Perimenopause and menopause affect 75% of women in the U.S. workforce at any given time, yet remain one of the most overlooked, under-discussed, and poorly supported workplace health realities.
For many women, perimenopause occurs over several years and brings a range of debilitating, fluctuating symptoms, including difficulty concentrating, loss of confidence, and persistent fatigue. Women in their 40s and early 50s, often at the peak of their careers, frequently manage these challenges in silence or conceal them altogether, as disclosure can feel risky and adequate workplace support is often unavailable.
It doesn’t help that the precursor to menopause is not discussed as frequently as its more final counterpart. Nor that women themselves aren’t always well-enough educated on its symptoms, or when they can expect them to start, to ask for help in a comprehensive way.
When employees struggle without speaking up, employers often recognize the issue only after symptoms have already affected performance and taken a serious toll on wellbeing. A key part of the problem lies in how the conversation is framed. Menopause* is still too often treated as a single milestone, rather than the long, uneven, and deeply personal transition it actually is.
That misunderstanding has real consequences in the workplace, impacting everything from support structures to culture, and leaving critical needs unaddressed until it is too late.
Perimenopause at Work: Symptoms, Stigma, and Silence
Perimenopause can last from several months to more than a decade, while menopause is clinically defined as twelve consecutive months without a period. Although every woman’s experience is different, common symptoms include disrupted sleep, brain fog, fatigue, anxiety, irregular cycles, temperature fluctuations, and difficulties with memory and concentration.
These symptoms are often intermittent and unpredictable, meaning an employee may feel fully capable one week and significantly impacted the next, making them difficult to identify or address in a work context.
Stigma remains a major barrier. Many women do not disclose their symptoms due to concerns about being perceived differently or uncertainty over whether their experiences will be taken seriously.
As a result, the culture of silence around perimenopause and menopause often leaves employers unaware of the scale of the issue until it begins to affect engagement, performance, and ultimately retention of experienced talent.
One Initiative Breaking the Silence around Menopause
Allwork.Space spoke with Neika Colbourne, VP of Brand Marketing at Hone Health. The company recognizes menopause as a major health transition that occurs during women’s peak working years, often without formal workplace policies or structured support in place. Its Menopause Time Off (MTO) initiative encourages employers to adopt more inclusive policies and practical accommodations for employees navigating this stage of life.
As Colbourne explains, menopause is a clinical reality many women experience during their highest earning years, often while managing symptoms without workplace recognition or support.
“Despite being a predictable part of life, it remains largely overlooked in workplace policy,” she says.
The urgency is underscored by the data: menopause affects a significant share of the U.S. workforce; including one in five working women aged 45 to 54, the peak period of transition.
By 2040, nearly 45 million women over 55 are expected to be in the workforce, yet an estimated 95% of companies still offer no menopause-specific support.
The MTO Movement calls for menopause-inclusive workplace policies and invites employers, healthcare leaders, and policymakers to sign an Open Declaration. Colbourne states that this initiative underscores menopause support as a shared responsibility.
The initiative is further supported by the MTO Fund, which provides $1,000 microgrants to individuals without access to paid leave, intended as short-term assistance rather than a replacement for systemic workplace reform.
The Case for Action on Perimenopause: Supporting Women and Business
When women experiencing perimenopause are not supported at work, the impact is rarely an immediate exit from the workforce, but rather a gradual disengagement that can show up as reduced visibility in meetings, events, and broader workplace participation.
Over time, this translates into a measurable economic effect on women’s earnings and career progression, often referred to as the menopause penalty. Alongside this penalty is an often invisible physical burden: women continuing to work through symptoms such as fatigue, brain fog, anxiety, and sleep disruption.
Productivity is maintained, but only through increased physical and emotional effort, longer hours, and constant self-management, all of which take a toll on wellbeing.
Nearly 90% of women reported that perimenopause or menopause symptoms impact their work, and almost 70% said they lose up to 10 hours of productivity per week.
