Gabriella Conti, an economist from University College London, has been researching something for years about which there is still very little scientific evidence: the economic cost of menopause. This biological period in women occurs between the ages of 45 and 55, when many of them are at the peak of their professional careers. And, as Conti explained in a recent conference at the Areces Foundation in Madrid, menopause can affect multiple dimensions of life. The economic costs include temporary inability to work with the same productivity as before, overmedication for psychological reasons, and increased use of health services. And if the woman leaves the labor market, she becomes an additional burden on Social Security. All women will go through menopause sooner or later, and more or less problematically. However, this is a dimension that has not interested economists. Until now.
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This 49-year-old Neapolitan documented the economic cost of the menopausal transition in a pioneering study published in 2022. Her data, obtained from administrative records in Norway and Sweden, reveal that women lose up to 20% of their income in the four years following diagnosis, a penalty comparable to that of motherhood, and that the cause is not only biological: the work environment and the health system determine how great the economic damage is. Conti spoke with EL PAÍS before her conference, in which she also presented one of her most surprising findings: a television program about menopause broadcast in Sweden in 2018 increased diagnoses and, later, women’s salaries. Information, she concludes, can be the best public policy.
Q. How did you come to study menopause from an economic perspective? It is quite an unusual interdisciplinary crossover.
A. I am a health economist and much of my work had focused on what happens to women in the period before conception and then when they have children, especially in the preschool years. And I realized that everyone studied the motherhood penalty, but that is only the beginning of the reproductive cycle. There are many women who stay in the labor market or return to it after raising their children, who are at the peak of their careers and aspire to promotions. And yet, there was practically no study on the economic aspects of the end of that cycle. In fact, when I started studying it, I couldn’t believe there wasn’t more research on it. Part of the answer is that, when I started looking for data, I saw that it is an extraordinarily difficult topic to research. In many datasets from various countries, there is not a single question about women’s menstrual period or when it ends. What you really need is not just to know when menopause arrived, but to understand the whole transition, because many problems begin earlier, in perimenopause, when periods become irregular and hormones fluctuate. It’s a bit like puberty: hormones go everywhere. But in most countries, there is no primary care record that collects whether a woman is menopausal. Doctors simply do not ask systematically. The only available information is found in Scandinavian records and is what we call the clinical diagnosis: when symptoms are severe enough for the woman to go to the doctor and the doctor records it. And that is what we used.
Q. And what are the main conclusions of that study?
A. The main thing is that menopause affects multiple dimensions of a woman’s life. First, we see a brief but clear increase in doctor visits, with more expensive tests, more referrals to specialists. They are prescribed more medications, including, as expected, hormone therapy, but also antidepressants, and that deserves another conversation, and cardiovascular drugs. And then, in the labor market, we see a 7.4% drop in income over the four years following diagnosis. In the most severe cases, it can reach 20%. Sick leaves and the probability of applying for disability benefits also increase. And what seems to happen is that women gradually leave the labor market: first they reduce hours, then increase disability income, and probably end up in early retirement, although we still do not have enough data to confirm this.
Q. You mention antidepressants. Are doctors prescribing these drugs for symptoms that should be treated with other medications?
A. It is a very important question, and we were all surprised when we saw the data. The increase in antidepressant prescriptions is persistent, while the use of hormone therapy is more variable: some women try it, but do not maintain it. I am not a doctor, but I can say that there is quite a bit of controversy in the scientific literature. Some specialists argue that hormone therapy has good evidence for vasomotor symptoms, such as hot flashes, but not for mental health conditions. Others say it works for everything. The truth is that there are menopausal symptoms that resemble depression a lot, such as fatigue, insomnia, or mood swings, and that probably leads some doctors to prescribe antidepressants. To what extent that is appropriate or not depends on each woman and each doctor, but I think there is a lot of room for improvement there.
Q. The finding about the Swedish TV program is one of the most striking in your research. What does it tell us about the power of information?
