From whispered complaint to public priority: Menopause is finally a policy issue

For decades, menopause was treated as a private inconvenience, as something women managed quietly, insurers ignored, with little expectation of medical help or workplace acknowledgment. That is finally changing, and quickly.

In 2024 and 2025, a handful of states passed the first laws ever requiring health insurers to cover menopause treatment. By early 2026, nearly 20 new state bills had been introduced in a matter of months. The FDA just months ago removed a decades-old warning label that discouraged hormone prescriptions. And researchers put hard numbers on what untreated menopause actually costs—not just for women, but employers and the entire economy.

Still, whether a woman receives coverage for perimenopause or menopause treatment inevitably depends on her ZIP code.

Why It Matters

The average age of menopause in the U.S. is 52, meaning the bulk of this transition happens during women’s peak working years.

An estimated 54 million American women are currently in perimenopause (on average, four to seven years before menopause) or menopause (defined as 12 consecutive months without a menstrual period), yet only about 25 percent are actively receiving treatment, according to Mayo Clinic research.

The gap between the scale of the problem and the level of response is what policymakers are trying to close.

The costs of inaction are measurable. A landmark Mayo Clinic study estimated that unaddressed menopause symptoms cost the U.S. economy approximately $1.8 billion a year in lost workplace productivity alone — rising to $26.6 billion when direct medical expenses are included. About 13 percent of employed women between the ages of 45 and 60 report at least one adverse work outcome such as missed days, reduced output, or diminished career advancement.

The health impacts for women are real. Brain fog, such as memory lapses and concentration difficulties tied to hormonal shifts, impairs decision making and task performance. Chronic insomnia from night sweats erodes stamina. Hot flashes and joint pain can affect confidence in client-facing or leadership roles. Mood changes such as heightened anxiety, depression, and irritability can impact team dynamics and relationships.

For lower-income women, the stakes are higher. Without insurance coverage, hormone therapy can cost between $500 and $1,000 per year out of pocket. This is a significant barrier for millions of women who rely on Medicaid or bare-bones insurance plans. The policy gap is also an equity gap.

Background

Several forces kept menopause out of the policy conversation.

The most consequential was a 2002 study from the Women's Health Initiative, a federally funded trial, that linked high-dose hormone replacement therapy (HRT) to elevated risks of breast cancer and cardiovascular disease. The FDA then added a prominent “black box” warning on estrogen products, the strongest caution the agency can attach to a prescription drug. HRT prescriptions dropped sharply, and the medical profession grew reluctant to recommend it.

The policy void was reinforced by education gaps: fewer than one-third of OB-GYN residency programs include structured menopause training, and about 80 percent of OB-GYN residents report feeling unprepared to discuss it with patients.

There was also a cultural dimension. Menopause has historically been framed as something to endure, rather than a medical condition to treat. One Harvard Law review essay described it as a subject addressed “in the shadows.”

What Changed?

Several things shifted in a relatively short period that encouraged state legislative action and policy changes.

In 2025, the FDA removed the black box warning from estrogen products, reflecting a more nuanced understanding of the actual risk profile of hormone therapy.

Separately, the Mayo Clinic and other institutions published a series of large-scale studies that put real numbers on the treatment gap. Research showing that menopause costs nearly $2 billion a year in lost productivity gave advocates and legislators a strong  economic argument.

Advocacy also became more visible. High-profile public figures, including actress Halle Berry, who testified before Congress, helped shift menopause from a topic of private conversation to public discourse.

At the federal level, in 2024 and again in 2026, a bipartisan group of senators introduced the Advancing Menopause Care and Mid-Life Women’s Health Act proposing $275 million over five years for research, provider training, and education. Though not yet enacted, the bill signals that menopause is a legitimate legislative priority.

What New State Laws Do

State laws are tackling the problem on several fronts. Insurance mandates are the most direct. As of mid-2026, five states require health insurers to cover menopause treatment: Illinois (HB 5295) and Louisiana (Act 784 (HB 392) with comprehensive mandates covering both hormonal and non-hormonal therapies; New Jersey, whose Menopause Coverage Act is described as the most expansive in the country; and Oregon (HB 3064) and Washington (HB 1971), with  partial mandates.

Several more states, including Ohio (HB 767), Missouri (SB1569), Massachusetts (SB 4838) , and Maryland (HB1435), have bills actively advancing.

Workplace protections are a second front. Rhode Island became the first state to require employers to provide reasonable accommodation for employees experiencing menopause symptoms. Washington state established similar protections through its anti-discrimination law. The city of Philadelphia passed an ordinance extending workplace accommodations that takes effect in January 2027.

Provider education is a third area. California enacted laws allowing physicians to earn continuing medical education credits specifically for menopause training. Massachusetts has proposed requiring the state medical board to assess whether residency programs provide adequate training.

Medicaid coverage, for low-income women, is arguably the most consequential category for equity. Louisiana and Illinois now mandate Medicaid coverage for menopause care, and New Jersey's law extends to NJ FamilyCare.

Challenges Remain

Even with these advances, structural obstacles remain. There is no federal mandate requiring coverage of menopause treatment, and the Affordable Care Act does not classify hormone therapy as a standard preventive service. State mandates don’t bind self-insured employer plans, which cover about 60 % of privately insured Americans.

The provider training gap remains. Laws that allow continuing education credits for menopause training are a first step, but they do not require that training.

Finally, California's experience is a cautionary note. Gov. Gavin Newsom vetoed comprehensive menopause insurance mandates twice, in 2024 and 2025, citing cost concerns. The state is a reminder that the legislative trend, while accelerating, is not inevitable.

Resources

Mayo Clinic - Majority of Midlife Women with Symptoms Do Not Seek Care
Mayo Clinic - Global Study — Gap Between Expectations & Experience in Perimenopause
Mayo Clinic - Impact of Menopause Symptoms on Women in the Workplace
NIH / PubMed — 2023 Study: Menopause and the Workforce
Harvard Petrie-Flom Center - Out of the Shadows — Menopause and the Law
Ms. Magazine - What's Next for Menopause Legislation in Your State?
News From The States - Menopause Coverage Bills Meet Mixed Fates