Survey findings from Hone Health underscore the scale of the issue. Nearly 90% of women reported that perimenopause or menopause symptoms impact their work, and almost 70% said they lose up to 10 hours of productivity per week. As Colbourne notes, “That’s not a personal inconvenience, it’s a structural workforce issue.”
The data also highlights broader workforce implications. Sixty-two percent of women said symptoms affected their earnings, performance reviews, or career progression in the past year, while one in three has considered leaving or has already left the workforce due to menopause symptoms.
Colbourne emphasizes that these employees are often highly experienced professionals in leadership and mentoring roles, meaning organizations risk losing significant institutional knowledge when support is lacking.
Notably, 62% of women reported avoiding time off because menopause is not formally recognized in workplace policy, leaving many without the language or permission to seek support without fear of judgment.
Ultimately, the impact extends to organizations as well, through reduced productivity, absenteeism, turnover, and the loss of leadership potential and institutional knowledge. These factors contribute to an estimated $5.4 billion in lost productivity annually, which reinforces the case for perimenopause support as both a workforce wellbeing and economic priority.
According to RAND’s The Economic Impacts of Menopause in the United States report, that $5.4 billion is the estimated annual economic cost of menopause symptoms and represents “a conservative lower-bound estimate that excludes additional costs associated with factors such as early retirement, missed promotions, or transitions to lower-paying jobs.”
Beyond Policy: What Employers Need to Put in Place
Early, proactive support helps employees remain engaged, confident, and connected to their careers. Delivering this effectively typically requires a combination of education, flexibility, and an inclusive working environment.
- Employer education is essential for reducing stigma. As Colbourne notes, explicitly naming menopause in workplace policies helps normalize the experience and gives managers the language to respond appropriately and without judgment. Organizations can also use resources such as Hone Health’s free Employer Toolkit, which includes sample HR policy language and implementation guidance. However, as Colbourne emphasizes, “Awareness without action leaves women more visible in their struggle, not more supported. The next chapter has to be infrastructure.”
- Flexible working arrangements are a key form of support. The MTO approach encourages options such as flexible leave, allowing employees to take time off when needed without fear of penalty. Broader flexibility, including adjusted schedules, hybrid or remote work, and temporary workload adjustments, enables employees to manage fluctuating symptoms while maintaining performance and participation.
- Inclusive workplace conditions further reduce day-to-day barriers. Access to quiet spaces, appropriate facilities, and supportive HR processes can significantly improve comfort and concentration. Small adjustments, such as the ability to take short breaks or make temporary changes to working patterns without scrutiny, can have a meaningful impact on wellbeing and productivity.
- Open workplace dialogue helps normalize perimenopause in the same way as other life stages, such as caregiving or mental health. Colbourne notes that 66% of women in their survey have never discussed symptoms at work due to fear of bias or being perceived differently. “That silence is a policy failure as much as a cultural one,” she says. MTO advocates embedding open language into workplace culture, creating an environment where menopause can be discussed without fear or stigma.
From Intention to Meaningful, Sustained Impact
Massachusetts lawmakers have introduced legislation to improve access to perimenopause and menopause care by establishing a state commission to study current gaps in healthcare access, medical training, workplace impacts, and public awareness. Now consolidated into a single bill, the measure aims to strengthen support for women experiencing menopause.
Advocates and clinicians say it could help address long-standing shortcomings in how menopause is understood and treated, particularly in workplace settings. The proposal also reflects a broader national trend of states pursuing policy changes to expand care, improve insurance coverage, and reduce stigma.
Whether an organization supports employees through perimenopause is a clear indicator of how seriously it values retaining experienced talent. Policy alone is not enough. Without meaningful cultural change, even well-designed frameworks fall short in practice. Lasting impact requires commitment at every level of the organization, embedded in leadership, reflected in management behavior, and reinforced in everyday workplace culture.
The employee experience must be prioritized at every life stage, including this one. Only then will women feel truly seen, heard, and supported through perimenopause and beyond. The question is no longer whether perimenopause affects work, but whether employers can afford to keep ignoring its impact.
* In some cases, the term “menopause” is used in this article to reflect the language of the cited sources. However, here it is used as an umbrella term covering all stages from perimenopause onward.
