When experience meets biology: The silent crisis of menopause in the workplace

It is precisely when women reach the peak of their careers, after years of climbing the organizational ladder and accumulating hard-earned expertise, that they begin to experience menopause symptoms that slow them down, and sometimes even push them out of the race.

“In the end, we lose talent in the areas that hurt us the most. And it’s not just managers; even a supermarket cashier at this age is already highly skilled, and replacing her is expensive,” says Hila Carmel, founder of Freeda.ai and co-founder of the community and podcast “Menopause Talk”, together with Saleet Granit.

When discussing women in the labor market, the focus is usually on wage gaps, maternity leave, and discrimination. Menopause, however, is almost absent from the conversation. Yet according to Carmel, the cost of untreated menopause symptoms is enormous. In Israel, the total cost to the labor market is estimated at NIS 6.9–8.3 billion per year.

About 90% of women aged 45–60 experience menopause symptoms, but only 15% receive treatment. Twenty-six percent of women with symptoms report decreased work performance, and 14% are absent from work as a result. Based on the average national wage, Carmel estimates that the cost of decreased productivity is NIS 2.8 billion per year; absenteeism costs employers another NIS 118 million; and employee turnover and replacement costs are estimated at NIS 3.75–5.36 billion annually, according to an economic model she built in the absence of official data on the subject.

Studies in the UK show that one in ten women leave the workforce due to untreated menopause symptoms, while one in five consider leaving or forgo promotions. Sick leave rates rise, and effectiveness declines. “That figure is based on three components: retention, the cost of replacing an employee; sick leave; and reduced effectiveness,” Carmel explains. “It’s a statistic that can’t be ignored, and employers in the UK are already creating solutions around it.”

Like many issues related to women’s health, menopause remains under-researched. A March 2025 survey in Israel found that 96% of menopausal women experience one or more symptoms, and 50% have never sought medical help. “Most of the economic data come from the UK, where awareness of menopause and its economic cost began to rise about seven years ago,” says Carmel. “It started from the bottom up, with a documentary series that opened up the topic, and became a real movement led by journalists, doctors, and opinion leaders that pushed the government to recognize menopause as a public and economic issue. That led to the first comprehensive study examining menopause’s impact on the labor market.”

Following this wave of awareness and research, the UK government included hormone treatments in its health coverage, built a national strategy, and introduced regulations requiring employers to provide support. “Israel has a unique advantage,” Carmel adds. “Our HMOs hold comprehensive data, giving us a real opportunity to lead groundbreaking research and develop technological solutions as a startup nation.”

“I was sure it was Long Covid”

Carmel, an entrepreneur and former EY partner who previously sold a company she founded, came to the field through personal experience. “I was sure it was Long Covid,” she recalls. “After leaving my job and starting another venture, I suddenly realized, during a conversation with a friend, that what I was feeling was menopause. I couldn’t believe I’d missed the connection. That’s when I started looking for solutions.”

She founded Freeda.ai, an AI-based companion that helps women identify and manage menopause symptoms in plain language, via WhatsApp, guiding them from the first signs through to treatment coordination.

It’s not easy, she admits, to link job loss or decreased productivity directly to menopause symptoms, especially given how varied they are. “It’s true that isolating variables is hard,” Carmel says. “But when you ask women directly, as in the UK study, you get a consistent picture. Employers are seeing a drop in productivity, more absenteeism and turnover at certain ages, and they need practical solutions.”

Why should employers be involved? These are health-related symptoms, why should employers be responsible?

“Because they have a clear economic interest,” Carmel says. “In the UK, they realized that the public health system alone can’t close the gap, so they involved employers as partners. When workplaces fund awareness programs and guidance, employees identify symptoms earlier, see the right doctor, and recover faster. Many doctors aren’t even aware of the issue. Women go to orthopedists because of pain or to neurologists because of brain fog, but they don’t connect it to menopause. Involving employers helps close that diagnostic gap.”

“There are physical, mental, and cognitive symptoms,” Carmel explains. “In management roles, the term ‘brain fog’, difficulty concentrating and remembering, often comes up. It can create insecurity and discourage women from seeking promotion. I experienced it myself but didn’t know it was menopause. From someone who never took notes in meetings, I suddenly had to.

“On the mental side, there’s anxiety, depression, mood swings, and burnout. You lose passion for your work, and fear being seen as less capable, which makes women hold back. Physically, sleep deprivation destroys productivity. These are subtle symptoms that creep up slowly, so awareness is critical.”

“We pay a high price for denial”

In Israel, we’ve been living through two years of war, so depression, anxiety, and lack of sleep are common. How can you tell what’s menopause-related?

“That’s one of the biggest barriers to early detection,” Carmel says. “But that’s why awareness is so crucial. We pay a high price for preferring to take Cipralex rather than be identified with an age we’d rather not acknowledge, and then skipping hormone treatment. There are 80 possible symptoms, and most doctors don’t know how to link them to menopause.”

Globally, the cost of untreated menopause symptoms is estimated at $120 billion. Over one billion women worldwide suffer from menopause symptoms, and 75% receive no treatment. The World Economic Forum estimates the total annual cost to the global labor market at $810 billion, with women in the United States alone spending $13 billion per year out of pocket for symptom treatment.

Why aren’t women being treated if the treatments exist?

“The gap comes from a lack of knowledge, stigma, and insufficient medical training,” Carmel says. “Gynecologists study menopause for only about three hours during medical school. In Israel, a special course began about a decade ago, but only a minority of doctors have taken it.

“When a woman comes prepared with the right tools, the medical encounter becomes more effective. But menopause symptoms are often invisible, and awareness is low. These changes begin in our forties and last for the rest of our lives, half our lifespan, yet most women don’t recognize the connection. Untreated symptoms can lead to further health issues, and the household cost when a mother leaves or slows down her career is enormous.”

What does Freeda.ai offer?

“It’s a WhatsApp-based chat agent that supports women throughout the process,” Carmel explains. “It tracks symptoms, offers focused information, compares treatment options, creates an appointment plan for the doctor, and follows up on progress.”

Freeda.ai’s goal is to help women reach treatment, whether that means yoga, hormone therapy, or other approaches. “In Israel, most treatments are covered by the public health basket,” Carmel says. “The problem isn’t access to medication but the shortage of specialist doctors. This isn’t a recognized specialty, so many doctors give incorrect advice simply because they don’t know.”

Freeda.ai operates in the UK with health providers and is currently running a workplace pilot. In Israel, the company plans to launch an employer-based model with menopause doctors, as well as explore a B2C option for its podcast community.

Menopause, Carmel emphasizes, is also a stage of opportunity. “It’s a time when women are highly professional, no longer taking maternity leave, and often free from intensive childcare. Beyond symptom management, there are real opportunities here for women in the labor market,” she says.

“The framing of menopause as decline, symptoms, aging, irrelevance, is just a narrative. In reality, this stage can be an upgrade. The brain changes: you become more focused, intuitive, and leadership-oriented. Estrogen levels drop, but that shift can strengthen managerial qualities. Women at this age often have more time, experience, and confidence. This is when they can really soar, and yet many leave.”

“I hope to lead real change,” Carmel says. “Just like in the UK, Israel can turn menopause from a taboo into a subject that is openly discussed and properly addressed.”