Cost of Menopause in the Workplace: 2026 U.S. Data and Evidence Map

The most detailed current national U.S. model located in this review estimates the cost of menopause in the workplace at $5,411,092,788 a year—roughly $5.4 billion—in wage-equivalent workplace and labor-market losses among employed women aged 45 to 60. RAND's 2025 model counts missed workdays, reduced hours, and wages forgone after menopause-related layoffs. The older $1.8 billion figure counts missed workdays only. The widely repeated $26.6 billion figure adds about $24.8 billion in medical spending and is not a workplace-cost figure.

Those are not three competing estimates of the same thing. They answer three different questions.

Here is the part that should give a careful writer pause. We reproduced RAND's national model from its published inputs and matched its reported total to within 40 cents. The reproduction shows that RAND applies one national set of work-outcome rates across every state and industry. The underlying modeled loss is 0.3579064% of the annual wage basein each jurisdiction and sector; the tiny differences visible after recalculating from RAND's published rows come from rounding. The state and industry tables are maps of wages and headcount. They are not maps of menopause.

This page records the scope behind each major estimate, the party that bears each cost, the arithmetic needed to reproduce the U.S. model, and the limitations that have to travel with the headline numbers.

The three U.S. numbers, decoded

The $1.8 billion, $5.4 billion, and $26.6 billion figures measure different things. The safest current U.S. workplace figure is RAND's $5.4 billion scenario estimate, provided it is described as a mixed workplace-and-labor-market loss rather than an audited employer expense.

What the $1.8B, $5.4B, and $26.6B menopause figures actually measure

Source: The HRT Index Research, compiled from Faubion et al., Mayo Clinic Proceedings (2023), the official Mayo Clinic summary, and RAND RR-A4292-1 (2025). Last verified August 1, 2026.

The sentence to avoid: “Menopause costs U.S. employers $26.6 billion a year.”

That wording assigns the medical component and the lost-work-time extrapolation directly to employers. The underlying sources do not establish that. About 93% of the combined $26.6 billion figure is medical spending, not workplace loss.

What is the cost of menopause in the workplace in the United States?

The most detailed current national U.S. model located in this review estimates $5.4 billion a year in wage-equivalent workplace and labor-market losses among employed women aged 45 to 60. It is a scenario estimate built from public data and survey-derived rates, not a national audit of expenses paid by employers.

RAND published The Economic Impacts of Menopause in the United States—report RR-A4292-1, DOI 10.7249/RRA4292-1—on September 30, 2025. The authors are Jennifer A. Heissel, Shannon D. Donofry, Amanda Bonheur, Daniel Shinnick, Julia Rollison, and Wendy M. Troxel. RAND reports that the work was funded by gifts from RAND supporters and income from operations.

One review-status correction matters. RAND says that all RAND research reports undergo rigorous peer review. The report is not a journal article, but it is wrong to describe it as unreviewed or as having passed only an internal quality check.

RAND identified 24,047,236 employed women aged 45 to 60 in the 2023 American Community Survey data used for the model, with an average annual income of $62,871. The report says roughly 30% of women in the U.S. labor force fell within that age proxy, ranging from 22.6% in the District of Columbia to 32.5% in Vermont.

RAND describes $5.4 billion as its broadest modeled scenario and also says the estimate is conservative relative to the full economic burden. Those statements are compatible: it is the broadest of RAND's scenarios, while still excluding presenteeism, resignations, recruitment and replacement costs, early retirement, missed promotions, lower-paid job moves, unpaid work, and workers outside the age range.

Source: RAND, The Economic Impacts of Menopause in the United States (2025). Last verified August 1, 2026.

Why do sources report $1.8 billion, $5.4 billion, and $26.6 billion?

They use different scopes, populations, and data vintages. The $1.8 billion figure counts missed workdays; RAND's $5.4 billion model adds reduced hours and layoff-related forgone wages and updates the population and income inputs; the $26.6 billion figure adds medical spending to the older lost-work-time estimate.

The dependency almost nobody mentions

The $1.8 billion and $5.4 billion estimates are not independent findings. RAND states that it used estimates from Faubion and colleagues' 2023 Mayo study to model the economic cost by state and industry.

Inputs behind RAND's $5.4 billion model

Source: The HRT Index Research, from RAND RR-A4292-1, the report's approach section and notes. Last verified August 1, 2026.

The dependency is straightforward: RAND applies the Mayo survey's work-outcome rates to a newer national population and wage base, then adds outcomes Mayo's $1.8 billion headline did not count. Quoting the two estimates as independent confirmation of a range would misdescribe the evidence.

