Solving the Billion Dollar Problem and Unlocking the Billion Dollar Opportunity

The U.S. economy loses billions every year due to the failure to address the challenges faced by women during menopause. For too long anachronistic attitudes have prevented candid conversations about how menopause affects women in the workplace. And for too long the stigma associated with menopause has deterred investment in solutions and innovations that would eliminate or mitigate the economic and social cost of failing to address the consequences of menopause. Read how we can eliminate the cost and unlock the returns on investment by pulling back the curtain on menopause.

A woman's reproductive lifecycle – from menstruation to menopause – is a deeply intimate aspect of her life. As women, we experience the physiological and often psychological aspects of these stages of our lives. However, how often do we stop to consider, demographically, the social and economic consequences of these life transitions? In March 2022, I wrote about how a transformative technology – the birth control pill – unleashed remarkable gains in women's economic empowerment and contributed broadly to an increase in the U.S. gross domestic product. Similar economic empowerment and impact could be achieved by systematically changing historical attitudes about menopause, by normalizing the conversation around the symptoms of menopause and how to address them, and by investing in innovations that improve women's lives during this period of transition.

The Economic Cost of Menopause

Menopause generally occurs in women between the ages of 45 and 54, and that demographic makes up 20% of the female workforce in the U.S. Based on U.S. Bureau of Labor statistics published in February 2022, 47% of the U.S. workforce at the time was female. That means that approximately 9.5% of the entire U.S. workforce is in menopause. A study conducted by the femtech company Joylux estimated that, by 2025, 54 million women in the U.S. will be in menopause.

While varying from person to person, menopausal symptoms are urogenital (incontinence, vaginal pain), psychological (depression, anxiety), and physical (hot flashes, sleep problems, joint and muscle discomfort). Any of these can affect a woman's productivity at work, not to mention her life outside the workplace.

A recent study by the Mayo Clinic estimated that the U.S. economy is conservatively losing more than $26 billion annually due to the failure to address the effect of menopause on working women. That staggering figure includes $1.8 billion attributable to lost workdays and $24.8 billion of direct medical expenditures. But as noted in the study, the true economic cost is likely much larger because that figure does not include costs associated with reduced hours of work, loss of employment, early retirement, or change of jobs.

By any measure, the Mayo Clinic study reveals that the failure to address menopause openly and in a comprehensive manner has a demonstrable effect on the U.S. economy.

The Social Cost of Menopause

In addition to the economic toll of menopause, there is at least an equally substantial social cost. Women who leave the workforce due to inability to work during menopause may experience financial insecurity later in life, affecting their ability to care for and support themselves and their families. And at a time when there is a significant labor shortage, we cannot afford to lose some of our most productive workers. Additionally, menopause affects women when they are often at the height of their earning power and career development. This is also the time of life when women take on or are in contention for important leadership roles. As the Mayo Clinic report notes, the effect of menopause on working women in midlife is "a potentially unrecognized reason for the leaky leadership pipeline and the paucity of women in senior leadership positions."

According to McKinsey's Women in the Workplace 2023 report, women's representation in the C-suite is 28%. And in June 2023, Fortune reported that 10.4% of the CEOs of Fortune 500 companies were women. While this represents some improvement, the number of leadership roles filled by women still lags far behind those held by men. Apparently, no research has attempted to determine whether there is a correlation between menopause and the dearth of women in leadership positions. However, simply connecting the dots supports the supposition in the Mayo Clinic report: the effects of menopause are likely reducing the talent pool of accomplished women and resulting in continued incremental progress in gender equality in senior corporate positions.

Why Menopause Remains Unaddressed

Given the undeniable economic and social cost of menopause, why have we failed to do something about it?

In general, women's health has been historically neglected. According to Daisy Robinton, PhD, the co-founder and CEO of Oviva Therapeutics, female physiology is much more complicated than male physiology and has long been overlooked in biomedical research and clinical studies. Women and underrepresented groups were not required to be included in clinical trials until 1993. And as recently as 2018, only 15% of the budget of the National Institutes of Health (NIH) was allocated to women's health.

When it comes to menopause, society as a whole still treats the subject as taboo, reflecting the bias against addressing women's health while engaging in a much more open conversation around men's health. As a result, public discourse regarding the personal and societal consequences of menopause is stifled and, due to constraints imposed by marketing platforms and media, information regarding the availability of menopause products and therapies is not as widely disseminated as it could be. (For a disheartening example of this double standard, read this post by Joylux.)

