Menopause and the institutions that were never designed for women

What happens when institutions are designed around an “ideal worker” who never menstruates, never gets pregnant, never gives birth, and never experiences menopause?

Perhaps the answer lies in how many of our modern institutions were originally built. Long before women entered public life in significant numbers, men dominated politics, commerce, governance, and formal employment. From the early democracies of Athens to Wall Street, many of the assumptions underpinning our institutions were shaped around male life experiences.

For me, it is always another day out here seeking an equitable world. That was certainly the case recently while attending WILAN’s cross-sector convening, where women leaders from law, health, finance, agriculture, and other sectors gathered to discuss solutions to challenges they faced in leadership and development. As I listened to the conversations around the room, I was struck by something unexpected.

The women were discussing different industries, different professions, and different experiences. Yet many of them were describing variations of the same reality: navigating systems that were never fully designed with women in mind.

And then it dawned on me. Who are our systems built for? That question led me down a path I had not expected and eventually brought me to menopause.

Let’s consider it for a moment. Millions of women will experience menopause, many at the height of their professional, economic, and leadership contributions. Yet menopause remains largely invisible within workplace policies, health systems, social protection frameworks, and public policy conversations.

To be honest, I thought we were much closer to the finish line on gender equality than this particular issue suggests. Yet the more I researched menopause, the more I realised that it represents one of the clearest examples of institutional blindness to women’s experiences. So once again, I found another bottleneck. And that is where today’s conversation begins.

Menopause illiteracy is rooted in a culture of silence

Perhaps the first reform challenge is that before institutions can become menopause-responsive, societies must first become menopause-literate. Because it is difficult to design solutions for realities we are unwilling to discuss.

Before we discuss workplace policies, healthcare systems, or social protection programmes, it is worth asking a more fundamental question: why has menopause remained invisible for so long?

Part of the answer may lie within the informal institutions that shape how societies understand women’s bodies. Across many cultures, conversations about women’s reproductive health often exist within a framework of silence, privacy, and, at times, shame. Menstruation, fertility challenges, reproductive health conditions, pregnancy loss, and menopause are frequently treated as deeply personal matters rather than legitimate public health and development concerns.

As a result, many women enter menopause with limited information about what to expect. Symptoms that can affect sleep, concentration, mood, confidence, and physical wellbeing are often endured quietly. In some cases, women may not even recognise that they are experiencing menopause at all.

This culture of silence has consequences beyond individual wellbeing. It shapes institutional behaviour. Issues that are rarely discussed are rarely measured. Issues that are rarely measured are rarely prioritised. And issues that are rarely prioritised often remain absent from policy design, workplace planning, healthcare investments, and social protection systems.

The result is a paradox. Menopause is one of the most universal experiences in a woman’s life course, yet it remains one of the least visible within the institutions that serve her.

Why Menopause Matters Beyond Health

It would be easy to dismiss menopause as a private health issue. Increasingly, however, global health experts, employers, policymakers, and development institutions are treating it as a workforce, economic, and gender equality issue.

The first concern is talent retention. Menopause often occurs when women are at the peak of their professional experience, leadership capacity, and earning potential. Yet many continue to navigate symptoms such as sleep disruption, anxiety, fatigue, brain fog, and difficulty concentrating without adequate workplace support. Experts at the Mayo Clinic note that psychological and neurocognitive symptoms often have a stronger relationship with adverse work outcomes than the more commonly discussed physical symptoms such as hot flushes. Their argument is simple: organizations that fail to recognize and support menopausal employees risk losing experienced talent at a critical stage of women’s careers.

The second concern is economic productivity. According to the Astellas Global Health Report’s “True Cost” analysis, closing the broader women’s health gap, including better support for menopause, could unlock productivity gains equivalent to bringing an estimated 137 million women into full-time employment globally by 2040. As populations age and labour markets seek to retain experienced workers, the economic costs of ignoring menopause are becoming increasingly difficult to overlook.