What the Mayo survey actually measured

Faubion and colleagues published Impact of Menopause Symptoms on Women in the Workplace in Mayo Clinic Proceedings in 2023. The survey was fielded from March 1 through June 30, 2021, across four Mayo Clinic primary-care sites.

Mayo workplace study: sample and outcome details

Source: Faubion et al., Mayo Clinic Proceedings (2023), PMID 37115119. Last verified August 1, 2026.

The official Mayo Clinic news release says 485 respondents missed work, while the primary journal record reports 480. We use 480 because the primary article takes precedence.

This study is the empirical source for the work-outcome rates used in both headline U.S. estimates. Its limits therefore carry into the national extrapolations: a 16.1% response rate, one health system, four primary-care sites, a sample that was 93% White, and self-reported symptoms and work outcomes. The authors called for confirmation in larger and more diverse groups.

What the data shows—and what it does not

The evidence shows economically meaningful associations between menopause symptoms and missed work, reduced hours, earnings, employment, and labor-force attachment for at least some women. It does not establish one audited national employer bill, an effect for every worker, or a guaranteed return from any workplace or clinical intervention.

What the evidence supports:

• RAND's current national scenario model produces a broad U.S. total of approximately $5.4 billion a year.
• Missed workdays account for less than half of RAND's broad modeled total.
• RAND's state and industry totals vary because workforce size and wages vary; its model does not use state- or industry-specific symptom rates.
• Norwegian and Swedish administrative-record evidence finds effects extending beyond absence into earnings, hours, employment, and social transfers.
• Every national monetary estimate located in this review omits material categories.

What it does not support:

• A directly measured national total for what U.S. employers pay.
• A prediction of any particular organization's actual productivity or expense.
• A claim that every woman aged 45 to 60 is menopausal, symptomatic, or affected at work.
• A claim that one intervention will produce a specific financial return.
• Adding or directly comparing U.S., UK, Canadian, Australian, Japanese, Norwegian, and Swedish figures as though they measure the same thing.
• Treating “the cost of being menopausal” as a single measurable object. These studies estimate specific symptom-associated outcomes under specific definitions.

An age band is a population proxy, not a diagnosis. Not every woman aged 45 to 60 is menopausal or symptomatic, and some people who experience menopause do not identify as women. This page preserves each source's population language when reporting its findings.

How we produced this evidence map

We reviewed primary research, original institutional reports, government evidence reviews, and original data producers, then recorded each estimate's population, date, method, scope, cost bearer, exclusions, review status, and funding context. We did not combine currencies or incompatible methods into a global total.

For the U.S. model, we independently reproduced RAND's national result from its published population, income, workday, missed-work, reduced-hours, layoff, and unemployment-duration inputs. We also:

• calculated each component's share of the total;
• normalized the model into attendance-time and broader wage-base coefficients;
• calculated per-worker values using RAND's national average income;
• divided each published state and industry total by its corresponding worker count;
• recalculated the implied coefficient and days-of-pay equivalent for every published row;
• summed the state and industry appendices separately as a validation check; and
• recorded the resulting data in versioned CSV files.

Each evidence record is labeled as one of the following:

Source: The HRT Index Research methodology, version 1.0. Last verified August 1, 2026.

Commercial pages and forum discussions were not used as factual evidence. The source order was: official government or original public data; peer-reviewed journal article; original institutional research report; author-hosted or institutional working paper, clearly labeled; and original survey report with its methodology and sponsorship disclosed.

The downloadable evidence map records one row per estimate rather than one row per publication. That keeps the $1.8 billion and $26.6 billion Mayo figures separate because they have different components and different safe wording.

What is included in RAND's $5.4 billion estimate?

RAND's broadest scenario consists of approximately $2.31 billion from missed workdays, $1.00 billion from reduced hours, and $2.10 billion from layoff-related forgone wages. Missed days account for 42.70% of the total, reduced hours 18.45%, and layoffs 38.85%.

Components of RAND's broad U.S. model

Source: The HRT Index Research, reproduced from the inputs in RAND RR-A4292-1 (2025). Rounded component figures correspond to RAND's published figure. Last verified August 1, 2026.

Attendance-time changes—missed days plus reduced hours—make up 61.15% of the model. The remaining 38.85% is layoff-related forgone income. That component is a real worker and economy-level loss, but it is not employer spending. Presenting the entire $5.4 billion as a direct employer cost changes the composition of the estimate.

RAND's full- and part-time scenario is about 8.6% larger than its full-time-only scenario, moving the modeled total from roughly $4.98 billion to $5.41 billion.

What is the modeled cost per worker or organization?

