The Economic Impact of Menopause Women Can't Ignore

All right, ladies, I have some conversation today for you. Did you know that women control $31 trillion of the worldwide economy? We can't sleep and no one seems to give a shit. So today on Menopause Mastery, I am going to go into some of the impact of the midlife woman in particular, and it's, it's not really around It's not a political thing, so don't worry, I'm not going to go into politics. What I am going to go into is why the Dalai Lama said the midlife woman was going to change the world. And this is actually probably one of my more driving forces behind Minerva, behind Menopause Mastery, behind the clinic that I own. It's because I want to make you feel better. I want you to have a healthier and more long-lasting life, but I also want to have you to have an epic life. And I don't think anybody realizes the amount of power that women have. And I think some of the things that we see going on is probably because some people don't like it either. Right? So let me give you some perspective. I spoke at the Women's Wealth Symposium over the weekend, and it was all these women from different walks of life, different experiences, and many of them were self-made. And I learned so much in that 8-hour day that I had never heard of. And the reality is, is we aren't allowed in the rooms, right? And so what would happen if women stepped into their health and their power and use their collective spending to change what they felt they needed. That's what we're going to talk about today. So I said it, so I gave you a number: $31.8 trillion. That's the amount of consumer spending women control globally, globally each year. Not household, not family spending. That is you and you alone. And spending is where women have the biggest decision power. And here's what's happening with these women right now. 90% are moving through their life thinking life is just grand. But 100% of us are going through menopause at some point. Most women are going to experience some pretty significant symptoms that are going to be really disruptive to your work, to your sleep, to your relationships with yourself and others, and your career, your cognition. Your sex life. And it can happen for at least a decade or more. And less than 4.8% right now of women in midlife are actually receiving the treatment that they need to actually feel their best and reduce their risk for long-term impacts from the loss of those hormones. So the reality is, is the gap is the most economically powerful demographic in human history. Human history. And the healthcare system designed to serve them is not on the same page, and it is a wellness issue, and it's an economic emergency. And today we're going to dig into it and we're going to talk about it because I want you to feel so empowered by the end of this episode that you're like, this is going to be my epic multiple decades. It won't be the marginal decades. It's going to be the epic decades. So like I said, women over 40 control $31.8 trillion of consumer spending. We make 85% of all household purchasing decisions and 87% of all healthcare decisions we buy for 3 different generations at a minimum. And we are on the verge of the largest transfer of wealth ever in human history. And we're also in the middle of menopause, and we probably want to strangle people, and we probably want to scream, cry, and eat a box of Häagen-Dazs and also drink a bottle of wine all at the same time. So we're going to go through all of these pieces. So Stanford did a study and they saw that of the $1.8 billion in annual US productivity losses due to menopause, the 10% earnings penalty— also, researcher documented that the impact is $2 trillion in preventable healthcare costs that we would avoid if women were actually getting treated appropriately for perimenopause and menopause. Okay, let me kind of restate that. There's a 10% earnings penalty just for going through menopause, and there's a $1.8 billion US productivity loss. And then if you add Mayo Clinic, they estimated all of that in presenteeism, absenteeism, healthcare costs, and the removal of women from the workforce, cuz they just can't take it anymore, at $46.8 billion a year. And this is all because of one deeply misunderstood and overstated study, the Women's Health Initiative, that just destroyed women's health 23 years ago. I've talked at length about that. I'm not going to today. So if you're over your 40s or 50s and your symptoms are not— are being seen as just a part of aging, this is about economics as much as it is your symptoms. All right, so So before we go anywhere near the biology of this, I need you to understand that the economic scale of what we're talking about— so I talked about the $31.8 trillion. Women make up 40% of the entire global GDP, right? 