A. It is one of the results that excites me the most. In October 2018, a program about menopause was broadcast on a Swedish public channel, where celebrities, doctors, and women talked about their experiences, symptoms, and treatments. It was simply information, presented in a way that everyone could understand. What happened that week was that Google searches for “menopause” skyrocketed, women went to the doctor, there were 30% more diagnoses in the week following the broadcast, and 50% more women started hormone therapy in the three months after. And most importantly: three years later, women who watched the program had up to 10% higher incomes. What I find especially relevant is that these benefits were concentrated among women with less education, who are precisely those who suffer the most penalty and had less access to initial information. So it was also an equity intervention.
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Q. There is a Spanish study from EADA last year showing that 53% of women never talk about their symptoms at work because they do not feel safe. Is stigma one of the main obstacles?
A. Yes, definitely. There is still stigma around the topic in many work environments. I remember that the first time I gave a conference on this at a human resources congress, I met a lawyer who defended women who had been fired, in her opinion, due to discrimination related to menopause. At that time, I was surprised. Now, if we look at the data, more and more women win these unfair dismissal cases, which reflects a change in perception of what is acceptable in the workplace. I think this is a bit like what happened with mental health. Not long ago, it was an absolute taboo. You couldn’t mention it at work. Now, at least in many countries, there are mental health days and sick leaves for that reason, without those people being judged. Menopause probably needs that same cultural change. And for that, sustained pressure, momentum, and institutions, political and business, also need to do their part.
Q. Your study also indicates that the most affected women are those without university education, which again shows that this is not just a biological problem…
A. And it is not just a problem of access to information either. In many countries, to see a good gynecologist specialized in menopause, you have to go to the private sector, and that is exactly the kind of inequality that concerns us. You depend on the beliefs of the general practitioner you get. And if that doctor has doubts about hormone therapy or directly believes it is dangerous, they will not offer it to you. And that is not determined by your clinical situation, but by your geographic and economic luck.
Q. What can companies do about this issue?
A. What we see in the data is clear: women who work in the public sector or in large companies have a smaller penalty, probably because they already have some kind of support in place. But the evidence on which specific measures work best is still limited. We know that some of the measures to implement include training for managers, support groups, cognitive-behavioral therapy, flexible work… But this evidence is mostly based on small and unrepresentative studies. What worries me is that if the government gives employers a list of possible measures, the company will choose the cheapest, not necessarily the most effective. What we need is a rigorous large-scale study that says: these are the combinations that work. Because you cannot act on just one dimension. You can give a woman access to cognitive therapy and create a support group, but if she still cannot get up and leave the room when she has a hot flash because she fears stigma, none of that will work.
Q. Is there a risk of over-medicalizing a natural process?
A. It is a real tension. What I advocate is not to medicalize menopause, but to give each woman the best available information so she can make her own decisions. Not all women need hormone therapy. There are women with very few symptoms for whom the transition is simply that, a transition. But those with severe symptoms deserve to have access to evidence-based information, not fears inherited from the 2002 study or opinions of bloggers. The ultimate goal is for women to age with the best possible quality of life. That is all.
Q. What is next in your research?
A. We are working on several things at once. On the one hand, we want to quantify the penalty in as many countries as we can; we have ongoing work in Austria, the United Kingdom, Mexico, and we are starting in Brazil. And I also want to better understand which interventions work in the health system: what happens when hormone therapy is made cheaper or subsidized, as Ireland has done, which is the first European country to offer it for free. And hopefully one day we can do a large workplace trial that truly tells us which combination of measures produces results. Politically, the moment is interesting. In March, I participated as an expert in a joint hearing in the European Parliament on menopause and the economy. When Ireland assumes the presidency in July, with all they have already done in the country, it could be the time to push something at the European level. Someone at a meeting recently commented that if men suffered menopause, there would be treatments at gas stations, and I could only agree. The good thing is that now there are women with power in research, politics, and science funding, who are pushing for this to change. We were not in this position a generation ago. So, with all that remains to be done, I am optimistic.
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