Reproducing RAND's assumptions gives an attendance-time coefficient of 0.2188679% and a broader wage-equivalent coefficient of 0.3579064% of the annual wage base for employed women aged 45 to 60. At RAND's national average income of $62,871, those equal approximately $137.60 and $225.02 per worker in the age proxy. Neither is a measurement of a particular employer's actual loss.

The formulas

RAND assumes a 212-day work year. The formulas below reproduce its model; they do not convert the Mayo study's reported median of three missed days into an independently observed mean.

Missed-day coefficient
  = 0.108 × 3 ÷ 212
  = 0.001528301887
  = 0.1528302% of annual wage base

Reduced-hours coefficient
  = 0.056 × 5 × 0.5 ÷ 212
  = 0.000660377358
  = 0.0660377% of annual wage base

Layoff-related coefficient
  = 0.003 × 24.1 ÷ 52
  = 0.001390384615
  = 0.1390385% of annual wage base

Attendance-time coefficient
  = 0.001528301887 + 0.000660377358
  = 0.002188679245
  = 0.2188679%

Broader wage-equivalent coefficient
  = 0.001528301887 + 0.000660377358 + 0.001390384615
  = 0.003579063861
  = 0.3579064%

The reproduction check

24,047,236 workers × $62,871 average annual income × 0.003579063861
  = $5,411,092,788.40

RAND's published national total
  = $5,411,092,788

The reproduction matches the published total to approximately $0.40 on $5.4 billion.

Modeled annual values at RAND's national average income

Source: The HRT Index Research, derived from RAND RR-A4292-1 (2025). Last verified August 1, 2026.

The broad coefficient is equivalent to approximately 0.7588 days of pay per yearfor each worker in RAND's age-proxy population.

Applying the model to a workforce

Use two aggregate inputs:

• N = number of employed women aged 45 to 60; and
• W = their average annual wage or salary.

Attendance-time wage equivalent = N × W × 0.002188679
Broader labor-market equivalent = N × W × 0.003579064

Worked example: 100 workers at RAND's national average wage

Source: The HRT Index Research scenario calculation using RAND's published assumptions. Last verified August 1, 2026.

Three labels have to travel with the result:

1. Scenario estimate, not an observed company expense.
2. The broader result includes wages forgone after layoffs, a worker and economy-level loss rather than payroll paid by the former employer.
3. The model excludes presenteeism, recruitment and replacement costs, resignations, early retirement, missed promotions, moves to lower-paid roles, medical spending, and unpaid work.

The formula is suitable for aggregate scenario analysis. It should not be used to identify, diagnose, or assign an expected loss to an individual employee.

Which states have the highest modeled menopause workplace costs?

California has the largest absolute total in RAND's model at $687.7 million, followed by Texas at $432.6 million, New York at $385.3 million, and Florida at $335.7 million. But the same national work-outcome rates are applied everywhere, so these totals primarily reflect workforce size and income—not state-specific symptom prevalence or severity.

This is the most important thing to understand before quoting a state figure. RAND uses state-specific worker counts and incomes, but no state-specific menopause symptom or work-outcome rates. The underlying formula applies the same 0.3579064% wage-base coefficient to every jurisdiction.

When the implied coefficient is recalculated from RAND's published, rounded rows, it ranges only from 0.357903% to 0.357909%. The derived days-of-pay equivalent ranges from 0.758755 to 0.758768 days. That tiny variation is consistent with publication rounding rather than a modeled difference in menopause outcomes.

They are maps of wages and headcount. They are not maps of menopause.

Selected state results: absolute total versus per-worker value

Source: RAND's worker counts and modeled totals come from Appendix Table 1 of RAND RR-A4292-1. Per-worker values and both orders are HRT Index calculations. Last verified August 1, 2026.

California, Texas, New York, and Florida together account for approximately 34.03%of RAND's national total.

The movement between the two orders is the point. The District of Columbia is 44th by absolute total and first per worker. Texas is second by absolute total and 26th per worker. Florida is fourth and 31st. Those movements are wage and workforce-size effects, not evidence of different menopause rates.

Download the complete 51-jurisdiction RAND state model dataset (CSV)

Which industries carry the largest modeled menopause workplace costs?

Health Care and Social Assistance has the largest absolute sector total in RAND's model at $1.244 billion, followed by Educational Services at $797.6 million. The five largest sectors account for approximately 66.39% of the national model, but the per-worker order is driven by wages rather than measured symptom burden.

Selected industry results: absolute total versus per-worker value

Source: RAND's worker counts and modeled totals come from Appendix Table 2 of RAND RR-A4292-1. Per-worker values and both orders are HRT Index calculations. Last verified August 1, 2026.