This taboo is nowhere more detrimental than in the workplace, where there remains a great deal of stigma around speaking about menopause. A recent study of menopause in the workplace conducted by Bank of America found that there was a "clear disconnect" when it came to how HR benefit managers and employees perceived their companies' attitude towards menopause. Seventy-six percent of HR benefit managers said they discuss menopause with their employees regularly or sometimes, while only 3% of employees who experienced menopause reported talking about the subject with their HR departments.

What It Will Take to Eliminate the Cost and Fulfill the Potential

Government Action.
Systematic change could be made through legislation. However, in the past, at least two bills – one that would have expanded Medicare to include hormone replacement and other menopause therapies and another that required additional research by the NIH into menopause related treatments – were introduced in the House of Representations but did not progress to a vote or even debate. In December 2023, Congresswoman Yvette Clarke and Congresswoman Debbie Lesko introduced the Menopause Research and Equity Act of 2023 which directs the NIH to evaluate the current status of menopause research and recommend new studies to improve the understanding of menopause and midlife women's health. Despite its bipartisan sponsorship, given the current state of play in Congress, the prospect of this bill progressing through the legislative process does not seem promising without concerted lobbying efforts.

While Congressional action may be a long shot, the Biden Administration is stepping forward. Last month, the U.S. Department of Health and Human Services announced a $100 million investment in research and development for women's health through the Advanced Research Projects Agency for Health, an agency within HHS. This follows the launch in November 2023 of the first-ever White House Initiative on Women's Health, an effort led by First Lady Jill Biden and the White House Gender Policy Council.

Change in the Workplace.
In the absence of government intervention, the private sector can take the lead in addressing menopause. More companies are starting to realize the importance of creating a menopause-friendly culture in the workplace in order to attract and retain experienced women. Some companies are providing menopause-specific solutions in the form of employee benefits such as virtual access to certified menopause specialists and coverage for hormone treatments that may not be included in insurance plans. As the Bank of America study notes, companies can also offer manager training to increase awareness of menopause and coaching to facilitate more open discussion. Companies can also establish employee networks or peer support groups for menopausal women.

Investment in Menopause Therapies and Treatment.
In addition to changing the culture around menopause in the workplace, the private sector can have an enormous impact by investing in innovations that are addressing menopause and its symptoms.

There is a paucity of data regarding the total market value of the menopause market in the U.S., which among other things includes therapeutic solutions to lengthen ovarian health, hormone replacement therapies, medical devices, virtual clinical care, and consumer products. But by any estimate, it is huge. According to Grand View Research, the global menopause market for dietary supplements and over-the-counter pharma products (hormonal and non-hormonal treatments) was $16.93 billion in 2023, with 35.64% or approximately $6 billion of that revenue generated in the U.S. However, that figure significantly understates the value of this opportunity by excluding, among other things, the market for medical devices, virtual care, biotech innovations, and other consumer products.

In a recent market analysis, SJF Ventures discussed the untapped market opportunity in menopause. With an average of 6,000 women in the U.S. reaching menopause every day and experiencing menopause for anywhere from two to fourteen years, there is a large – and evergreen – market for solutions. And, as SJF Ventures notes, with 80% of healthcare dollars controlled by women, companies innovating in this sector "can reach a large audience with high spending power."

Summarizing the investment landscape SJF Ventures notes that, since the mid-2010s, approximately $530 million has been invested in menopause care companies, a "drop in the bucket of VC funding." And that amount ($530 million) represents only 3% of the $1.9 billion invested in femtech startups and barely a fraction of the $30.7 billion invested in digital health companies, in each case in one year (2021) alone.

Clearly, the enormous investment potential in addressing menopause continues to be overlooked.

Where Does This Leave Us?

The stigma around menopause and more broadly women's health has impeded change in the workplace and investment by the government and the private sector, resulting in a huge economic and social cost and an unrealized opportunity to tap into the returns offered by a large and constantly regenerating market for solutions. It will require progress on all fronts – government action, changing workplace culture, and private investment in innovation – to eliminate the billion-dollar cost to the economy and unlock the billion-dollar market opportunity. And it will require collective action to do so. Each of us can be part of that action: