is further compounded by limited options for other viable alternative treatments for menopausal symptoms, a result of insufficient research, policy prioritization, and investment in women’s health. Governments around the world are taking important steps to make MHT more accessible for women experiencing menopause, though barriers remain, as insurance coverage of MHT can be inconsistent or limited. In the U.K., the introduction of the “HRT Prescription Prepayment Certificate” in April 2023 allows women to purchase a year’s worth of MHT medications for the cost of just two standard prescriptions, significantly reducing treatment costs. Meanwhile, the provinces of British Columbia and Manitoba are partnering with the Canadian federal government to provide free hormonal therapy for menopausal symptoms.
MHT is not suitable for everyone, particularly those with a history of breast cancer and blood clots. For women who cannot or prefer not to use MHT, there is a limited selection of effective treatment options. Women can attempt lifestyle changes, including diet and exercise but these alone may be inadequate to manage menopause symptoms. Hormone-free drug options to manage vasomotor symptoms include antidepressants, anticonvulsants, and antihypertensives. More recently, neurokinin-targeted therapies, which can block a specific brain receptor that plays a role in regulating body temperature, have been introduced as a treatment option. Access to these options, however, can be limited and uneven, as healthcare providers may not reimburse the cost of new and innovative treatments. In general, there are very few available and affordable options for women and far greater investment in research, innovation, and development is required.
Women and their doctors need a broader set of options to enable informed choices for menopause care. Narrow treatment options are a result of a dearth of scientific research around menopause and historical neglect of its health and socioeconomic impacts. Gaps in research could be improved through market incentives as well as government grants. But without better incentives for industry, research and development of treatment options will remain scarce, impairing both health and gender equity. The public and private sectors have a role in making treatments affordable. When options are restricted or mandated by government and insurance providers, patient control is constrained, and personalized care is undercut. When insurance companies or government programs restrict access to existing, new, or alternative therapies or impose restrictive requirements before women can access effective treatments, health care outcomes are undermined. This is particularly concerning in the context of non-hormonal treatment options, which offer a critical alternative for women who cannot use hormone therapy or prefer not to. The lack of adequate coverage for these therapies results in financial burdens for women, limiting their access to evidence-based interventions.
Without broader coverage and support for a diverse range of scientifically validated treatments, women are left with fewer therapeutic options, which can negatively affect not only their immediate health outcomes but also their long-term well-being. Limited and inadequate access to comprehensive care can have far-reaching implications, including increased health care costs, reduced workforce participation, and adverse effects on overall quality of life. These systemic barriers highlight the need for targeted policy interventions to address both the health care coverage gaps and the insufficient research funding for menopause-related treatments. In-depth, wide-ranging research on menopause symptoms, treatments, and policy impacts can also benefit populations in lower-resourced settings over the long term. By 2050, more than three-quarters of the world’s population over age 60 will live in low- and middle-income countries, many of which do not yet dedicate financial resources or policy attention to menopause research. Bidia Deperthes, Programme and Technical Adviser, Sexual Health, HIV and STIs at UNFPA, noted in an interview with FP Analytics that, “When high-income countries summon the political will and invest in critical research—especially given their rapidly aging populations—they don’t just serve their own people, they ignite progress with lasting benefits for the entire global community.”
Though progress has been slow, governments are prioritizing improvements in menopause research and clinical care. In the U.K., the Menopause Pathway Improvement Programme launched by the NHS in 2021 aims to enhance clinical care, reduce disparities in treatment access, and provide comprehensive education for health care professionals. This initiative is part of a broader effort to address the gaps in menopause knowledge and care. In the U.S., former President Biden’s administration committed USD 12 billion in new funding for women’s health research, including the creation of a Comprehensive Research Agenda on Menopause and a National Institutes of Health (NIH) Pathways to Prevention series designed to identify research gaps and guide future innovation in menopause care. However, federally funded research on menopause may be paused or permanently disbanded due to the Trump administration’s federal funding freezes and de-prioritization of research on gender and women.
In addition to the need for greater research into menopause and its impacts, interviewees for this report consistently emphasized the importance of accurate, accessible, clear information on menopause, potential symptoms and co-morbidities, and available treatments. Interviewees based in Germany, Canada, the U.K., and the U.S. all shared concerns regarding the spread of menopause misinformation, including messaging that MHT was either beneficial for all women or dangerous for all women. From health care workers to civil society advocates, interviewees agreed that ensuring accurate information is critical to safeguarding women’s health throughout the menopause transition. In an interview with FP Analytics, Dr Ekta Kapoor, an endocrinologist and associate professor of medicine at the Mayo Clinic, highlighted the importance of educating women on menopause and midlife, saying, “Menopause education ought to be treated like puberty or pregnancy education; menopause is a normal, physiological transition and not a sickness.” To be most effective, information needs to be shared both on- and offline, via trusted institutions including primary health care centers, religious institutions, and community centers, and be translated into a variety of languages, reflecting the needs of local communities.