Health care and education together account for approximately 37.73% of the national model. The four largest sectors account for approximately 57.97%, and the five largest account for approximately 66.39%.

The per-worker spread is 3.95×, from $492.44 in Management of Companies and Enterprises to $124.82 in Accommodation and Food Services. Because the same underlying coefficient is used in every sector, that spread comes from average income. It does not establish that lower-paid workers experience fewer symptoms, less work disruption, or less need for support.

RAND's literature review points to evidence of pronounced work effects in manual, routine-intensive, and caregiving roles and among women without a college degree. Its dollar model can still assign those workers lower values because wage-equivalent costing prices the same fraction of lost time at a lower wage. That is a feature of the metric, not a finding about who is most affected.

Download the complete 20-industry RAND model dataset (CSV)

Verification: a small discrepancy in RAND's published tables

The independently summed state and industry rows are each about $12,000 higher than RAND's separately published national total. The difference is approximately 0.00023% and does not affect the headline result, but the report does not explain it.

Row-sum validation of RAND's appendices

Source: The HRT Index Research, calculated from Appendix Tables 1 and 2 of RAND RR-A4292-1. Last verified August 1, 2026.

Rounding or separate aggregation is a plausible explanation, but RAND does not document the reason. We therefore keep RAND's separately published national total of $5,411,092,788 as the headline figure and record the discrepancy rather than guessing at its cause.

How many women leave a job because of menopause?

The most repeated figure is one in ten, but its denominator matters: in a 2022 UK survey, 10% of women aged 45 to 55 who had worked during menopause reported leaving a job because of their symptoms. That is not the same as 10% of all women leaving the labor force.

Finestripe Productions commissioned Savanta ComRes to survey 4,014 UK women aged 45 to 55 who were currently experiencing or had previously experienced perimenopause or menopause. The online fieldwork ran from January 26 through February 4, 2022, and results were weighted by age and region. The research supported the Channel 4 documentary Davina McCall: Sex, Mind and the Menopause and was shared with the Fawcett Society, which published Menopause and the Workplace on May 2, 2022. The report was sponsored by Wates Group.

Selected Fawcett workplace findings

Source: The Fawcett Society, Menopause and the Workplace (2022). Survey by Savanta ComRes, n=4,014. Last verified August 1, 2026.

The report's public-facing finding is “left a job,” not a measured national count of permanent workforce exits. It is a self-reported result within an eligibility-screened survey population. It should not be converted into a share of all UK women or a national labor-force exit total without additional population and employment assumptions.

What does the strongest causal design say about the menopause earnings penalty?

The strongest causal design located in this review produces no national dollar total. In the November 21, 2025 version of The Menopause “Penalty,” earnings in Norway fall 3.3% on average over the four years after a menopause-related diagnosis and 7.4% by the fourth year in the baseline specification.

Gabriella Conti, Rita Ginja, Petra Persson, and Barton Willage use Norwegian and Swedish administrative health, tax, employment, and social-security records. The paper is a working paper, not a peer-reviewed journal article. Its Norwegian design compares women diagnosed earlier with women diagnosed later using a stacked difference-in-differences approach.

Labor-market outcomes in the November 2025 working paper

Source: Conti, Ginja, Persson, and Willage, The Menopause “Penalty,” working paper dated November 21, 2025. Last verified August 1, 2026.

A diagnosis share, not a prevalence estimate

The Norwegian cohort includes 266,101 women born from 1961 through 1968. Of them, 88,350 received a menopause-related diagnosis between ages 45 and 55. Mean age at first diagnosis was 50.47, and 63% of diagnoses came from primary care.

That one-in-three figure is a diagnosis share in the study cohort. It is not biological prevalence, symptom prevalence, or the share of all women who need treatment. It captures diagnoses recorded in the health system under the study's code definitions.

What the Swedish care-access analysis can—and cannot—show

The paper also studies an October 2018 Swedish television program about menopause alongside contemporaneous changes in prescribing guidance. Women whose gynecology visit fell just after the broadcast were:

• 4.7 percentage points more likely to receive a menopause diagnosis, a 29.4% relative increase;
• 3.6 percentage points more likely to start menopausal hormone therapy within three months, a 50% relative increase; and
• estimated to have 10% higher earnings over the following three years in the reduced-form result, with the paper's most conservative robustness specification at 3.4%.

The labor-market gains in that analysis were concentrated among women without a college education.

The authors explicitly state that the design cannot isolate the causal impact of any single feature. It captures an aggregate package of greater awareness and demand, diagnosis, and prescribing changes. The result does not establish that hormone therapy alone caused the earnings increase.

