The 3H Framework™

When it comes to workplace menopause support, there are:Three pain points, and one integrated answer.

In Menopause at Work: Why Integration Beats Innovation, Kacy Fleming, MA, shows employers how to connect the benefits they already offer to menopause, prepare leaders for hard conversations, and make menopause therapy accessible and affordable.

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25+ peer-reviewed sources

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New study results · October 1, 2026

Menopause at Work: From Echo Chamber to Mainstream Practice

When it comes to menopause support at work, most of the benefits employees ask for are already paid for. What is missing is the connection to menopause and clear communication.

Findings are from a national mixed methods study of 1,110 U.S. employees and human resource/benefits decision-makers by the Society for Women’s Health Research (SWHR) and The Fuchsia Tent (TFT).

See the findings

The problem

Menopause is invisible in the systems designed to support it.

The treatments exist. The science is clear. The access remains restricted.

Menopause symptoms cost an estimated $26.6 billion a year in the United States in lost work time and medical costs.^1,2

01Invisible in the data 02Fragmented in the benefits 03Blocked at the formulary

Employers cannot see menopause in their claims data.

Poor sleep, anxiety, and joint pain are usually coded one symptom at a time. The menopause behind those symptoms is rarely recorded, so menopause does not show up in the claims reports employers review.

14.7%

of women ages 45 to 64 with employer-sponsored insurance had any menopause diagnosis in 2022, even though natural menopause most commonly occurs between ages 45 and 56.^3,4

What the research shows

Only 6.8% of U.S. medical residents surveyed in family medicine, internal medicine, and obstetrics and gynecology felt adequately prepared to manage menopause care.⁵
In an Oregon survey, 62.4% of people with moderate and severe menopause symptoms were not receiving any therapy. The most common reason given was that a clinician had not recommended therapy.⁶

Benefits that may ease menopause symptoms exist in the plan. The connection to menopause is missing.

Medical, mental health, prescription, flexible scheduling, and telehealth benefits can all help ease menopause symptoms. Benefits portals and employee communications rarely connect those benefits to menopause.

86%

of employees say they are confused about their benefits.⁷

Employees who say their employer offers

Medical coverage72.7%
EAP or mental health64.6%
Prescription coverage61.9%
Flexible scheduling54.8%
Telehealth51.4%
Menopause-specific support9.9%

SWHR and TFT national study, 2026.⁸

What the research shows

Fewer than 1 in 3 women are aware of the benefits available to them, and 1 in 10 use them.⁹

Drug therapies for menopause symptoms exist. Cost and coverage rules block access.

Pharmacy benefits decide which menopause therapies are covered, what employees pay, and which steps come before coverage.

30%

more was spent out of pocket on prescriptions by women than by men in 2024.¹⁰

Barriers to limit or remove

Cost-sharing. Plans that cover estradiol often place estradiol products in higher tiers, which have the highest copays.¹¹
Prior authorization and step therapy. Insurers often require one or both for some non-hormonal therapies.¹²
Rising prices. List prices for menopause medications have gone up almost 60% over the last 10 years.¹²

References

Faubion SS, Enders F, Hedges MS, et al. Impact of menopause symptoms on women in the workplace. Mayo Clin Proc. 2023;98(6):833-845. doi:10.1016/j.mayocp.2023.02.025
Mayo Clinic study puts price tag on cost of menopause symptoms for women in the workplace. Mayo Clinic News Network. April 26, 2023. Accessed September 27, 2026. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-study-puts-price-tag-on-cost-of-menopause-symptoms-for-women-in-the-workplace/
Health Care Cost Institute. Data Brief: Menopause Diagnosis Steadily Increased From 2018-2022. Health Care Cost Institute; October 18, 2024.
Carlson K, Vadakekut ES. Menopause. In: StatPearls. StatPearls Publishing; updated March 23, 2026.
Kling JM, MacLaughlin KL, Schnatz PF, et al. Menopause management knowledge in postgraduate family medicine, internal medicine, and obstetrics and gynecology residents: a cross-sectional survey. Mayo Clin Proc. 2019;94(2):242-253. doi:10.1016/j.mayocp.2018.08.033
Rodriguez MI, Burns H, Schrote K, Cichowski S, Adams K. Association of insurance type with unmet need for menopause care in Oregon. Menopause. 2024;31(12):1062-1068. doi:10.1097/GME.0000000000002437
Businessolver. New data: benefits costs are “unsustainable,” but some employers are saving $3 million annually with AI and decision support. GlobeNewswire. March 11, 2025.
Society for Women’s Health Research; The Fuchsia Tent. Menopause at Work: From Echo Chamber to Mainstream Practice. October 1, 2026.
Bank of America. BofA report finds 64% of women want menopause-specific benefits, yet only 14% believe their employer recognizes the need for them. June 1, 2023.
GoodRx. GoodRx report reveals striking gender divide in prescription medication spending. Business Wire. March 10, 2025. Accessed September 27, 2026. https://www.businesswire.com/news/home/20250310126491/en/GoodRx-Report-Reveals-Striking-Gender-Divide-in-Prescription-Medication-Spending
George C. Hormone replacement therapy costs. GoodRx. Updated February 15, 2023. Accessed September 27, 2026. https://www.goodrx.com/conditions/estrogen-replacement/hrt-cost
Marsh T. Menopause medication costs have surged 58% in the last decade. GoodRx. October 23, 2024. Accessed September 27, 2026. https://www.goodrx.com/healthcare-access/research/menopause-medication-prices-climbing

The 3H Framework™

When it comes to menopause at work:Integration beats innovation.