The third concern is equity and human rights. The United Nations Population Fund (UNFPA) has explicitly framed menopause as a human rights and age-equity issue, arguing that while women drive economies and communities, menopause remains under-prioritized and under-resourced by policymakers, employers, healthcare systems, development institutions, and investors. This concern is particularly relevant for low- and middle-income countries, where the majority of the world’s menopausal women will live and where access to health coverage and workplace protections often remains limited.

Perhaps most telling is that institutional responses are beginning to emerge. In the United Kingdom, recent policy and legislative discussions around employment rights have increased expectations that employers demonstrate how they support menopausal workers. The shift signals an important change in thinking: menopause is no longer being viewed solely as a private matter for women to manage individually, but increasingly as a workforce and institutional issue requiring deliberate policy responses.

What Could Institutional Reform Look Like?

If menopause exposes a gap in institutional design, then the solution is not simply awareness. It is reform. And because women participate in both formal and informal economies, the response must extend beyond the workplace.

1. Flexible Work as a Productivity Strategy

Principle: Build flexibility into workplace design rather than forcing women to choose between performance and wellbeing.

What this could look like: Flexible scheduling, hybrid work arrangements, and short-notice wellness breaks during severe symptom periods.

Example: A growing number of employers in the UK and Australia have adopted menopause workplace policies that prioritize flexibility and symptom management.

2. Manager Training and Leadership Accountability

Principle: Ensure symptoms are not mistaken for declining competence or ambition.

What this could look like: Training managers to recognize menopause-related challenges such as brain fog, sleep disruption, or anxiety, and respond appropriately.

Example: Several large UK employers now include menopause awareness within leadership and diversity training programmes.

3. Menopause-Friendly Workplace Environments

Principle: Small environmental adjustments can have disproportionate impacts on employee wellbeing and retention.

What this could look like: Better ventilation, access to cooling facilities, breathable uniforms, and private rest spaces.

Example: Menopause workplace standards emerging across Europe increasingly include environmental accommodations as part of employee wellbeing frameworks.

4. Integrating Menopause into Health Coverage

Principle: Menopause care should be treated as a routine health need rather than a specialist luxury.

What this could look like: Coverage for hormone replacement therapy (HRT), specialist consultations, and psychological support within employee health plans.

Example: Employers in the UK and parts of North America are increasingly expanding benefits packages to include menopause-specific care.

5. Bringing Menopause into Primary Healthcare

Principle: Women in the informal economy cannot rely on employer-based solutions.

What this could look like: Integrating menopause screening, counselling, and affordable treatment into primary healthcare systems.

Example: Rwanda’s community-based health insurance model demonstrates how subsidized health systems can expand access to essential care for women across the life course.

6. Social Protection for Mid-Life Women

Principle: Menopause should be recognized as a life-course transition with economic implications.

What this could look like: Health vouchers, targeted cash transfers, or subsidized healthcare support for vulnerable women aged 40–60.

Example: Kenya’s social protection systems and digital payment infrastructure demonstrate how governments can reach women directly through mobile platforms.

7. Designing Markets for Women’s Realities

Principle: Public infrastructure should reflect the realities of the people who use it most.

What this could look like: Well-ventilated market spaces, access to clean water, sanitation facilities, and rest areas for traders.

Example: Market modernization programmes across parts of West and East Africa increasingly recognize the importance of gender-responsive infrastructure.

8. Building Social Insurance for Informal Workers

Principle: Health shocks should not force women to deplete business capital or depend entirely on family networks.

What this could look like: Micro-insurance, micro-pension schemes, and subsidized social protection tailored to informal workers.

Example: Senegal’s Simplified Social Security Scheme (RSPC) and India’s Self-Employed Women’s Association (SEWA) demonstrate how social protection can be adapted for informal-sector women.

Ultimately, the goal is not to create special treatment for women. It is to ensure that institutions recognize the realities of women’s lives. An institution designed around the full life course of its citizens is not a concession to gender equality; it is a stronger institution.