The Long Term Cost of Major Menopause Misconceptions

If more than half of the world's population will undergo the menopause, then why has it been such a misunderstood topic, especially in the workplace?

It’s a mix of taboo and the misinterpretation of data from the Women’s Health Initiative study, explained Stephanie Faubion, M.D., MBA, director of the Mayo Clinic’s Center for Women’s Health and medical director for The Menopause Society, in an interview with Managed Healthcare Executive.

Stephanie Faubion, M.D., MBA

Faubion said that although menopause is less of a taboo subject than it used to be, there's lingering areas of ignorance and confusion, the workplace included. Missed workdays from disruptive menopause symptoms, such as hot flashes and mood swings, cause an estimated $1.8 billion in lost revenue in the United States every year, according to a 2023 study published in Mayo Clinic Proceedings by Faubion and her colleagues.

The Women’s Health Initiative was a 15-year study that began in the year 1991 to study the effects of hormone therapy in menopause to protect cardiovascular and bone health. Results published in 2002 in were widely characterized — including by the study's authors — as showing a link between hormone therapy and an increased risk of breast cancer, although that is now seen by many as misinterpretation. Those results and subsequent media coverage led to a precipitous decline in women using hormone therapy to relieve their menopause symptoms, a trend that’s had negative consequences for many women, in Faubion's view.

Faubion currently practices general medicine and specializes in women’s health. She works at two Mayo Clinic locations, one in Rochester, Minnesota, and the other in Jacksonville, Florida.

This is a transcript has been edited for clarity and length.

Why is menopause education so important?

Over 50% of the global population is going to experience menopause if they're lucky enough to live that long. While some women get through without any symptoms, those are the rare ones. ost women are going to have at least some symptoms that have the potential to be disruptive to daily activities and certainly their work lives and home lives.

About 80% of women are going to have hot flashes and night sweats, but that's not saying that they don't have other symptoms, like sleep and mood disturbances. I think even the women that say they have no symptoms are probably just not recognizing that some of what they're experiencing relates to menopause. For instance, in Asia, it's more common to experience joint aches, so they may not even relate the joint aches to menopause.

Can you discuss the fallout from the results of Women’s Health Initiative study?

That study was designed to see if estrogen should be used as a preventive to protect women against heart disease, should it be used for prevention and the answer to that was ‘no.’ That study was never designed to ask, ‘does hormone therapy work for hot flashes?’ We know that it does. I think the results were misinterpreted to say that we shouldn't be using hormone therapy at all. Results were also reported in a way that combined all age groups together: 50- to 79-year-old women were all in one bucket. That’s not a good way to report the data, because the women that are most symptomatic that are in my office are women in their 50s who are closer to menopause onset. For those women, we ultimately found, after subsequent reanalysis of the data, that the benefits [of hormone therapy] typically outweigh the risks for women who are symptomatic in their 50s.

I think we've come to understand the data in a better way, but it nonetheless led to an enormous drop off in the use of hormone therapy, which was used in around 22% to 25% of women at the time of the study. It dropped to 4% to 6% after and remains there as of the last studies that were published in 2012.

The labeling of estrogen doesn't help, either. every product that contains estrogen that is approved by the FDA has a box warning on it that says this product causes dementia and breast cancer. That doesn't apply to low dose vaginal estrogen, but nonetheless the label looks the same and looks very scary.

Why is menopause becoming more talked about?

I think it's a combination of things. I think it's a shift in the generations, from the baby boomers the Gen Xers and even the millennials. The younger generations are not willing to suffer in silence anymore and that's a good thing.

I also think part of it is that women, after the Women's Health Initiative came out, were largely left with [no treatments] and found it to be problematic, and again, were not willing to just suffer and go through it without anything. It also led to a huge drop off in menopause education. If there wasn't anything to do about [menopause symptoms] we didn't even need to teach it in medical schools and residency programs and so you have a whole generation of providers that never got any education on menopause management.

How can employers help their employees as they go through menopause?

I think employers need to know that women are missing work due to menopause symptoms. These women are often the most experienced workers. They have institutional memory and to replace an employee is about two and a two to two and a half times their salary.

I think employers also need to look at their workplace policies. It’s not that we need to rewrite everything and put in a whole different menopause policy. A lot of it will fall under existing policies. For example, we found in our data that the biggest driver for missing work related to menopause symptoms was psychological symptoms, and those can fall under the normal mental health policies that that an employer would have.

There's also pregnancy policies at work, there's lactation policies at work, but pregnancy lasts nine months and it goes away, right? Menopause symptoms can last for decades. A lot of women don't want to admit that they're at that time in their lives. With pregnancy, you're in the middle of your reproductive years. Menopause is associated with aging and may get into age discrimination in the workplace or anywhere else.

Employers also need to have culturally competent conversations with their managers and supervisors and to make sure there is no harassment. We’ve all heard all the water cooler jokes about sweating, and you know, “are you having a menopause moment?” Bottom line is that we need to support women through this and treat it as you would any other condition.