The version change that matters

Earlier coverage of the same paper reports a 4.3% average earnings decline, a 10% decline by year four, and little or no penalty among college-educated women. Those results correspond to the March 2025 version. The November 21, 2025 version reports 3.3% and 7.4% in the Norwegian baseline and finds similar negative labor-market effects across education groups; the education gradient appears in the separate care-access analysis.

A citation to this working paper therefore needs a version date. The figures are not interchangeable.

What does menopause cost outside the United States?

Published estimates from the United Kingdom, Canada, Australia, and Japan use different populations, currencies, components, and methods. They are useful as separate records. They cannot be converted, added, or presented as a single global cost.

International menopause workplace cost evidence

Sources: UK Department for Work and Pensions review (2025); Menopause and Work in Canada (2023); RANZCOG submission to the Australian Senate inquiry; Japan Ministry of Economy, Trade and Industry estimate; and Sarrel et al., PMID 25714236. Last verified August 1, 2026.

United Kingdom: unusually candid evidence gaps

The Department for Work and Pensions published its 45-page literature review on July 17, 2025. It reviewed evidence published from April 2016 through October 2024 and included 42 publications. Only two quantified the financial cost to the UK economy.

The review reports approximately £1.5 billion associated with unemployment or non-participation, £191 million from absenteeism, and £22.4 million from presenteeism. It also records important limitations in the underlying work: narrow age bands extrapolated to wider populations, limited methodological detail for some survey inputs, and omissions including welfare savings, retention, ripple effects, and unpaid work.

The review also found a lack of high-quality evidence about which workplace interventions work and found no studies quantifying cost savings from employer interventions. That means the current UK literature can describe possible costs and worker experiences far more confidently than it can price an intervention's return.

Source: Department for Work and Pensions, Menopause in the Workplace Literature Review, ad hoc research report no. 116 (2025). Last verified August 1, 2026.

Canada: the clearest published split between employer and worker losses

The Canadian report's published split is more useful than its rounded C$3.5 billion headline:

Source: Menopause Foundation of Canada, Menopause and Work in Canada (2023). Economic analysis by Deloitte Canada; survey research by Leger; sponsored by Sun Life. Last verified August 1, 2026.

The two displayed components sum to C$3.537 billion, not exactly C$3.5 billion, because the published figures are rounded. The safe conclusion is not an exact percentage. It is that the report assigns the overwhelming majority of its modeled loss to women's income rather than employer productivity.

Australia: a headline estimate challenged in the evidentiary record

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists told the Australian Senate that the A$17 billion estimate was based on a UK market-research survey and an assumption that 25% of menopausal women experience debilitating symptoms leading to long-term absence or early retirement. Its submission states that the evidence does not support that 25% assumption and concludes that Australian data points instead to a small but important minority whose symptoms affect work.

The Senate Community Affairs References Committee tabled its report on September 18, 2024. The presence of the estimate in the policy debate does not turn it into a settled national measure.

Sources: RANZCOG submission and Australian Senate inquiry report. Last verified August 1, 2026.

Japan: a large official estimate with a different model

Japan's Ministry of Economy, Trade and Industry estimates annual economic losses associated with menopausal symptoms at approximately ¥1.9 trillion. METI separately estimates approximately ¥3.4 trillion in annual losses from women-specific health issues as a broader category.

Those figures belong to METI's own Japanese framework. They should not be converted into U.S. dollars and compared with RAND without reconstructing and normalizing the underlying populations, cost components, data years, and methods.

Source: Japan Ministry of Economy, Trade and Industry, estimate of economic loss from women-specific health issues. Last verified August 1, 2026.

The U.S. per-patient claims estimate

Sarrel and colleagues' 2015 retrospective claims analysis used 1999–2011 data on women with untreated vasomotor symptoms. Compared with matched controls, the study reported 57% more productivity-loss days and an incremental indirect cost of $770 per patient per year(95% CI $726–$816), alongside incremental direct medical costs of $1,346 per patient per year(95% CI $1,249–$1,449).

This is a per-patient estimate for untreated vasomotor symptoms, not a national estimate for all people experiencing menopause. The study's author affiliations included Noven Pharmaceuticals, which belongs beside the result.

Source: Sarrel et al., Menopause (2015), PMID 25714236. Last verified August 1, 2026.

Who actually bears the cost?

The published figures assign losses to employers, workers, health systems, public finances, and the wider economy. Calling all of them “employer costs” is the fastest way to turn a valid number into a false claim.

Cost-bearer map for menopause workplace estimates

Source: The HRT Index Research synthesis of the primary records listed on this page. Last verified August 1, 2026.

