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Before 2023, Danielle was the “workhorse” at her job in the front office of a large dental practice in Puyallup, Washington. “I was only given positive reviews,” she told me. But after doctors found a mass in her uterus and recommended a preventive hysterectomy at age 35, everything changed.
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The procedure sent her into early menopause. Caused by a drop in hormones that typically occurs after a woman’s last menstrual cycle, the shift to menopause can cause a variety of symptoms. Danielle was engulfed by intense mood swings. Hormone replacement therapy helped, but not for the cognitive effects that came on later, like brain fog. “I renamed box fans into ‘air boxes’ because I just couldn’t remember what a box fan was,” Danielle said. Her work suffered and she had problems getting tasks done. The more she struggled, the more stress she felt.
Danielle, who requested a pseudonym for this story because she is pursuing a legal claim against her former employer, is not alone. Each year, about 1.3 million American women transition into menopause. About 13 percent experience at least one adverse employment outcome, such as missing work or getting fired, thanks to things like uncontrollable hot flashes or intense mood swings that impede their jobs.
Danielle told her supervisor she needed support, and because the practice had been accommodating in the past, she assumed it would be “a cake walk,” she recalled. But, as she found out the hard way, workplace laws regarding disability and medical leave don’t always apply to menopause. “Sometimes existing federal laws can provide support,” Deborah Widiss, a professor at the Indiana University Maurer School of Law, told me, “but it’s very confusing to both employees and employers—and there are still gaps.”
The gap between law and real life is where Danielle ended up. In August, she gave her employer a letter from her doctor outlining changes she needed at work, such as written directions, a quieter workspace to minimize distractions, and flexible breaks to help her manage sudden symptoms. The practice said it would try, but “there was no follow-through,” she said, which brought about a “complete breakdown anxiety attack.” On the advice of her doctor, she went on leave in October and hasn’t returned, despite wanting to do her job. Danielle is convinced that the failure of labor laws to define employers’ responsibilities regarding menopause let her bosses ignore her needs. “There was nothing saying, ‘You have to do this because otherwise, it’s illegal,’” she said. “There was so much gray area.”
Pregnant women faced similar gaps until 2023, when the Pregnant Workers Fairness Act began requiring employers to grant them accommodations unless the employer could prove it would create an undue hardship. No explicit federal protection exists for menopause; only one state officially grants such rights: Rhode Island.
For Rhode Island state Sen. Lori Urso, it was a personal cause. About a half-dozen years ago, she was dealing with a range of perimenopausal symptoms: heart palpitations, brain fog, lack of sleep, irritability. Things got so bad that she wasn’t sure she could continue her job as executive director of a museum; she worried that if she asked the mostly male executive council for changes, they were going to “be laughing at me behind my back,” she told me.
In 2024, when Urso was elected to the Statehouse, mandating workplace accommodations for menopause was among the first issues she tackled, speaking to the current Senate president before she was even sworn in. She didn’t expect her bill to pass easily—a veteran female senator told her she’d never heard the word “menopause” uttered in the chamber.
But Urso’s fears were unfounded. A House sponsor, Karen Alzate, soon agreed to sign on. The law “didn’t cost any money,” and though it made her male colleagues uncomfortable, Alzate said, they didn’t push back. There was also, surprisingly, no opposition from the business community. The bill passed unanimously in June, and Urso started getting calls from interested lawmakers all over the country. “We’re really seeing this movement happening now,” she said. “I guess it took the one.”
Philadelphia, this past November, became the first city to pass such a law. Statutes that grant explicit rights, the way Philadelphia’s and Rhode Island’s do, are “the gold standard,” noted Marcy Karin, a professor at Rutgers Law School.
Other states may soon follow. In New York, Assemblymember Linda Rosenthal has introduced a suite of bills related to menopause, one of which makes it illegal for an employer to refuse a reasonable accommodation for menstruation- or menopause-related needs. Rosenthal expects “a lot of enthusiastic support,” she said, and has yet to face any opposition. Virginia lawmakers passed a similar bill this session, but the governor didn’t sign it. The California Legislature is pondering its own bill, while New Jersey lawmakers may require remote work options and paid leave for perimenopause and menopause. Pennsylvania and Massachusetts have proposed commissions to look into the issue. “Menopause is having a moment,” Karin told me.
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But even when there are statutes on the books to protect them, workers may hesitate to ask for what they need, Widiss said. “Until the stigma is decreased and it’s clear that you can’t harass or retaliate or bully based on these bodily [needs],” Karin added, the laws will be “chipping away at a much broader problem.”