Economic Contributions of Menopausal Women
Women experiencing severe menopausal symptoms—such as hot flashes, mood swings, and sleep disturbances—are eight times more likely to report low workability, compared to those with fewer symptoms. They also report higher rates of absenteeism, worsened job performance, and higher turnover intentions. Despite these challenges, women over age 50 are one of the fastest-growing employment groups in many developed countries, with employment rates in those aged 55 through 64 years steadily climbing throughout Europe as well as in countries such as the United Kingdom, Canada, and the United States. This trend, alongside rising retirement ages and aging populations implies that more women than ever will be working during the menopausal transition and into their post-reproductive years. Although employment trends for menopausal women are gradually improving, surveys from Canada, the U.K., and the U.S. show that menopausal symptoms affect the job performance and workplace engagement of roughly half of menopause-aged women. This, in turn, not only impacts their career longevity and opportunities for promotion but also has wider impacts on the strength and growth of the broader economy.
Menopause symptoms tend to coincide with growing caregiving responsibilities, which can further exacerbate menopause symptoms. Caregiving responsibilities disproportionately fall on women, who globally perform 76.2 percent of all unpaid care work—a burden that grows as populations age. As many women in the “sandwich generation” juggle the demands of caring for aging parents and children, the toll of unpaid caregiving can lead to burnout, stress, and health issues. This is particularly true for ethnic minorities, including Black women, who are disproportionately involved in informal caregiving roles. To cope with symptoms of menopause while juggling caregiving responsibilities, women may miss additional days of work or reduce their weekly hours as a consequence of experiencing menopause while undertaking a disproportionate care burden, thereby impacting their wages and overall economic output.
FIGURE 2: CASE STUDY ANALYSIS
Economic Impact of Menopause on the Workforce
Menopausal women face significant economic challenges, with lost workdays, early retirement, and reduced income affecting productivity across economies.
Sources: Menopause Foundation of Canada, Mayo Clinic, Fawcett Society, U.K. Department for Work and Pensions, Federal Statistical Office of Germany, U.S. Bureau of Labor Statistics, Berlin School of Economics and Law, Statistics Canada, Author’s Calculations
The economic cost of menopause on the workforce is substantial. In the U.K., the 2024 NHS Confederation report estimates that unemployment due to menopause symptoms produces a direct economic impact of GBP 1.5 billion annually. Similarly, a 2023 Mayo Clinic study estimates that menopause-related work disruptions in the U.S. contribute to a loss of USD 1.8 billion annually. Other studies estimate the annual cost of menopause at USD 3.3 billion in Canada, USD 9.9 billion in Germany, and USD 12 billion in Japan. These figures underscore the significant financial impact that menopausal health issues have on businesses and the economy, highlighting the need for more supportive workplace policies and resources to mitigate these costs.
Yet, surveys show that many women feel unsupported by their employers during menopause. A 2023 survey by the Chartered Institute of Personnel and Development (CIPD) showed that only one-third of menopause-age women in the U.K. felt that their employer was supportive in helping them cope with symptoms. In Canada, a similar survey of menopausal working women found that only a quarter of women felt supported by their employer. These findings highlight the urgent need for workplace policies that address both health and work-environment factors, such as flexible hours, remote work, and mental health support, to support menopausal employees better.
Governments worldwide are increasingly focusing on improving workplace policies for employees experiencing menopause, with rising pressure on employers to act. In the U.K., the Women and Equalities Committee’s inquiry into menopause in the workplace has led to key recommendations, such as the appointment of a Government Menopause Employment Ambassador and the creation of model policies for nationwide implementation. While the British government has not made menopause accreditation mandatory, over 500 companies have already committed to becoming “menopause friendly” under a voluntary accreditation scheme. Similarly, the Menopause Foundation of Canada’s Menopause Works Here™ campaign promotes menopause-inclusive workplaces. In Japan, the Ministry of Health, Labour, and Welfare is preparing to introduce a certification to recognize businesses supporting women’s health, including menopause-related policies. These efforts reflect a growing recognition of the silent costs associated with inadequate menopause support, as the public and private sectors work to create more inclusive and supportive environments for affected employees. Nevertheless, progress is slow and uneven, with the need for greater prioritization of menopause in national and sub-national health, economic, and social policies.
Looking Ahead: Pathways to Addressing Menopause Across Sectors
International cooperation on menopause is extremely limited. Although the World Health Organization (WHO) has recognized menopause as a public health issue, it has not issued any global guidelines as of May 2025 that are specific to menopause. Other relevant international bodies have similarly produced little programming or thought leadership on the issue but efforts are emerging to bring greater focus on menopause. This absence of global policies to date around menopause is mirrored by, and contributes to, a failure to prioritize the issue within national budgets, public health agendas, and legislative frameworks. While some countries, such as the U.K. and Japan, have taken initial steps, the overall lack of policy integration leaves many menopausal women without the support they need, undermining not only their well-being but also wider socioeconomic development. While some multilateral institutions—such as the United Nations Population Fund (UNFPA), which recently published basic information on menopause and human rights—are slowly beginning to recognize the relevance of menopause to their work, much more can be done by all stakeholders to support women during this transition and to reduce the costs of inaction.
FIGURE 3
Correlation Between Menopause Onset and GDP Per Capita, Selected Countries
Socioeconomic factors shape reproductive health including the onset of menopause, which tends to occur later for women in higher income settings.