Supporting menopause at work does not start with a new program. The 3H Framework™ starts with the benefits you already offer, prepares leaders for hard conversations, and makes therapy accessible and affordable.

H1Healthcare
H2Help
H3HRT and FDA-Approved Non-Hormonal Therapy Access

See how the audit works

H1

Healthcare

Audit before you add.

Most traditional health and wellness benefits can help ease symptoms of menopause, but they are rarely connected on benefits portals or in communications to employees.

What we deliver

A score for your coverage against defined criteria
The number of your employees affected by menopause
A review of how your benefits portal and communications connect your benefits to menopause
Educational resources for employees

H2

Help

Build universal leadership capabilities.

Menopause is one of many hard conversations a leader must hold. Universal dialogue frameworks cover all complex conversations without increasing stigma.

In one evaluation, a 30-minute online training raised managers’ knowledge and confidence, but four weeks later managers were no more likely overall to have held a menopause conversation.¹

What we deliver

Leadership training in the 3Cs Method of Compassionate Leadership™
The Thriving Through Menopause at Work workshop
Self-advocacy training for employees

A pharmacist going over a prescription with a woman at the pharmacy counter

H3

HRT and FDA-Approved Non-Hormonal Therapy Access

Open access to therapy.

Therapies for menopause symptoms already exist. They must be made accessible and affordable for employees to utilize.

Our review of pharmacy access draws on the 22 years of biopharmaceutical experience of Kacy Fleming, MA, many of those years in reimbursement and market access. We review access and never recommend therapies.

What we deliver

A review of pharmacy coverage and barriers for each type of menopause therapy
The questions to ask your pharmacy benefit manager
A plain-language explanation of how pharmacy benefits work, for your benefits team

References

Hardy C, Griffiths A, Hunter MS. Development and evaluation of online menopause awareness training for line managers in UK organizations. Maturitas. 2019;120:83-89. doi:10.1016/j.maturitas.2018.12.001

The Cost of Inaction Model

The Business Case for Workplace Menopause Support, Measured.

The Cost of Inaction Model calculates what inadequate menopause support costs your organization this year, based on your headcount.

01
The most cautious figure first. Where the research gives a range, the model uses the low end.
02
Every number has a source. Each figure names its published or federal source.
03
You can change every assumption. If an assumption looks too high, lower the assumption.

20+Published and federal sources
900Stress tests run on the model
ISPORBudget impact standards
23Defined criteria in every audit
100%Audit scores traced to your own documents

Ask us the hard questions.

We love hard questions. Bring them to the discovery call.

Book a discovery call

Why trust a number from a firm that sells consulting?

Because the model is designed so you do not have to trust us. Every input is visible, every source is named, every assumption is adjustable, and the default is the most cautious one.

Isn’t some of this research funded by drug companies?

Two of the twenty sources are, and we say so in the model itself. We use those two sources because no independent equivalent exists, and the model lets you test the result with those inputs discounted.

Self-reported productivity loss isn’t proof of cause.

Correct. Self-reported productivity loss is the standard measure in workplace productivity research. We use the lowest published rates, show the assumption, and let you cut the assumption further.

The cost to careers

Menopause affects women’s earning potential. Access to care makes a difference.

10% Lower earnings by year four, in Norway

In Norway, women’s earnings were 10% lower by the fourth year after a menopause diagnosis, with the losses concentrated among women without a college degree. In Sweden, women who saw a gynecologist shortly after a national TV program on menopause, when diagnoses and HRT prescriptions rose, experienced earnings gains.¹

A penalty tied to biology would be eradicated with better structural support in healthcare and organizations, which benefits all employees, not just midlife women.

Kacy Fleming, MAMenopause at Work: Why Integration Beats Innovation, 2026

References

Conti G, Ginja R, Persson P, Willage B. The menopause “penalty.” NBER working paper 33621. National Bureau of Economic Research; March 2025. doi:10.3386/w33621

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About the author

Kacy Fleming, MA

Kacy Fleming, MA, is an organizational psychologist, the Founder and CEO of The Fuchsia Tent, and the author of Menopause at Work: Why Integration Beats Innovation. She is Co-Principal Investigator, Survey Architect of Menopause at Work: From Echo Chamber to Mainstream Practice, the national study with the Society for Women’s Health Research, and brings 22 years of biopharmaceutical experience, many in reimbursement and market access.

Meet Kacy

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On a discovery call, we look at how your current benefits support employees in menopause and show you what the audit would cover.

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Questions? Email kacy@thefuchsiatent.com

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