40%. We're talking all women worldwide. This is the most consequential economic impact you'll ever see. And when we look at the impact of women going through menopause, And basically having a longer lifespan, but poorer healthspan is the health failure, I would say, in modern history. And the numbers really prove it. So here's another number for you, because you know, I'm a nerd. I can't help it. McKinsey Global Institute calculated that a women's paid labor alone accounts for roughly 37% of the global GDP. So that's our paid labor, right? And then if you look at Another estimate, it was 40. So both of them are pretty darn close. Now, if we added women's unpaid labor— now you know what that is, that's coming home after work and cleaning and cooking and preparing everything, driving everybody to school, going to the grocery store, coming home, doing laundry. When we add all those things together, the New York Times estimates that that's $10.9 trillion worldwide, and women were producing closer to about 60% of the goods and services for the entire world. So who's got the power? Okay, on the spending side, right, I— like I said, we look at all the purchase decisions. They account for about $7 trillion in consumer spending and business spending, and we make up 87% of all the healthcare buying decisions. And hey, we also decide 91% of all household purchases. So Buying a home, buying a home, 91% reside on the female in the home. And 70% of all travel plans are made by women. I don't know about you, but that's 100% in my household. And within this group, the over 40 is the apex. Okay. So this is us, right? The 50 to 70-year-olds have higher incomes. So those midlife women today have higher incomes than our mothers could have ever imagined. We have greater net worth and stronger spending power than any other female segment. And once our kids are done and through college, if you happen to have them, we will spend 2.5 times the average consumer comparatively. And the boomer women, you know, the women that were born before 1965, make up 95% of the buying decisions of households across multiple generations. Because again, we insert ourselves into other people's lives and help make decisions because our children want us to help out. So women control 60% of personal wealth in the US, and in the next decade they're projected to control two-thirds. Part of that is because women outlive men, and we are also entered the workforce en masse in the '80s and '90s, and we have our own wealth. And a 2024, uh, Bank of America report projected $54 trillion transferring to surviving spouses in the next decade, and 95% of which will be women. And again, $47 trillion will go to younger women through inheritance. All right. So this is the group that health— the healthcare system is absolutely failing. So while I was in this wealth summit, I'm sitting there and, you know, we're all talking about wealth accumulation or how to prepare for your older years. And what is just absolutely clear after caring for my mother for 2 and a half years in an assisted living facility, those places are full of women. And a huge amount of the wealth that has been received or held onto by the older generations, like my mom's generation, was held onto in scarcity around, is there gonna be money there to take care of you as you get older? Now, yes, there are women on the other side of this equation and men and children and everybody else that are on the other side of this equation. But I think the women of means need to recognize that we need to leverage that wealth now in the decision-making world where it means something. Because what it does do is make the world that we might move into in our marginal— what people like to call the marginal decades, the '80s and the '90s. But what we are leaving behind is a world better suited for our daughters. All right. Now, approximately one-third of US women will enter menopause every single year. It's 6,000 women a day. And an AARP survey found that 90% of women 35 years old or older report at least one menopausal symptom, but the average have 5 distinct symptoms. So this is hot flashes, night sweats, anxiety, depression, sleep, mood, cognitive impairments. These are not beliefs. These are real things, and they can last decades. So what does that cost us? I mentioned this earlier. Mayo Clinic published this landmark study in 2023 that showed that menopause work-related disruption and expenses cost the US economy $1.8 billion annually in lost workdays alone. And that number explicitly excluded reduced hours, employment loss, or early retirement. And I can tell you from executives I've talked to over the last decade when I've done public speaking, they have a brain drain going on. Women leave the workforce at this time period. Sometimes it's for other reasons, but a lot of times it's because they just don't feel like they can take that next step. When we count in the medical direct costs are added for women in the 45 to 60 range, it's $26.6 billion annually. And if we look at that AARP, uh, 2024 survey, they estimate the global productivity loss from menopausal symptoms is $150 $1 billion in total. And then if we take that and add that to the total healthcare costs, it's $600 billion worldwide. Now, our little friends in the UK, they are further along in their menopause treatment journey and, and the basically getting the guidelines put into standard of care. The UK estimated that unemployment caused by menopausal symptom cost the UK economy over $1.5 £5 billion, um, and that Canada estimated a 3.3, Germany estimates a 9.9, and Japan a $12 billion annually. All right, so what is really happening? So, A, there's a lot of things that we aren't acknowledging, kind of this career destruction effect. And again, that menopause transition usually happens when women are at the pinnacle of their success. They have reached a substantial change in their situation at work. They are at a sustained earning potential if they felt like they did a decade earlier. And we get this earnings penalty that happens. So when we look at government-funded disability insurance and other things following menopausal transition, women are permanently left out of the workforce. We don't have coverage for menopause. So many, many, many insurance programs, state-run programs, self-insured employers do not cover menopausal therapy. And at this time, women experience more expenses with healthcare. So we're spending more for our