Julia Pitcher was 43 when perimenopause smacked her in the face, as she describes it. She was experiencing heavy fatigue and joint pain, along with weight gain, disorientation and extended hot flashes.

“My body was breaking down,” says Pitcher, an Annapolis, Maryland-based director of state government relations for the Michael J. Fox Foundation for Parkinson’s Research. “I thought it was normal for aging until I went to my doctor.”

Pitcher ended up losing 75 pounds and receiving menopause hormone therapy, which she says relieved many of her symptoms.

She says she wants to talk openly about perimenopause and menopause because “it’s time for people to speak up” and for women to support each other in the workplace.

“Our bodies are changing, and we should be able to have these conversations,” she says. “We’re 50% of the population, and every child comes from our bodies, so why have our bodies been ignored for so long?”

Traditionally, menopause hasn’t been the subject of most work-related conversations or legislation trends, says Naomi R. Cahn, a professor at the University of Virginia School of Law who specializes in family law, feminist jurisprudence and reproductive technology.

But with the success of the menstrual equity movement—which fought to normalize conversations around menstruation and increase access to tampons and other menstrual products—women’s health advocates and feminist legal experts like Cahn have turned their attention to menopause.

In the past few years, women’s health advocates have been pushing for—and in some cases, successfully passing—legislation addressing access to health care, workplace accommodations and protection against employment discrimination for employees experiencing menopause.

“We’re seeing things change. We’re seeing Michelle Obama being wonderfully open about menopause and other celebrities talking about it and some women wanting to talk about it in the workplace,” Cahn says. “There’s a confluence of culture and business around reproduction and menopause that is leading to legislative changes and changes in the workplace.”

In June 2025, for example, Rhode Island became the first state to enact a law barring employers from discriminating against workers because of their menopause symptoms, with Philadelphia enacting a similar ordinance that will go into effect in January.

Most women experience menopause sometime between the ages of 45 and 55, although some start experiencing symptoms much earlier. Women can experience hot flashes, brain fog, memory loss, headaches, fatigue, sleeplessness, muscle pain, mood swings, anxiety and depression.

There’s also some evidence of a link between increased attention-deficit/hyperactivity disorder symptoms and menopause.

Menopause transition symptoms can typically last between a few years and eight years, but sometimes even longer. The menopause experience varies widely, from mild to severe and debilitating. Some women even describe dry mouth, sensitive teeth or vertigo.

“I had no idea that menopause can cause joint pain,” says Bridget J. Crawford, a law professor specializing in civil rights and gender issues at the Elisabeth Haub School of Law at Pace University. “I hope that we can now see how much of an impact it can have and that it’s more than just a laugh line on Golden Girls.”

The menopause equity movement is growing in numbers, advocates say, as it seeks to dismantle the stigma surrounding menopause and close gaps in research and workplace support.

“It may be becoming a bit of a cliché, but menopause is certainly having a moment,” says Cahn, who, along with Emily Gold Waldman and Bridget J. Crawford, wrote Hot Flash: How the Law Ignores Menopause and What We Can Do About It.

But not everyone who experiences menopause wants to talk about it or supports recent legislative efforts, expressing concern that they might unintentionally reinforce sexist and ageist stereotypes.

Crawford points out that women of perimenopause and menopause age are often at their career peak.

“Some women think that talking about menopause could lead to pushing women out of the workforce or out of leadership roles when women have fought so hard to get there,” says Crawford, adding that some professional women don’t want to be seen as “complaining.”

They worry that admitting the issues associated with menopause will have them seen as “aging and useless,” she says, and “that other people will think of it as weakness.”

During perimenopause, a woman’s body reduces its production of estrogen and progesterone. Menopause occurs when a woman’s ovaries stop producing eggs.

Women who are near or at the end of their reproductive years account for an estimated 20% of the U.S. labor force.

The statistics, women’s health advocates say, are increasingly showing that women’s careers can be stalled or cut short because of menopause.

A 2023 Mayo Clinic study found that 13% of women reported at least one adverse work outcome due to menopause symptoms, with about 10% of women reporting missing one or more days of work in the preceding year due to symptoms.

A survey conducted by the Korn Ferry Institute in partnership with Vira Health revealed in 2023 that 13% of respondents say they have quit their jobs because of menopause, while another 15% have considered it. The survey was given to 8,000 women around the world and focused on individuals currently experiencing perimenopause or menopause.

Rhode Island was the first state to legislate that menopause and perimenopause-related symptoms must be accommodated in the workplace. The new law amends the Rhode Island Fair Employment Practices Act and requires reasonable accommodations unless the employer can prove that doing so would pose an undue hardship on the employer’s business operations.

More recently, the Virginia legislature in March passed a similar law, but in April, Gov. Abigail Spanberger declined to sign it, instead calling for the state’s labor department to study the issue first and make recommendations.

In December, Philadelphia became the first city to enact an ordinance prohibiting discrimination and requiring accommodations based on needs related to menstruation, perimenopause or menopause.

Accommodations can include flexible scheduling, temperature controls, remote work options and access to private spaces.

“This is an unusually ripe moment for state and municipal advances,” says Jennifer Weiss-Wolf, executive director of New York University School of Law’s Birnbaum Women’s Leadership Center and a leading voice in the menopause equity movement. “It seems like menopause reforms are inevitable.”

