Welcome to the Perimenopause Playbook—your guide to navigating the most overlooked and misunderstood phase of the menopausal transition. Read the rest of the stories, from how to get a diagnosis to treatment options to where to actually find good care, here.
An estimated 1 billion women worldwide are currently in perimenopause or menopause and, yes, that includes millions of millennials. Despite our enormous collective footprint, investments in critical menopause research and dedicated training for doctors are dismal and practically nonexistent, which poses a real health crisis.
Perimenopause is the time leading up to and through menopause (it can last anywhere from two to 10 years) and menopause refers to 12 consecutive months without a period (a.k.a. when ovulation has stopped). For younger women, typical symptoms such as hot flashes, mood swings, insomnia, and brain fog—as well as less commonly-recognized symptoms like frozen shoulder, depression, itchy skin, and about 50 others—not only start in perimenopause, but also can have a major impact on bone, brain, and heart health.
The recent rise in menopause influencers, along with millennials’ knack for breaking taboos, is catalyzing a new era of awareness. As for the two of us—a lawyer and a doctor—we are big believers that among the most critical things all of us can do right now is join the mobilization for better public policy around perimenopause and menopause.
Yes, the Trump administration undeniably poses significant challenges. It has already halted billions in federal research grants and stalled prior commitments to women’s health. At the same time, there’s an extraordinary counter-force happening throughout the country. In 2025, 15 states have introduced more than two dozen bills to improve menopause care, several of which passed and have been signed into law. And today, the FDA will hold a two-hour briefing on the latest evidence surrounding menopausal hormone treatments (you can watch it here). Here are our top priorities and how you can keep the momentum going in your own state:
Get Rid of Outdated Warning Labels
Hormone therapy is the most effective way to treat peri- and menopause symptoms. Over two decades ago, its usage was derailed by a high-profile study that, though well intended, misinterpreted and overgeneralized its results. This led to an unfounded fear of breast cancer and an under-appreciation of the beneficial effects of hormone therapy. Though squarely debunked—the official position of leading experts today is that the benefits of hormone therapy outweigh the overall risks for most healthy, symptomatic women—the damage continues to reverberate.
Patients too often are denied hormone therapy by untrained doctors. Black women who suffer from menopausal symptoms longer, earlier, and more severely are prescribed hormone therapy the least. Vaginal estrogen, for which there are virtually no contraindications and no risk, still carries outdated and inaccurate warning labels that cause unnecessary alarm.
Meanwhile, testosterone has the potential to treat menopause-related symptoms like loss of libido, muscle mass, physical energy, and even bladder health—but is only FDA-approved for men. This makes it harder for doctors to prescribe and for women to afford or access. Compare this to prescriptions for erectile dysfunction, engineered to be inexpensive and accessible with or without insurance.
The FDA has the power to rewrite outdated labeling requirements on hormone therapy products. Unboxing Menopause is a national citizens’ campaign directed at urging the FDA to do so. Coordinated by the nonprofit Let’s Talk Menopause, you can send your own letter to the FDA by clicking here.
Invest in Modern Menopause Research
Before 1993, medical research didn’t legally have to include women in clinical trials. This history of exclusion carries over to funding today. In 2024, the National Institutes of Health (NIH) spent only 10 percent of its $48 billion budget on women’s health, with menopause-specific research at a paltry one percent.
To date, there’s zero research that follows healthy women who start hormone therapy in perimenopause, or who stay on it continuously starting in ther 50s through their 60s. Among the key gaps that new funding could help answer: What, if any, are the preventive, preemptive, or proactive benefits of hormone therapy on brain, bone, and heart health? Is there a certain window in which taking hormone therapy might maximize the benefit? How can we better understand racial disparities in the timing and severity of menopause symptoms to improve the experiences of women of color?
Research is a priority that can’t wait, even if the fight ahead is a thorny one. Contact your own state representatives and governor, as well as leaders in Congress (in the U.S. Senate and House of Representatives), to urge them to voice support for perimenopause and menopause research.