The bearer of a missed day depends on the arrangement. Paid leave may shift wage-equivalent time to the employer; unpaid leave may shift the immediate income loss to the worker; work redistributed to colleagues may not appear in either wage line. Reduced hours have the same problem. A national model cannot resolve those firm-level arrangements from a single rate.

This is why the $5.4 billion total is best described exactly as RAND describes its scope: a wage-equivalent workplace and labor-market loss. It is broader than a direct employer expense and narrower than the total social and economic burden.

Why does the cost of menopause in the workplace matter now?

The evidence base is still incomplete, but the policy and workforce context is moving. Rhode Island enacted the first explicit U.S. state workplace protections for menopause in 2025, the United Kingdom launched voluntary menopause action plans for large employers in 2026, and RAND projects a modest rise in the share of working-age women within the relevant age range through 2050.

Rhode Island's workplace protections

Rhode Island legislation was signed on June 24, 2025. The state General Assembly describes Rhode Island as the first state to explicitly enact workplace protections for menopause. The law amended the state's Fair Employment Practices Act to include menopause and menopause-related conditions within protections related to pregnancy and related conditions.

This is a legal development, not proof of a national cost figure. The dedicated menopause workplace laws by state tracker covers the operative language and state-by-state status.

Source: Rhode Island General Assembly, workplace protections for women experiencing menopause. Last verified August 1, 2026.

UK employer action plans

The UK's Employment Rights Act 2025 created the statutory framework for equality action plans addressing the gender pay gap and support for employees going through menopause. Employers with 250 or more employees can publish plans voluntarily during the 2026–27 reporting year. Government guidance says the plans are expected to become mandatory from spring 2027, subject to secondary legislation.

The voluntary reporting deadlines are March 30, 2027 for most public authorities and April 4, 2027 for private, voluntary, and other public-authority employers. There is no verified basis for describing April 2028 as the first mandatory deadline.

Sources: Employment Rights Act 2025, equality action plans and UK government guidance for employer action plans. Last verified August 1, 2026.

The age distribution is not static

RAND projects the share of working-age women in the 45–59 proxy band to rise from 36.7% in 2020 to 37.7% in 2050. Because Census projections use five-year age bands, this projection uses ages 45–59 within the 25–64 working-age population rather than the exact 45–60 model population. RAND reports state-level changes ranging from a 2.4% decrease in Kentucky to a 19.3% increase in the District of Columbia.

That projection says the age group will remain a large part of the workforce. It does not project symptom prevalence, diagnosis, support, or cost.

Source: RAND RR-A4292-1 (2025). Last verified August 1, 2026.

Recognition and care may affect the economic outcome

The Swedish portion of the Conti working paper is the strongest evidence located here that the economic outcome is not fixed. Greater awareness, diagnosis, and prescribing occurred together after a national broadcast and guideline changes, followed by higher estimated earnings in the exposed group.

That finding cannot identify which part of the package caused the change, and it does not establish a return on any particular treatment or employer program. It does show why a cost estimate should not be read as a permanent property of menopause itself. The surrounding health-care and workplace context is part of the outcome.

What are the limitations of menopause workplace cost data?

The main limitations are age proxies, self-reported outcomes, nonrepresentative participation, shared dependence on one Mayo survey for the headline U.S. models, uniform rates across states and industries, wage-based valuation, omitted cost categories, and limited causal evidence. These are not side notes. They determine what the numbers mean.

We would rather state these than have someone else find them.

Age is a proxy, not a diagnosis

RAND's national model uses employed women aged 45 to 60 as its population. Not everyone in that group is menopausal or symptomatic, and workers outside it may experience perimenopause, menopause, premature ovarian insufficiency, surgical menopause, or treatment-induced menopause.

The headline U.S. models share one survey foundation

Mayo's $1.8 billion estimate and RAND's $5.4 billion estimate both depend on work-outcome rates from the same 2021 Mayo survey. The newer model broadens the scope and changes the population and wage inputs; it does not provide an independent national measurement of the behavioral rates.

The Mayo survey is not nationally representative

The 16.1% response rate, single health system, four primary-care sites, 93% White sample, and self-reported outcomes limit generalizability. The national dollar estimates are extrapolations from those rates, not observed totals.

RAND uses the Mayo median as a model input

Mayo reports a median of three days missed among respondents who missed work. RAND's formula uses three as the mean number of days missed. That is necessary to reproduce the published model, but it should not be described as an independently observed mean.

State and industry variation is imposed by wages and headcount

RAND does not use state- or sector-specific menopause symptom or work-outcome rates. The same national rates are applied to local worker counts and incomes. The resulting geographic and industry totals therefore cannot show where symptoms are more prevalent or severe.