Andrew D. La Fiura, a partner in the Philadelphia office of Jackson Lewis who specializes in labor and employment law, says that the main challenges with the Philadelphia ordinance are “communication and training to the HR team and frontline managers.”

“HR and managers need to understand that they will likely be presented with new types of accommodation requests; and the requests, in large part, will need to be granted,” he says. “Employers should update their handbooks and policies to reflect the new protected classes and update their training material.”

Meanwhile, New Jersey recently joined four other states in mandating insurance coverage for menopause treatments. Illinois and Louisiana require coverage for all patients, while Oregon and Washington limit the mandated coverage for menopause treatments to specific plans and employees.

In 2025, California Gov. Gavin Newsom vetoed legislation that would have mandated insurance coverage for perimenopause and menopause treatments.

However, this year Newsom offered a budget plan including mandated menopause-related coverage that he says is fiscally responsible and focuses on FDA-approved treatments, such as menopause hormone therapy.

But a bipartisan bill introduced in 2024 in the U.S. Senate that would have authorized $275 million for menopause research, provider education and public awareness never made it to the floor. The bill—which was introduced by U.S. Sens. Patty Murray (D-Wash.), Lisa Murkowski (R-Alaska), Tammy Baldwin (D-Wisc.), Susan Collins (R-Maine), Amy Klobuchar (D-Minn.) and Shelley Moore Capito (R-W.Va.)—got stuck in the Senate Committee on Health, Education, Labor and Pensions.

Even as there’s an increase in menopause-related legislation and bills, there’s also a heightened concern about women’s privacy in the workplace, Cahn says.

“This is private information, and there’s always the possibility of having sensitive data at risk of being exposed,” Cahn says. “We need to make sure that women’s health information is protected as we legislate in this area.”

In July 2025, Maine’s governor signed off on a law aimed at improving education and awareness about menopause for health care providers and the public.

Weiss-Wolf says that education should include the most current information about the safety and efficacy of modern hormone treatments.

In 2002, researchers leading the Women’s Health Initiative, the largest federally funded clinical trial studying post-menopausal women, announced that part of their research showed a link between women taking a combined hormone therapy of estrogen and progesterone and an elevated risk of breast cancer.

The news caused prescriptions to plummet as clinicians became reluctant to prescribe it, and patients grew alarmed about taking it.

Shortly after, in 2003, the FDA required its most stringent warnings, indicating a risk of serious harm or death, on products related to menopause hormone therapy.

Since then, there’s been a shift in medical consensus on hormone therapy and concerns about blind spots in the earlier study. In November, the FDA decided to remove the boxed label requirement and update the warning language on several hormone therapy products.

“The research and science around menopause, especially in the aftermath of the Women’s Health Initiative, has been deeply lacking and highly politicized,” says Weiss-Wolf, whose latest book, When in Menopause: A User’s Manual and Citizen’s Guide, is coming out later this year. “That vacuum connects directly to gaps in care we face today, including lack of adequate education, clinical training and insurance coverage.”

Crawford stresses that education should include trans men, some of whom can experience menopause, depending upon how they transitioned.

Some global employers, such as Nvidia, appear to have embraced the menopause equity movement. In the U.S., companies like the biotechnology firm Genentech have led the way in adopting menopause-specific benefits aimed at attracting and retaining women, advocates say. Other businesses are ensuring menopause-specific accommodations.

But many employers are still resisting changes to their culture and policies, says Jack Tuckner, an attorney who represents women seeking menopause-related accommodations from their employers.

Tuckner, a partner at Tuckner, Sipser, Weinstock & Sipser in New York, adds that these cases tend to get settled.

“Employers could try to say, ‘No soup for you, sister,’ but most of them are completely uncomfortable staking out a position that they just don’t care about women’s health issues,” he says, referencing a stern soup vendor character in the 1990s sitcom Seinfeld.

Tuckner says that sometimes employers provide accommodations and his clients can continue to work there, but sometimes both parties determine the “marriage can’t be saved,” and his clients want to get out with “as much severance and dignity” as possible.

In the United Kingdom, legal employers have been innovators in finding ways to support and retain their employees through the menopause transition. Global law firms like Dentons and Freshfields Bruckhaus Deringer have publicized their menopause-friendly workplaces.

U.S. law firms and legal employers, Crawford says, would be better off adjusting their firm policies to account for the “bodily needs of half the workforce.”

“It’s expensive to lose well-trained lawyers, so it makes sense for law firm leaders to be interested in this topic,” Crawford says.

What if, Crawford asks, law firms could avoid losing senior-level attorneys by instituting a few changes, such as a cool break room to lie down in during hot flashes?

But the legal world “can be slow to implement changes, and the topic of reproductive health is still taboo in some professional settings,” says Lauren Tetenbaum, author of Millennial Menopause: Preparing for Perimenopause, Menopause & Life’s Next Period.

She counsels professional women in menopause transition and suggests that firms and other legal employers consider providing nutrition education, gym memberships, mental health counselors and sleep specialists. She adds that any services should be accessible to everyone on staff, whether through a flexible spending account or another way of providing benefits.

“These conversations can be awkward,” she says, “but they’re so important to have.”