Mandate Menopause Education and Training
A lack of menopause education and training has led to a dearth of good care options for women, whose symptoms not only go untreated, but who find themselves dismissed and disregarded along the way. The average woman will spend upwards of 40 percent of her life in her post-reproductive years. All specialties—OB-GYNs, internists, endocrinologists, orthopedic surgeons, and cardiologists—must be aware of how perimenopause and menopause affect every major organ system in the body.
The Menopause Society, the nonprofit that developed the primary accreditation program for menopause certification, recently announced an exciting expansion titled the “NextGen Now Initiative.” It’s a $10 million comprehensive training program designed to reach 25,000 healthcare professionals by 2028 and equip them with the “knowledge, tools, and support needed to improve the care of midlife women.” Telehealth companies specializing in perimenopause and menopause are also an excellent innovation to ensure broader access to care.
But there is no substitute for public policy mandating better education for all. Last year, California passed a law encouraging its various state medical boards to include coursework in menopausal health. In 2025, legislatures in Arizona, California, Connecticut, Maine, Massachusetts, New Jersey, New York, Pennsylvania, Texas, and Wisconsin also introduced bills to improve provider and/or patient education. As of July 8, the Maine bill has been signed into law; New York’s passed and awaits the governor’s signature. But we still have a long way to go.
In addition to contacting your state representatives, check out the Citizen’s Guide to Menopause for sample letters that are easy to adapt and send.
Expand Insurance Coverage…
A 2025 study conducted by GoodRx found that one in five women delayed or passed up menopause treatment due to financial concerns. Only 26 percent had insurance coverage for hormone therapy, leaving most to seek out discount cards or pay entirely out of pocket. Neither Medicaid nor Medicare have a mandate to cover menopause care.
Illinois and Louisiana have already passed laws to change this. A bill passed in California last year, only for the governor to veto it. Now, it’s back in action, reintroduced once again this year. New Jersey, New York, Oregon, Pennsylvania, Texas, and Washington have introduced similar legislation that’s waiting to get passed. The Texas bill died in committee; Oregon’s passed (and awaits the governor’s signature), as did Washington’s.
This is definitely something to raise with your own state representatives and governor.
…And Workplace Protections
As menopause has gone mainstream, the concept of a “menopause-friendly” workplace has also caught fire. Among the menopause accommodations often touted, we think too many miss the mark. Some, like desk fans and cooling rooms, are mere surface level fixes and have short-term value. Few, like flex time, are realistic for women in low-wage or hourly or service jobs; this typically only benefits women in white-collar roles. And there’s no employee in the U.S. guaranteed full protection under the law from discrimination on the basis of menopause.
As of 2025, several state legislatures—Massachusetts, New Jersey, New York, and Rhode Island—introduced bills to extend broader workplace protections to menopause such as paid leave for symptoms that impact quality of life, which is crucial to fight for. In fact, Rhode Island’s legislature recently passed and signed into law an expansion of its current fair employment practices pertaining to pregnancy and pregnancy-related conditions to include menopause and menopause-related conditions.
The Menopause Society offers a bundle of resources for employers and employees, “Making Menopause Work,” which includes how to make the case for health benefits, educational resources, and accommodations. For employees, options might include tapping your human resources team, affinity groups and employee resource groups (ERGs), or union leadership (if you’re in one).
Menopause is inevitable for all of us—it’s just a matter of when—so it’s never too early to join this movement and prioritize these reforms. There’s absolutely a pathway to progress if enough of us are committed to fighting for it. Our health, and the next generation of women’s health, depends on it.
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Jennifer Weiss-Wolf is executive director of the Birnbaum Women’s Leadership Center at NYU Law and author of Periods Gone Public.
Dr. Sharon Malone is chief medical advisor at Alloy Women’s Health and author of New York Times best-seller, Grown Woman Talk.