Wage-equivalent valuation assigns lower dollar values to lower-paid workers

The model prices time at the worker's wage. The same modeled fraction of lost time is worth fewer dollars in a lower-paid sector. That is appropriate for a wage-equivalent calculation but cannot be used as a measure of health burden, disruption, or need.

Presenteeism is omitted from the U.S. totals and measured inconsistently elsewhere

Neither Mayo's $1.8 billion lost-work estimate nor RAND's $5.4 billion model includes reduced productivity while a worker remains at work. Some other models attempt to price presenteeism, but the definitions, instruments, and assumptions differ enough that the results should not be inserted into the U.S. total.

Several career and household effects remain unpriced

RAND excludes resignations, early retirement, missed promotions, moves to lower-paid roles, replacement and recruitment costs, unpaid work, and several demographic subgroups. Other sources capture fragments of those outcomes, but no current model combines them in a comparable national estimate.

Causality remains limited

Cross-sectional surveys can identify associations but cannot fully separate menopause symptoms from age, other health conditions, job quality, work stress, caregiving demands, or financial insecurity. The Conti working paper uses stronger causal designs, but it studies diagnosis and a Swedish care-access package in specific institutional settings rather than producing a universal employer-cost estimate.

Review status differs across the evidence base

• The Mayo workplace study and the Sarrel claims study are peer-reviewed journal articles.
• RAND states that all RAND research reports undergo rigorous peer review; the report is not a journal article.
• The Department for Work and Pensions publication is a government literature review.
• The Conti paper is a working paper and has not passed journal peer review.
• The Fawcett and Canadian records are commissioned or advocacy-organization reports with their survey firms and sponsors disclosed.
• The Australian A$17 billion figure is a contested estimate recorded in parliamentary evidence, not a settled national finding.

International figures are not exchange-rate variants of the same estimate

The estimates differ in their populations, years, currencies, institutions, work outcomes, medical components, and cost bearers. Currency conversion alone does not make them comparable.

Frequently asked questions

How much does menopause cost U.S. employers?

There is no current audited national figure for the amount U.S. employers directly pay. RAND modeled approximately $5.4 billion in annual wage-equivalent workplace and labor-market losses, but 38.85% of that total is layoff-related forgone wages borne principally by workers and the wider economy. The employer-borne portion cannot be isolated nationally from the published inputs.

Is $26.6 billion the cost of menopause in the workplace?

No. The $26.6 billion Mayo figure combines approximately $1.8 billion in lost work time with approximately $24.8 billion in medical spending. Describing the full amount as a workplace or employer cost changes its meaning.

Why is RAND's $5.4 billion estimate higher than Mayo's $1.8 billion?

RAND uses newer 2023 population and income data, includes full- and part-time workers, and adds reduced hours and layoff-related forgone wages. The two estimates are not independent: RAND reuses the Mayo study's work-outcome rates.

How many U.S. workdays are lost because of menopause?

The Mayo study reported that 10.8% of its 4,440 employed respondents missed work in the prior 12 months, with a median of three days among those who did. RAND uses those rates in its model, but neither source publishes a directly observed national count of workdays lost.

What is the modeled cost per employee?

At RAND's national average annual income of $62,871, the broader scenario normalizes to approximately $225.02 per employed woman aged 45 to 60 per year. About $137.60 is the attendance-time subtotal and $87.41 is layoff-related forgone wages. This is a population-average scenario, not a prediction for an individual employee.

Which state has the highest modeled menopause workplace cost?

California has the largest absolute total in RAND's model at $687.7 million. The District of Columbia has the highest HRT Index derived per-worker value at approximately $439.87. Both results are driven by worker count and income because RAND applies the same national work-outcome rates to every jurisdiction.

Which industry has the highest modeled cost?

Health Care and Social Assistance has the largest absolute total at approximately $1.244 billion. Management of Companies and Enterprises has the highest derived per-worker value at approximately $492.44. The difference reflects workforce size and wages, not measured sector-specific symptom rates.

Do the U.S. figures include presenteeism?

No. The Mayo lost-work estimate and RAND's $5.4 billion model do not include reduced productivity while a worker remains at work. Presenteeism estimates from other countries use different methods and cannot simply be added to the U.S. total.

How many women leave work because of menopause?

The Fawcett Society reported that one in ten women aged 45 to 55 who had worked during menopause said they had left a job because of symptoms. That is a self-reported result in an eligibility-screened UK survey. It is not a national count and should not be restated as 10% of all women permanently leaving the labor force.

Are the U.S., UK, Canadian, Australian, and Japanese figures comparable?

Not directly. They use different currencies, populations, years, methods, assumptions, and definitions of cost. Some principally measure employer productivity, others worker income, medical spending, GDP, or a mixture.