premiums, we're spending more for our care, and the care that would change our lives, the hormone replacement therapy, is actually considered for quality of life and isn't covered by our insurance. So the economic costs are even bigger. And that Mayo Clinic study that we talked about, they found that 13.4% of women 45 to 60 experienced and reported at least one adverse work outcome directly related to their adverse menopausal symptoms. And here's the thing, women of color bear this disproportionately. Black women are nearly, uh, 3 times more likely to experience adverse effects of menopause on their work experience compared to white counterparts. If we look at East Asian population, Indian populations, that still holds true. So the truth is, is we get penalized for menopause. We have adverse experiences at work. We may not get promoted. And if you are a woman of color, your experience is even worse. And researchers have called menopause a potentially unrecognized reason for leaky leadership pipeline. I alluded to this earlier. So women's representation in the C-suite, right, your upper echelons of companies, stands still at about 28 to 29% despite women being nearly half of the workforce. For every female director promoted, 2 leave their companies. What does that do? That means that we're not in the room making decisions. We're not in the room influencing the buying decisions of the people that actually spend the money for the companies that you serve. And so it's a huge brain drain on corporate America and for, and this gap continues and it's invisible to most corporations. All right. Now, we already talked a little bit about the crime that started this whole thing, the Women's Health Initiative. And because this treatment gap was substantially manufactured by this single misinterpreted study, millions of women paid for that, right? You know, the, the idea that they asserted that breast cancer was caused by hormone replacement therapy, despite the fact that the women that were on Premarin alone had a 23% reduced risk of breast cancer. Compared to the women who did nothing at all. What happened is it plummeted from a significant portion of women in the United States. It was about 40% of postmenopausal women were being treated, down to less than 4% by 2010. We have only climbed since 2010 to 4.8% in the United States. So of 100% of women who should be being treated with hormone replacement therapy, only 4.8% are currently getting treatment now. Now it's accelerating because the FDA removed that, uh, black box warning. But the problem is obvious right now. Let's look at the biology behind the economics. I want to take a minute why untreated menopause is not just miserable, it's dangerous, right? This is why connecting your biology to your finances is important to me. So estrogen is not just a reproductive hormone. It is a system-wide hormone regulator. Your hormones are communication systems. So it's just like having a cell phone, or it's just like having a landline. You can't talk amongst your body parts without those hormones. And it governs things like cardiovascular function, bone remodeling, brain chemistry, brain energy production, immune response. Your metabolism. And when all of that starts to fail, all of those systems are impacted. And that's really what's happening. And here's the thing, cardiovascular disease is the leading cause of death among postmenopausal women. So in 2023, 380,000 men died of a cardiovascular event, heart attack, stroke. Guess how many women? Only 310,000. They were almost equivalent. Women die at the same rate as men, but women still perceive that that's a man's disease. Over 32 million women have one or more types of cardiovascular disease. Your genetics can drive it. Lack of hormones can drive it. Aging will drive it on its own without hormones. Current clinical guidelines do not separate recommendations by sex or menopausal status, which researchers now consider a huge evidence-based care failure. What does that mean? When you go to your cardiologist, he doesn't know jack shit about your menopausal status. He doesn't know jack shit about your hormones. He doesn't know jack shit about the impact of your hormones on your vascular system. And when he goes to treat you, he's using older studies that excluded women before 1993 to make decisions about your cardiovascular risk. For instance, the use of statin drugs shows primary prevention in men. It's not that clear in women. And actually, there are studies showing that it increases our risk of type 2 diabetes to use a statin preventatively just because of cholesterol levels. The other thing is cardiovascular-wise, women have what we call small vessel disease. That means the little micro vessels, the tiny little capillaries and small vessels around your heart are more likely to be damaged than the big ones that we look at for calcium scores. So women might get a low calcium score and think that they're okay and have advancing microvascular disease in the heart, the brain, the legs, the arms, and they may be moving along thinking that they're okay. Here's bones, right? So women lose up to 20% of their bone density in the 5 to 7 years of the transition into menopause. So approximately half of women 50 and older will experience a bone fracture sometime in their life due to osteoporosis. Women over 65, 50% of those that have a break won't survive the first year. And when we see that, that fracture risk at 50 Goes up when we get significantly older. And currently the guidelines are not to even look at your bone density until you're 65. Guess what? That train has left the building. You're gonna have