Two years into a leadership role at a Rhode Island company, state Senator Lori Urso stopped being able to do her job. She experienced heart palpitations, brain fog and months without real sleep that went unexplained by her doctors.

"I just couldn't function at work anymore," she says.

She resigned, and months later discovered UK-based menopause resources that showed her what she was experiencing wasn't unique.

"This isn't just me," she remembers thinking.

During her first term, Urso sponsored the bill that made Rhode Island the first state to require employers to accommodate employees experiencing menopause. Governor Daniel McKee signed it into law in June 2025, and it added menopause to the section of the state's Fair Employment Practices Act that already covers pregnancy. It does not require a doctor's note.

Urso says she narrowed the bill's scope after watching more sweeping proposals stall in other states.

"I was advised to keep the legislation simple," she remembers. “And it worked.”

Illinois followed in August 2026 with the Menopause Equity and Care Act , signed by Governor JB Pritzker, and Philadelphia passed an ordinance in December 2025 covering menstruation, perimenopause and menopause that takes effect January 2027. California Governor Gavin Newsom vetoed menopause insurance -coverage bills in 2024 and 2025; likewise, Virginia Governor Abigail Spanberger vetoed similar workplace protections this year.

A 2023 Mayo Clinic Proceedings study of 4,440 employed women ages 45 to 60 found that 13.4% reported an adverse work outcome tied to menopause symptoms. Nearly 11% had missed work because of them. Researchers estimated lost work time related to menopause symptoms costs U.S. employers $1.8 billion annually, and that number rises to $26.6 billion annually when medical expenses are included.

Rachel Anne, founder of the Menopause Education Center and an expert workplace training and policy consultant, says the resistance she still encounters from employers has little to do with the numbers.

"It is still hard to get through the shame, stigma and emotional aspect of this," she says. "If you look at it strictly [as] data, there is no way anyone would say no."

She adds that her business's audits of corporate performance-improvement plans have repeatedly noted a pattern legal teams did not expect: more women in the 45 to 60 age bracket are among the employees who received a PIP.

Angela Black, co-host of the Menopause HQ podcast, describes a more personal version of that pattern. After two years in a new sales role, she missed two regularly scheduled meetings almost back to back, something she says never happened to her before. She eventually told her manager why.

"I said, 'I'm going through menopause,'" Black says. "I used to be able to multitask. I used to be able to remember things without having to write it down. I'm realizing now my brain does not work the same."

Her manager did not hold it against her, she says, but she knew from other women in her network that "there's no compassion" in many workplaces "because most of the managers are men" and have not been taught what hormonal changes actually do to cognition and mood.

Black says a workable policy would start small.

"There should be some type of rule in place" that gives a woman with a doctor's note "some extra days off" beyond her existing sick time, without penalty for using them.

What Some Employers Are Building

A handful of companies have begun treating menopause as a benefits category in its own right, similar to how they treat pregnancy and postpartum care.

At the eyewear company Zenni Optical , benefits manager Jessica Podesta says the company added menopause-related coverage in 2024 through Maven, a third-party women's health platform, after employee feedback pushed the company to look more broadly at support across life stages.

"One of the biggest needs employees raised was around egg freezing capabilities," Podesta says. "That feedback prompted us to look more broadly at how we could better support employees through different stages of their lives."

The benefit now reimburses qualifying costs tied to fertility, maternity and menopause care, including hormone replacement therapy, and works alongside an employee resource group called Women in Focus. Podesta says the company has not formally measured whether the benefit affects retention, but "we are proud to offer benefits that can make some of those experiences a little easier."

Smaller companies are building similar structures without outside vendors. Leah Garcia, founder of the skin- and hair-care brand Nulastic, spent two decades in television before menopause caught her by surprise.

"I vowed to myself that I would never ever let them see me sweat," she says of that earlier career. "The sad part is that I had to mask it because I didn't have the freedom to live it."

At Nulastin, which works fully remote, she says employees can post in a shared channel when they need to step away — for a headache, a school pickup or an unspoken symptom day — without explanation.

"No one's getting shamed, and there's no eye rolling," Garcia says. The company also gives employees a monthly stipend intended for self-care.

Only four states — Illinois, Louisiana, Oregon and Washington — now require insurance coverage for menopause-related treatment for all or some patients, according to a legislative tracker at Katie Couric Media . Most of the country lacks that requirement as well as a workplace-accommodation law, which means benefits like Zenni's and policies like Nulastin's remain voluntary rather than required.

Urso says that gap is exactly what continues to drive her advocacy.

"The intention of the law is to retain talented women workers," she says, "and allow them to remain in the leadership pipeline."