What is the menopause penalty?

The term refers to earnings and employment changes associated with menopause, by analogy with the motherhood penalty. In the November 21, 2025 Conti working paper, Norwegian earnings fall 3.3% on average over four years after a menopause-related diagnosis and 7.4% by the fourth year in the baseline specification.

Does treatment reduce the economic cost?

No current study establishes a universal financial return from a specific treatment. The Conti working paper finds that a Swedish package of public awareness, increased diagnosis, and increased hormone-therapy initiation was followed by higher estimated earnings, but the authors cannot isolate the causal effect of any one feature. Treatment decisions belong with a qualified clinician.

Data downloads

The datasets below are versioned, human-readable CSV files. Each row carries its primary source, calculation note, verification date, and dataset version. No registration is required.

• Menopause Workplace Cost Evidence Map, version 1.0 (CSV) — one row per major estimate, with scope, cost bearer, method, review status, safe wording, and comparability note.
• RAND State Model, version 1.0 (CSV) — all 50 states plus the District of Columbia, with published inputs and HRT Index derived per-worker values, coefficients, days-of-pay equivalents, and order positions.
• RAND Industry Model, version 1.0 (CSV) — all 20 published sectors with the same derived fields.

Dataset fields

Source: The HRT Index Research, dataset version 1.0. Last verified August 1, 2026.

Related research

• Companies with menopause benefits: verified employer documentation
• Menopause workplace laws by state
• Menopause insurance coverage laws by state
• Menopause research funding: NIH data and statistics
• How many women use HRT

How to cite this page

Reference information

The HRT Index Editorial Team. “Cost of Menopause in the Workplace: 2026 U.S. Data and Evidence Map.” The HRT Index Research, version 1.0. Last verified August 1, 2026. https://thehrtindex.com/research/cost-of-menopause-in-the-workplace/

Dataset reference

The HRT Index Research. Menopause Workplace Cost Evidence Map [dataset], version 1.0. Last verified August 1, 2026. https://thehrtindex.com/research/cost-of-menopause-in-the-workplace/data/menopause-workplace-cost-evidence-map-v1.0.csv

The source line under each table identifies whether a number comes directly from a primary source or is an HRT Index calculation. The derived coefficients, per-worker values, component shares, state and industry reordering, row-sum validation, cost-bearer map, and evidence-map structure are original calculations or syntheses documented on this page.

Primary sources

United States

• Faubion SS, Enders F, Hedges MS, et al. Impact of Menopause Symptoms on Women in the Workplace. Mayo Clinic Proceedings. 2023;98(6):833–845. PMID 37115119.
• Mayo Clinic News Network. Mayo Clinic study puts price tag on cost of menopause symptoms for women in the workplace. April 27, 2023.
• Heissel JA, Donofry SD, Bonheur A, et al. The Economic Impacts of Menopause in the United States. RAND Corporation, RR-A4292-1. September 30, 2025.
• Sarrel P, Portman D, Lefebvre P, et al. Incremental direct and indirect costs of untreated vasomotor symptoms. Menopause. 2015. PMID 25714236.
• Rhode Island General Assembly. Rhode Island first state to enact workplace protections for women experiencing menopause. July 1, 2025.

United Kingdom

• Department for Work and Pensions. Menopause in the Workplace Literature Review. Ad hoc research report no. 116. July 17, 2025.
• The Fawcett Society. Menopause and the Workplace. May 2, 2022.
• Employment Rights Act 2025, equality action plans.
• UK government. Creating an action plan: guidance for employers. Published March 4, 2026; updated May 13, 2026.

Canada

• Menopause Foundation of Canada. Menopause and Work in Canada. October 2023. Economic analysis by Deloitte Canada; survey research by Leger.

Australia

• Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Submission to the Senate Inquiry—Issues Related to Menopause and Perimenopause. March 2024.
• Australian Senate Community Affairs References Committee. Issues related to menopause and perimenopause. Report tabled September 18, 2024.

Japan

• Japan Ministry of Economy, Trade and Industry. Estimate of economic loss from women-specific health issues and the need for health management.

Norway and Sweden

• Conti G, Ginja R, Persson P, Willage B. The Menopause “Penalty.” Working paper dated November 21, 2025.

Version history

Version 1.0 — August 1, 2026. Initial evidence map; RAND national-model reproduction; derived component shares, wage-base coefficients, per-worker values, state and industry datasets, and row-sum validation; scope-controlled international evidence records; and neutral citation reference.

The “last verified” date changes only after the underlying records and calculations are rechecked. Material corrections are recorded here rather than silently replacing prior figures.