Women are taking pay cuts and 'white-knuckling it' to manage menopause and work: 'I feel like I'm sitting on the sidelines'

Around 2020, Amy Terry noticed she didn't feel like her usual self.

The 50-year-old Michigander was working as a director of programming at a health association when she says she began experiencing symptoms like memory loss, low energy, mental processing difficulties — or, as she describes it, "waking up every day feeling like you were slogging through mud."

"I went from being this highly competent professional person to barely being able to get through phone calls," Terry says.

As the healthcare system strained under the weight of the Covid-19 pandemic, Terry, like many other people, struggled to get care. When she finally did, she found out it wasn't Covid-19. It was perimenopause.

Terry got through a few more years juggling her symptoms with her job, but by 2023, she couldn't hold out any longer. She quit to start independent consulting.

Women, and some trans and non-binary people, often experience career setbacks stemming from menopause that can hurt them financially and professionally. Four in 10 women who have experienced menopause or perimenopause say it has negatively affected their life or work, according to a recent survey of over 3,800 U.S. women from Gallup and Melinda French Gates' Pivotal, a group of organizations focused on social progress for women and young people.

Of them, roughly 28% felt limited in the effort they could give at work, 15% decided against pursuing a promotion or leadership role, 12% reduced their hours, and 10% took an extended leave from work or didn't return.

"This isn't just a health issue," says Jasmine Escalera, career expert at resume builder site LiveCareer. "It's a workplace issue."

A 2023 Mayo Clinic study estimated menopause symptoms drove $1.8 billion in lost work time per year in the U.S. alone.

Perimenopause, the transitional period before menopause, typically begins in one's 40s and can last several years, often bringing symptoms like hot flashes, sleep issues, irritability and lower energy, according to the Office on Women's Health. Menopause typically occurs in one's 50s and marks 12 months since a person's last period, but is often used colloquially to include the preceding perimenopause as well.

The timing of menopause can create a perfect storm. It frequently comes at a time in many women's careers when they're breaking into leadership or approaching their peak earning years, which is often between the ages of 35 and 44 for women, according to data from the Bureau of Labor Statistics. It also typically happens when many are caregiving for aging parents or raising children. This can make for an impossible choice for many women.

"Women have fought so hard for their place in the workforce," says Mimi Wied, who began perimenopause around a decade ago. "They don't want to lose it by looking like they can't handle it."

The career consequences for women "may increase the gaps we're trying to decrease," Escalera says, referring to disparities such as those in women's pay and senior-level representation relative to men. "That is a definite talent breakdown."

For Terry, becoming an independent consultant cost her employer-sponsored healthcare at the time she most needed it. It also drastically changed her income: She says she took around an 85% pay cut in the transition.

"These are supposed to be my highest-earning years," Terry says, "and I feel like I'm sitting on the sidelines."

'I just have to white-knuckle it'

Many women are unprepared for menopause because of social stigma around discussing it, poor health education and dismissal of women's health issues.

"I've been in the healthcare environment for 30 years; if I can't figure this out, I don't know how anyone can," says Terry.

Wied also says she didn't know what to expect. The answer quickly became apparent: The 48-year-old from Brenham, Texas, says she experienced everything from night sweats and sleeplessness to anxiety and rage.

"Sometimes I didn't feel in control of my own mouth and my body and my actions," she says.

Wied left her job as a museum docent for a secretarial role paying roughly $20,000 less when she worried her irritability would affect her capacity to help visitors, she says: "If I could have quit working, I would have."

When women do scale back at work because of menopause, they may struggle to regain that professional ground later. Terry's job switch wasn't just downshifting to a part-time role: "It's an entire change in the trajectory of your career," she says.

Factors like ageism in the job search for those of menopausal age, as well as the high cost of healthcare, particularly for common menopause treatments like hormone replacement therapy, may keep some women silently struggling through their symptoms at work.

Erin Levin is currently working through perimenopause. As a high school English teacher, the 41-year-old from San Jose, California, needs to stay on her A-game because "there is no down moment in teaching," she says.

But since starting perimenopause around two years ago, she's experienced brain fog, difficulty sleeping, and heightened anxiety and stress that make her work difficult sometimes, she says. She sometimes struggles with tasks that "were not an issue" for her a few years ago.

"Now I'm just like, God, why does it just feel so exhausting all the time?" Levin says.

Her parents help with childcare some evenings, and she tries not to schedule big tasks first thing in the morning, but it's been an adjustment. Scaling back at work isn't an option financially, she says, as a single mother sharing custody of her child.

"I still have to maintain the same appearance of having all the same skills and energy level as other people who aren't in my medical position," Levin says. "I just have to white-knuckle it."

'I don't want my daughter to have to face any of that'

Some women see hope in coming legislation and employer benefits offerings.

Last year, Rhode Island became the first state to enact workplace protections for women experiencing menopause. In September, Sens. Kirsten Gillibrand, D-N.Y., and Rick Scott, R-Fla., held the first congressional hearing devoted to menopause. Illinois and the city of Philadelphia have also adopted legislation taking effect in 2027 providing accommodations and protections for those in menopause.

In September, a nongovernmental organization, the International Organization for Standardization, published the first standard for developing workplace policies and practices supporting people through menstruation and menopause.

Many organizations have a ways to go in providing menopause-related benefits for their employees.

In a 2026 study from the Society for Women's Health Research and workplace menopause research organization The Fuchsia Tent, fielded among 1,100 people, around one-third of decision-makers said menopause support is currently in place or actively planned in their workplace. Fewer than 10% of employees said their organization offers menopause-specific support.

Respondents said some broader benefits, like flexible scheduling, remote options, and confidential telehealth or virtual care, would also be helpful for menopause.

Terry, Wied and Levin said they had to meet with multiple doctors before finding one who'd take their concerns seriously and who'd prescribe them hormone replacement therapy.

Levin and Wied each have a daughter. They hope better support and women's healthcare are available for their daughters when they begin menopause.

"I'm hoping that by the time my daughter goes through this, we'll have a lot more information, a lot more resources, because as it stands, it makes you super angry," Wied says.

"It's a cost on my energy, it's a cost on my stress levels, it's a cost on my bank account," Levin adds. "I don't want my daughter to have to face any of that."

As for Terry, she says she was part of a study examining potential mental health impacts of hormonal fluctuations in perimenopausal women; she hopes the research can help future generations of women. Meanwhile, her switch to independent consulting has offered her greater flexibility and a more manageable workload. But it's not perfect.

"I'm worried about retirement, I'm worried about having enough money, I'm worried about being able to continue healthcare," she says. "But I also feel like I have to take the time to feel like I'm on solid ground again."