Germany

Country Context

Germany is the largest economy in Europe, with a GDP of USD 4.5 trillion and a population of 84.5 million, as of 2023. Older women are actively involved in the workforce: As of 2023, 72.6 percent of women aged 55 through 64 years participated in the labor force, compared to 83.4 percent of women aged 25 through 54 years. Given that Germany’s average age of menopause is 49.7 years, it is estimated that more than 80 percent of women in Germany are employed through the menopause transition.

Against a backdrop of perennial labor shortages and a progressively aging population, supporting menopausal women in the workforce is key to economic growth in Germany. However, a 2023 survey showed that only 15 percent of women reported believing that their employer offers a supportive environment for the menopause transition. Indeed, 25 percent of women experiencing menopausal symptoms reduced their working hours or left the workforce due to lack of workplace support, while more than a third took paid or unpaid sick leave. As a result, the study estimated that German companies lose EUR 9.5 billion (USD 10.3 billion) every year due to lack of treatment and support for women experiencing menopause symptoms.

FIGURE 1

Female Labor Force Participation Throughout the Menopause Transition

Women in Germany appear to continue working throughout and after experiencing menopause, but age-disaggregated data is limited, indicating a gap to be addressed

Note: No data for Labor force participation rate among women ages 45-54

Sources: World Bank, World Bank, World Bank, OECD via FRED

Beyond the workplace, in a 2022 study of 1,000 women between the ages of 45 and 60, two-thirds reported that menopause symptoms impaired their quality of life, and 37 percent reported that their health became worse during perimenopause. Improving health care and social support for women experiencing perimenopause, menopause, and postmenopause is therefore vital to ensuring a high quality of life for all.

Policies and Programs

Despite the significant role that perimenopausal, menopausal, and postmenopausal women play in the economy, Germany lacks any national legislation that directly addresses menopause. Germany’s Maternity Protection Act and the Equal Treatment Act can be interpreted to provide menopausal women with some workplace protections if symptoms are severe enough to qualify as a disability. Political and policy conversations regarding menopause are in their infancy in Germany, with the first parliamentary event bringing together menopause campaigners and experts taking place in March 2023, driven by MPs Dorothee Bär and Julia Klöckner. In October 2024, members of the Christian Democratic Union and Christian Social Union introduced a proposal in the Bundestag that would encourage more medical research on menopause, and improve corporate health management of menopause. In the wake of Germany’s February 2025 election, menopause strategy may change. However, the coalition agreement published in April 2025, intended to guide the new coalition government’s policy priorities and strategy, includes mentions of both menopause and research for women’s health, indicating a continued commitment to these issues.

Health Care for Menopause Symptoms

The German health system offers universal coverage through a combination of public (statutory) and private health insurance, in which costs are shared among the government, employers, and individuals. Approximately 86 percent of the population is enrolled in publicly funded health insurance, which provides inpatient, outpatient, mental health, and prescription drug coverage. Public insurance coverage includes menopause treatment if prescribed by a doctor, including hormonal, non-hormonal, and alternative medicine therapies. Private health care for menopause is available via private insurance plans or through out-of-pocket payment, but a legal cap on the amount doctors can charge insurers for menopause consultations disincentivizes holistic or long-term menopause care. Treatment of menopause and its attendant symptoms remains complex for a variety of reasons, including but not limited to: difficulty in securing diagnoses, including for vasomotor and other symptoms, lack of a billing code specific to menopause, skepticism of hormonal therapies among doctors and patients, and lack of menopause education during general medical training. Unmet need for menopause care in Germany therefore remains high.

As a result of a symptom-based, rather than holistic, approach to menopause treatment, it can be difficult to track the health impacts of menopause on German women and therefore to collect and analyze high-quality, accurate data on menopause in Germany. According to Dr. Andrea Rumler, Professor of Business Administration and Marketing at the Berlin School of Economics and Law, it is also challenging for women themselves to recognize and understand that the symptoms they are experiencing, such as sleep disturbance, hot flashes, or poor mental health, are menopause-related. Indeed, a 2022 study of the health impacts of menopause on German women collected health system data by tracking and analyzing the use of multiple billing codes, demonstrating the complexity of gaining a clear picture of women’s health.

However, a combination of stigma, a lack of provider knowledge, and insufficient awareness of menopause among health care professionals can hinder women from receiving the care they need, when they need it. Dr. Andrea Rumler noted that in Germany, menopause is not a widespread topic of conversation and is associated with social stigmas such as a loss of fertility and the end of menstruation, which can be seen as an essential aspect of female identity. This lack of discussion can feed into misinformation about menopause symptoms and treatments that is present in other case study countries as well. Rumler noted that many primary health care doctors and GPs will refuse to prescribe hormone therapies due to concerns that they cause cancer, while many patients may only be aware of hormonal treatments for symptoms, creating an information mismatch that can hinder effective treatment.

However, wait times for specialized menopause treatment can be onerous: the wait for hormonal therapy, for example, is estimated to be around 18 months. A 2021 study on menopause care found that 37 percent of women surveyed felt that their gynecologists provided poor or mediocre advice, and half of the women surveyed felt only moderately or even poorly informed about available therapies. As doctors do not bill separately for advice or treatment of menopause, German advocacy groups—such as Wir Sind Neun Millionen (We Are Nine Million)—have raised concerns that health care workers are not incentivized to educate themselves about menopause symptoms or treatments, or to spend time diagnosing and treating menopause-related ailments.