Sources: See expandable box at the end of report
Addressing menopause requires a multisector approach, integrating women’s lived experiences and drawing on expertise from various fields, including health, labor, finance, gender equality, and public policy. Efforts to tackle the issue should involve collaboration across government ministries, civil society organizations, health care providers, and the private sector. Menopause-related initiatives should not be seen as isolated health interventions but as part of broader frameworks for gender and health equity as well as economic growth. Initiatives seeking to drive impact should focus on:
- Developing Comprehensive National Menopause Policies: Countries analyzed in this report lack comprehensive national policies around menopause. Governments should develop policies that holistically address menopause. These policies should focus on health care access, funding dedicated research, creating workplace accommodations in the civil service, and establishing social support services for women experiencing menopause. A national policy framework should also outline clear goals, actions, and timelines to address gaps in menopause-related care and services. Moreover, menopause should be more clearly integrated into existing national policies, such as national aging plans.
- Reducing Stigma and Improving Education: Addressing stigma and improving education around menopause are essential for empowering women and improving their health outcomes. Civil society organizations play a key role in raising awareness and fostering open dialogue, while national governments also have a responsibility to integrate menopause education into public health strategies, as demonstrated by the U.K.’s decision to include menopause in the national sex education curriculum in 2019. Universities and medical schools need to recognize their role in addressing this gap by incorporating menopause into their curricula for health care professionals. Expanding continuing education and knowledge-sharing networks can help improve health care providers’ expertise and capacity to support women in perimenopausal, menopausal, and postmenopausal stages of life. Relatedly, raising awareness through public education can help women manage their symptoms and seek care options as needed.
- Leveraging Partnerships Across Sectors: Engaging stakeholders from various sectors is essential for creating lasting change. Governments can partner with businesses, educational institutions, nonprofits, and research organizations to support initiatives like workplace training programs, menopause-related health research, and the expansion of accessible health care services. Governments can also utilize push-and-pull incentives for the pharmaceutical and health care industries to improve treatment options. Such incentives can include grants and tax credits to reduce the cost of research as well as pull incentives such as market exclusivity or patent buyouts to ensure that a viable market exists for new drugs and treatments. Grants and other incentives may provide an improved reward system for industry and civil society to prioritize research around menopause, innovate better treatments, and leverage emerging technology to build data-driven strategies for diagnosis and treatment. Such partnerships can accelerate the implementation of effective policies and ensure that the needs of menopausal women are addressed in diverse contexts, from health care to the workplace.
- Building International Cooperation: With projections showing that by 2050, 80 percent of the world’s population over age 60 will live in LMICs, the need for cross-country cooperation is pressing. Developing economies are likely to face the most significant challenges in addressing the needs of their growing populations of menopausal women, particularly in the absence of robust health care systems, policy frameworks, and social protections. However, little funding exists to support menopause treatment and research in developing economies. Jennifer Barsky, founder of MenoGlobal the first international organization dedicated to global menopause policy and awareness, noted that, “Menopause isn’t prioritized in global health initiatives because it doesn’t directly lead to death, but it is a critical health inflection point where proper support and care can help prevent non-communicable diseases that shorten women’s health span and longevity.” Strengthening international cooperation through intergovernmental organizations, development assistance, and research partnerships will be essential to improving women’s health later in life. To that end, intergovernmental organizations—including multilateral development banks and multilateral agencies dedicated to public health and gender equality—need to bring a sharpened focus on menopause into their future strategies and programs of action.
- Expanding Leadership Opportunities for Women: While life expectancy has increased globally, women often spend a significant portion of their lives in poor health, which limits their productivity at home, in the workforce, in their community, and in public life, including in leadership positions. In an interview with Foreign Policy Analytics, Mary Stutts, the CEO of the Healthcare Businesswomen’s Association (HBA), noted that “while women are the majority of the health care workforce globally, we still need more women in decision making roles” to close “the trillion-dollar gap between men and women’s health.” According to the 2024 report Women in the Workplace, women in the United States are under-represented in leadership roles, with only 29 percent of surveyed women holding C-suite roles. Indeed, women often enter the menopause transition while under consideration for top management positions. Ensuring that women can assume leadership positions is critical not only for women’s late-in-life financial stability but also for advancements in women’s health and well-being. Interviewees consistently noted that women’s advocacy, entrepreneurship, and leadership have been critical to advancements in menopause treatment, care, and policy.
Addressing menopause across sectors will require a concerted effort from national governments, international institutions, civil society, and the private sector. It is an urgent step toward improving women’s overall health and well-being. It is also critical to supporting economic development and enabling growth. If offered targeted care and support during menopause, women can experience better health outcomes, reducing disability and enhancing their potential for engagement and contribution. Investing in menopause care is not just a health priority—it is a crucial step toward promoting health equity and maximizing women’s economic and social contributions throughout their lives.
By Miranda Wilson (Affiliate Researcher), Isabel Schmidt (Senior Policy Analyst and Research Manager, and Dr. Mayesha Alam (Senior Vice President of Research). Art direction and design by Sara Stewart, illustrations by Nhung Le.