osteoporosis and you're gonna be on a bunch of bone drugs because instead of replacing the hormone that actually tells your bones to build, they wait until the problem is big enough to then give you bone restoring drugs that make bone that even isn't as strong as the bone that was there before, but it makes the dexta look better. So we know estrogen protects the bones. It actually is the foreman for the construction and the demolition side of your bones. Estrogen protects bones even in men. Now let's talk about the brain. This is a huge area, and there's a lot of opportunity here for more research. Women are twice as likely as men to develop Alzheimer's disease. Alzheimer's has the clearest correlation to the menopausal transition. We can thank Dr. Lisa Mosconi out of the Weill Center in Cornell for these studies. And if we look at women, they make up two-thirds of the Alzheimer's cases. And emerging research really documents the role of estrogen in what we call synaptic— synaptic growth. So think of your synapses are the road and highways that go to your hippocampus for memories, or your executive part of your brain for function. And when estrogen gets taken away, those highways get broken apart and destroyed, and it's like the bridges were cut off. It also reduces neuroinflammation, and it acts as an antioxidant protecting the brain. So what's interesting is in the most recent research, brain fog was the second most common symptom behind fatigue for perimenopause. This is part of that brain transition. This is not just in your head, it's in your brains. And like I said, the metabolism, the effect of metabolic changes in your ability to burn fat, burn sugar, increased abdominal fat accumulation— so we're talking about the muffin top— and insulin resistance and elevated risk for type 2 diabetes, increased triglycerides and cholesterol that all come from the loss of estrogen not only drive weight gain and a change in clothing size, but they drive the risk for all those other diseases. Right? For the women that are worried about breast cancer, right? I get you. I hear you. It is disfiguring. It is horrible. But did you know drinking alcohol on a regular basis increases your risk somewhere between 11 and 21%? And being overweight and particularly obese is anywhere from 17 to about 27% on average in the research. So that is by far greater than even the assertion that they had on the Women's Health Initiative that didn't really play out on follow-up. Right. So the reality is, is menopausal hormone therapy is an economic driver as well as a longevity driver. Right. So I want to drive something home that the aggregate numbers hide, and the treatment gap does not distribute evenly across women. Right. So research for the Menopause Gap Study published in the British Journal of General Practice found that hormone replacement therapy prescription rates among Black women were 5.2%, among Asian women were 16— or I'm sorry, 6.2%, and it was compared to 23.3% with white women. And Black and Asian women were approximately 80% less likely to receive hormone replacement therapy as a recommended treatment. And what that reflects is in England's more advanced prescribing platform compared to the United States, they deprive women in areas especially that were more economically disadvantaged. So essentially, if you were affluent, you got the right treatment recommendations. If you were poor or less affluent, you were 29% likely— more likely to not get any recommendation at all. Black and Hispanic women also tend to experience more frequent and damaging vasomotor symptoms—hot flashes, night sweats, palpitation, and earlier onset of menopause. This not only sucks, but increased hot flashes and night sweats are associated with increased risk of heart attack and stroke, right? So the more frequent you have them, the more you have them, the more risk you have. This is linked in part to what researchers call weathering. This is a cumulative physiological toll of chronic social and environmental stress and biological aging in these marginalized communities. So not only are we seeing changes in hormones and variation among our ethnic backgrounds, because many of the women that are of color are also disadvantaged because of many other things that I won't go into today, we see that that collective effect is making not only their menopausal symptoms worse, but their healthspan poorer, their expense more, and the impact economically greater. So more menopause, worse symptoms, more barriers to care, less treatment when they actually seek it. So what do we— what do we deserve? So let's get to the solution, because I know this is the important part, right? So what's actually required to happen here? Because this is where a lot of the conversations stop short. Like I said, I gave this talk and I had 165 women in the room, and a whole bunch of them came up and said, I've been in many rooms with some of the luminaries from social media talking about hormones, but no one talked about the impact to health and wealth and economy, right? So, because I think this is where the problem really lies and we need better education. Here's the effective impact of menopausal care that actually looks like, right? So the first thing is, because of all that economics and also the variability of menopausal symptoms and also the long-term effects of the loss of those hormones, on your risk for disease, it's not a one-size-fits-all, right? And you, if you've listened to me, you know that I'm driving that home. And really, honestly, medicine is not a one-size-fits-all journey. It, that's, that's medicine 1.0 that comes out of