Women with perimenopausal symptoms lose more work time and have lower work productivity than women before or after menopause, according to research presented at The Menopause Society 2025 Annual Meeting in Orlando, Florida.

Researchers estimate the average perimenopausal woman (aged 44-54 years and earning the median salary) loses about $6000 in productivity per year, adding up to roughly $49 billion across the US workforce.

“Our research shows that perimenopausal symptoms, particularly fatigue, pain, and sleep disturbances, have a measurable impact on women’s productivity at work, even before menopause is reached,” said Yihan Xu, PhD, Lead Research Scientist and Health Economist at Flo Health and lead author of the study.

Xu and colleagues conducted a survey from February to March 2025 involving 1466 US women aged 35-59. After excluding women with certain medical conditions or those not in paid employment, the final sample consisted of 945 women with a mean age of 45.5 years. 

Patients identified the severity of their symptoms, such as sleep problems, fatigue, mood changes, and hot flashes using the Menopause Rating Scale. Researchers then measured how much these symptoms affected their time at work and on-the-job performance using the Work Productivity and Activity Impairment Questionnaire.

Perimenopausal women reported an average work impairment of 22.5% compared with 12.7% for premenopausal women and 16.9% for postmenopausal women. Work impairment increased with symptom severity. Women with mild symptoms reported about 10% impairment, whereas those with severe symptoms reported more than 33% impairment.

Xu said that women with low awareness may misattribute perimenopausal symptoms to other causes, which may delay appropriate treatment. “Without care to manage their symptoms, women may miss out on opportunities to be productive in their workplace,” Xu said.

Somatic symptoms, such as sleep discomfort and pain, were the strongest predictors of work impairment (β, 2.44; 95% CI, 1.81-3.07; P < .001), followed by psychological symptoms such as anxiety and irritability (β, 1.28; 95% CI, 0.80-1.76; P < .001) and urogenital symptoms, which did not have a significant effect (β, 0.36; P = .27).

Perimenopausal symptoms can manifest in multiple domains, Xu said. “When women experience psychological symptoms like anxiety or irritation, they might be less able to concentrate on work. When they experience physical symptoms like hot flashes, the discomfort might also affect their work.”

Catherine Cansino, obstetrician-gynecologist at University of California, Davis, said that it’s important for clinicians to look beyond symptoms alone to understand how patients’ symptoms affect their personal and professional lives.

"Many people have symptoms that they attribute to menopausal transition but the science doesnt necessarily directly address in a definitive way," Cansino said. "People may perceive that their clinicians are not listening to them or there’s no treatment that’s good for them. But that’s simply the limitations of where the science is right now."

Cansino said that women in the workplace experiencing medical problems may be hesitant to disclose them because they may feel it will negatively affect how they’re perceived. 

“I think that we as a society, as a culture, simply need to prioritize well-being and preventive health,” Cansino said. “And that seems to be the challenge that we’re experiencing in women’s health.” 

“More than 80% of women report experiencing symptoms during perimenopause, often at a time when they hold senior positions that involve great responsibilities,” Xu said. “It’s important to openly discuss it to support workplace equality.”

There was no specific funding associated with the study. Authors who are employees or contractors at Flo Health hold equity interests in Flo Health Ltd. No other disclosures were reported.