How the menopause has become an economic issue in Ireland

Analysis: The introduction of free HRT shows that the menopause is not just a medical issue, but one affecting health, work and quality of life

By Lee-Ann Burke and Tanya Mulcahy, UCC, and Clare Cromwell, Menopause Society of Ireland

In May 2021, something remarkable happened on Irish radio. Joe Duffy’s Liveline radio show devoted programme after programme to the menopause. Women from across the country rang in to share experiences that many had never previously discussed publicly. They spoke about hot flushes, anxiety, insomnia, brain fog, exhaustion, suicidal thoughts, workplace challenges and difficulties accessing treatment.

The floodgates opened and the response was extraordinary. What began as a single programme became several days of discussion as phone lines filled with women eager to tell their stories. For many listeners, it was the first time menopause had been discussed openly on a national platform. Women were being heard.

The programmes revealed something important. Menopause was not a niche issue affecting a small minority of women. It was a common experience that had remained largely invisible in public discourse.

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From RTÉ Radio 1’s Liveline in May 2021, women call in about going through the menopause

Five years later, the conversation has changed considerably. Menopause is increasingly discussed in workplaces, healthcare settings, the media and around kitchen tables and catch ups with school friends from the 1990s. Employers are developing menopause policies. Researchers are examining its impact on health and employment.

Women are speaking more openly about symptoms and treatment options. It is no longer the taboo topic it once was. Organisations such as the Menopause Society of Ireland have played an important role in improving public awareness, debunking myths and providing evidence-based information, while Femtech @ Health Innovation Hub Ireland have helped keep women’s health and innovation firmly on the policy agenda.

Perhaps the most significant policy development came in June 2025 when Ireland introduced a national scheme providing free Hormone Replacement Therapy (HRT), removing the cost of approved HRT medications and associated dispensing fees. The measure was rightly welcomed as a healthcare initiative. As the scheme approaches its first anniversary, it may also be worth considering another question: is free HRT a healthcare cost or an investment?

From RTÉ Radio 1 in June 2025, Tom Murray from the Irish Pharmacy Union how 87% of pharmacies have signed up to the free HRT scheme

Economists have long argued that spending on health should not always be viewed as consumption. In many cases, health expenditure is an investment in human capital. Better health can improve productivity, increase labour force participation, enhance wellbeing and potentially reduce future healthcare costs.

Viewed in this way, menopause becomes an economic issue as much as a health one. Menopause typically occurs during what are often peak career years. Women in their forties and fifties frequently occupy senior professional, managerial and leadership roles. Many are balancing employment with caring responsibilities for children, ageing parents or both.

Economists increasingly recognise the importance of presenteeism; being present at work but functioning below one’s normal capacity because of health challenges. While absenteeism is relatively easy to measure, presenteeism can impose significant hidden costs on organisations.

From RTÉ Radio 1’s Today with David McCullagh, the rising cost of going through menopause

A woman experiencing chronic sleep deprivation, brain fog, fatigue, anxiety or indeed, all of the above, may still attend work every day. However, her productivity may be lower than it would otherwise be. If treatment improves symptoms, the gains may be felt not only by individuals but also by employers and the wider economy.

Evidence from several countries suggests that menopause symptoms can influence employment decisions. Some women report reducing working hours, turning down promotions, changing roles or considering leaving the workforce altogether. If improved access to treatment helps women remain engaged in employment during these years, the economic value may be significant.

There is another aspect of the debate that receives less attention: prevention. While many people associate HRT primarily with symptom relief, declining hormone levels after menopause are also linked to accelerated bone loss. This increases the risk of osteoporosis, a condition that affects thousands of women and can lead to fractures, loss of independence and reduced quality of life.

From a health economics perspective, osteoporosis is important because fractures are expensive. Hip fractures, for example, often require hospitalisation, surgery, rehabilitation and ongoing care. They can also lead to increased demand for community supports, home help services and long-term residential care. As Ireland’s population continues to age, the healthcare and social care costs associated with fractures are likely to increase. While symptom management remains the primary reason women use HRT, its potential role in protecting bone health raises an important economic question: could spending on treatment today help reduce healthcare expenditure tomorrow?

This reflects a wider challenge in health policy. The benefits of preventive interventions are often realised years after the initial investment. The costs appear immediately in government budgets, while the savings emerge gradually through reduced healthcare utilisation, improved quality of life and continued participation in work and society.

Many women experiencing menopause belong to what is often called the “sandwich generation“. They are supporting children, helping elderly parents and maintaining careers simultaneously. Their contribution extends far beyond paid employment.

From RTÉ Radio 1, what menopause treatments should you ask your GP for?

When health problems affect this group, the consequences can ripple through families, workplaces and communities. Supporting women’s health therefore has benefits that may not always be captured in conventional economic statistics.

Perhaps most importantly, the growing public conversation around menopause reflects a broader shift in how society understands women’s health. For many years, ‘The Change’ was often treated as a private issue that women were expected to manage quietly. The willingness of women to share their experiences on Liveline in 2021 demonstrated how much demand there was for open discussion. Joe could have talked about menopause until his retirement!

The introduction of free HRT can be viewed as part of that wider transformation. It signals recognition that menopause is not simply a personal issue but one that affects health, work, productivity and quality of life and the wider family.

From RTÉ Radio 1’s Drivetime, mens’ knowledge of the menopause and the strain it can put on relationships

Of course, it is still too early to determine the full impact of the policy. Robust evaluation will require data on uptake, health outcomes, labour market participation and healthcare utilisation over several years, not just anecdotal evidence.

But the first anniversary of the scheme offers an opportunity to begin asking important questions. How many women have benefited from improved access to treatment? Has the scheme reduced financial barriers? Has it improved quality of life? Has it helped women remain engaged in work? And could the economic benefits eventually offset some of the programme’s costs?

Five years ago, Irish women used a national radio programme to make menopause visible. Now the issue is no longer getting people to talk about the menopause openly and honestly. It is understanding whether investing in women’s health can deliver returns not only for individuals, but for the wider economy and society as a whole.

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Dr Lee-Ann Burke is a lecturer in the Department of Economics at Cork University Business School at UCC. She is a former Research Ireland awardee. Dr Clare Cromwell is co-chair of the Menopause Society of Ireland. Dr Tanya Mulcahy is the director of Health Innovation Hub Ireland at UCC.

The views expressed here are those of the author and do not represent or reflect the views of RTÉ

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