warfare and communicable disease. The reality is between genetics and your epigenetics, your lifestyle, your diet, all those other things, and our ability to test, We can and do provide highly personalized precision medicine for women. So we not only get rid of the pesky symptoms and everything else, but we actually reduce all the risks of those diseases that I'm super concerned about. Now, what does that impact have on your overall standard of living? What would it mean to you? Just take a moment. Close your eyes. What would it mean to you if you're driving? Don't do that. Do it later. But what would it mean to you if you woke up and had massive energy? What would it mean that you didn't snap at your children or want to strangle your husband because he's chewing too loud or breathing too heavy? What would it mean when you walked into work and you could finish a sentence and you weren't word finding and you weren't breaking out in a hot flash every time somebody asks you a question in the room turned to look at you? What would it mean? Because that's the economics and that's the impact of actually getting treated appropriately for the next 3 to 4 decades of your life. Because not only do you feel better, but maybe you find the next thing that you love, right? Maybe you become the artist, the mother, the designer, the whatever, opera singer, I don't know. The person who does the best travel blogs. Or maybe you're like me and you go back and get a PhD and decide to take on the medical system. I don't know, but you only do those things when you feel great, right? Most people will step back from that kind of challenge. Maybe you're like, forget it, I'm just going to hang out and have a spa day. That's cool too. What I want is for you to have that choice, and we want to reduce the risk of us leaving the workforce early are reducing our impact on the GDP. I don't know about you, but I'm watching all the chaos going on right now, and we need the economic force of women to stabilize our economy, right? To stabilize our worldwide economy, because we not only want to have a great life for us, but we want to leave it for the generations behind us. And so treating menopause inadequately not only affects you, but it affects the world and affects the planet for decades to come. So here's my call to action. If this surprised you, A, like I said, I was talking to wealth managers and women who were investors and VC capitalists, and they were shocked. They had no idea the amount of influence, opportunity, wealth, and economic power we have. Now, if you're listening to this and you're like, Betty, that sounds like total bullshit. I don't have any of that. Here's what I want you to know. You can, you can, right? The biggest thing that happens to women and especially younger women and even women my age is we were never invited to the room to have these kinds of conversations. I can tell you, I went and raised capital last year. I had never been in venture capital rooms, investment bank rooms, merger and acquisition. I just gave a presentation 2 weeks ago in Houston. And I was one of only 3 women in the room, and I was the only one that was there as the head of the company. And this was a room full of men, and they had never ever been pitched a company designed around midlife women. Think about that. Think about that. So even if you don't feel like you have economics today, what would happen if you felt better? What would happen if you decided to go back to school? What would happen if you actually had the energy that you had 25 years ago, now that the Rugrats are out of the house? Because you could create that for yourself, right? So I hope if this episode landed at all for you, right? If you heard yourself in any of this, or if you're also like, this is bullshit, I want to have a better life. And I also want to see the planet reflect what my values are. Right? This is our thing. I want you to share this with the women in your life. Share this information. Like I said, I didn't know we had this much power. I didn't realize how much power we wield. So when we look around and we're like, what is this going on? We actually hold the purse strings. And I want you to know that you should never ever listen to somebody that says it's just part of aging. The data says otherwise. The economics say otherwise.. And you and your girlfriends deserve to leverage that. So if you want to go deeper, and you want to actually understand more about your hormonal picture, your lab, your genetics, maybe you're like, oh my God, she's speaking my systems. I've been feeling this way for a really long time. And I want more out of it. And you want a more personalized approach. And you want to talk to us. Come talk to us at gethormonesnow.com. That's my company, Minerva. Minerva is a telemedicine company providing hormone replacement in all 50 states. This is what I went back to get a PhD for at 49, not because I wanted a quarter of a million dollars of student debt. It's because I wanted to leverage what I knew about the science to make a difference in the world. And Minerva was really born of that, you know. So if you want more information, you want to understand that, go check us out at Get Hormones Now. And I wanna thank you for listening to Menopause Mastery. If you're listening to us on YouTube, please don't forget to subscribe, leave a comment. We read those and you help decide what episodes we're gonna talk about. And if you happen to be listening on your favorite podcast platform, don't forget to leave a 5-star review. And I wanna thank you for listening to Menopause Mastery. I'll be back with you next week.