FIGURE 2

Menopause Policy and Implementation Overview

In an effort to address misinformation and lack of knowledge around menopause and its symptoms, action is being taken at the state level. The Bavarian State Ministry of Health, Care and Prevention (Gesundheit, Pflege und Prävention) is piloting a scheme to provide reliable, trustworthy information on menopause, aimed at improving women’s understanding of their experiences. Webpages on the state website provide in-depth information on different menopause symptoms, co-morbidities, and treatments, including highlighting events and workshops across Bavaria for those seeking to learn more. Advocacy organizations are taking a similar approach. Wir Sind Neun Millionen, for example, includes a list of experts and specialist doctors on its website whom users can contact for advice and support. These approaches could be replicated in other states, or at the federal level, to improve access to accurate information, alongside non-digital communications such as pamphlets, which can be distributed by frontline health care workers—including primary health care providers—and through community and religious centers. To ensure that all women have access to appropriate, accurate, and accessible information about menopause symptoms and treatments, information and advice in their frequented spaces needs to be provided, and in German and non-German languages, particularly Turkish.

Menopause in the Workplace

Despite the significant role menopausal women play in the German economy, workplace policies and accommodations to support women during perimenopause, menopause, and postmenopause are uncommon, and the federal government offers no leadership on this topic. Dr. Andrea Rumler, who led the first-ever study on menopause in the workplace in Germany, published in 2023, noted that many managers in Germany are male and lack awareness or understanding of the symptoms and impacts of menopause. As a result, few companies have implemented menopause-friendly policies, and respondents to her survey reported feeling unsupported in the workplace.

Rumler sees awareness-raising as the first critical step in improving working conditions for menopausal women, particularly increasing awareness of the benefits to managers of supporting their menopausal employees and peers, such as improved productivity and reduced absenteeism. She is writing guidelines aimed directly at companies to that end. Similarly, in addition to health information, the Bavarian State Ministry of Health, Care and Prevention has created resources for managers and employers to support their employees who are experiencing menopause, including statistics on how menopause can impact productivity and profits.

While handbooks and guidance represent an important first step, Rumler noted that a one-size-fits-all approach will not work for all menopause support, as women in sedentary employment will require different accommodations from those for female nurses or police officers, for example, who spend their days on their feet. Accommodations and workplace policies need to reflect the needs and experiences of the women they seek to support, or risk being ineffective. In addition to the nature of the work, in order to be effective, menopause policies need to consider external factors that may influence menopausal women’s experiences in the workplace, such as their ethnicity, their economic status, and whether they live in an urban or rural area. Menopause symptoms, or simply the stigma of going through menopause, can interact and intersect with these and other factors to impact how women experience this period of their lives.

FIGURE 3

Economic Impact of Menopause on the Workforce

The estimated impact of menopause on lost income is significant, indicating more needs to be done to support women to remain in the labor force if they wish.

Sources: DeStatis, Berlin School of Economics and Law

In the absence of federal government-led policy regarding menopause support in the workplace, NGOs and CSOs such as Wir Sind Neun Millionen are pushing to improve understanding and awareness of menopause, its symptoms and impacts on women, and how their employers and communities can help. The Change, for example, offers consultancy services for companies seeking to implement menopause policies and accommodations, including providing information workshops, developing policy plans, and supporting the sustained implementation of changes. The NGO frames menopause support as key to employee retention and increased productivity, targeting its messaging to a corporate audience.

Looking Ahead

As Germany’s population ages and an increasing number of women work through and beyond the menopause transition, ensuring that they are adequately supported to thrive in the workplace, and to access high-quality, appropriate care for any symptoms, will be key to the country’s continued prosperity. Perimenopausal, menopausal, and postmenopausal women are significant contributors to the German economy, so safeguarding their health and well-being represents a long-term investment in the country. Notable obstacles impede this goal, however, including the piecemeal approach to menopause-related health care, treating symptoms rather than addressing menopause holistically and as part of a life-long commitment to women’s health. A lack of government leadership in developing workplace protections and accommodations represents another major hurdle. Addressing these gaps—especially by improving provider education, enhancing workplace policies, and potentially introducing national legislation—will be crucial to ensure that menopausal women in Germany can continue to thrive economically and socially. Steps to improve menopause care and support in Germany include:

• Learning from the successes and failures of other countries and adapt their interventions to be contextually appropriate for Germany. FP Analytics interviewee Andrea Rumler noted that among the earliest German companies to implement menopause accommodations were those with parent or subsidiary companies in the UK, where the government was already supporting the private sector to address this issue. Stakeholders within federal and state-level government can learn from the UK and other countries with similar economies and populations to implement effective, well-informed, and appropriate workplace and health policies.
• Catalyzing government leadership to implement federal protections for menopausal women in the workplace and develop in-depth policies to address menopause in all aspects of life, recognizing the micro- and macroeconomic incentives to do so. This work can build on recent momentum toward recognizing the needs of women in the workplace in the Bundestag and on the innovative work being done at the state level, for example, in Bavaria, which could be replicated in other states and at the federal level.
• Accelerating research on menopause and its health, economic, and social impacts. In particular, governments, universities, and philanthropy can support wider and more in-depth research on health impacts of menopause, on access to care, and on experiences and impacts in the workplace, including the cost of inaction. There is also a need for research focused on under-represented groups, such as immigrants and non-German speakers who may struggle to access the necessary care or workplace support.