When Carrie Odell, 49, reflects on her mother's generation, she's certain that people at the time didn't discuss perimenopause — the dreaded years in almost every woman's life leading to the end of her menstrual periods, or menopause.

Hot flashes, brain fog, mood fluctuations, insomnia: all aches and pains taken in stride for much of history as par for the course in women's health.

For Odell, the decadeslong dearth of information has made it difficult to fully comprehend her own symptoms or find help. A visit to her primary care physician was a flop after receiving medication that had no effect, she said.

I feel like I changed without changing," said Odell, who lives in Seattle. "What happened? I didn't do anything differently."

Odell, who manages a soccer league, wishes her employee benefits covered menopause treatment and provided resources for her to understand its associated physical and mental effects.

"I just want to know how to sort of navigate this — feel better," she said. "This is going to happen to all of us women."

Awareness of the need for menopause coverage is growing nationwide. Some of Washington's top employers are beginning to respond, with Microsoft, Amazon and Boeing extending access to menopause support.

However, most companies don't offer such benefits, leaving women in the labor force alone in navigating the broad array of ailments that can disrupt their workflow and lives.

Some may luck out with a primary care physician who also specializes in menopause care, but many must visit gynecologists, endocrinologists or certified menopause practitioners — sometimes on their own dime — to find relief.

The price tag for the right remedy can become another obstacle: Not every insurance plan covers treatments like hormone replacement therapy, and some do — but with astronomical out-of-pocket costs.

While social stigma has silenced many women, strides taken in Seattle are making up for lost time.

Jill Angelo, now vice president of women's health and commercial partnerships at health technology company ŌURA, launched Gennev, a virtual medical clinic for people in menopause, in 2015.

Back then, "it was kind of thought of as niche," she said, "even though 50% of the population goes through menopause."

'Definitely still lacking'

Some Americans are pressing for menopause benefits from their workplaces.

In the U.S., 42% of employees considered menopause support to be helpful to them or their families in 2023, according to Mercer, a global professional services firm. It counted as the No. 2 most popular reproductive benefit, behind preventive cancer screenings, at 50%.

Across Washington state, discourse about menopause care is taking place in formal settings.

Women in Tech Regatta, a community of professionals and students in the tech industry, held a session on the topic for the first time last year "after hearing directly from women in our community that they wanted more information," founder Melody Biringer said.

She described the key earning years for women in tech as falling between the ages of 40 and 50.

"And, then, they're experiencing all these perimenopause symptoms," Biringer said. "They just kind of come out of left field."

Some employers have approached Women in Tech Regatta on the topic of menopause education. Biringer pointed to one example: a gaming company that brought menopause experts into the fold in recent years "because it's just not being talked about."

But around the country, only a fraction of large employers offer menopause benefits. In 2023, that percentage was 15% — up from 4% in 2022, according to Mercer surveys.

"Employers are kind of stuck between a rock and a hard place," said Paul Fronstin, director of health benefits research at the Employee Benefit Research Institute. "They want to offer good benefits, but it's costly."

And those prices are typically always on the rise, he added.

Employers have to consider the cost of adding a benefit, any medical cost offsets and the potential impacts on turnover and productivity.

"Employees don't see all the costs," Fronstin said. "They see what they pay out of pocket."

Large employers are the businesses that often reap a meaningful return on investment by enhancing health care benefits as needed by workers, Fronstin said. "Without a doubt, larger employers have the means to do things smaller employers don't."

Microsoft provides access to menopause support through Maven Clinic, a digital health platform.

"There’s been growing awareness over the past few years about how perimenopause symptoms can affect women’s lives," said Sonja Kellen, general manager of global health, safety and well-being at Microsoft, in a statement. "We added menopause support to our benefits because it’s a natural extension of how we think about supporting employee wellbeing at every stage of life."

Amazon also offers menopause support, according to spokesperson Eileen Hards.

"Amazon's benefits cover a broad range of women's health needs, including reproductive health, family planning, fertility treatments, maternal care, and menopause support," Hards said in a statement.

At Boeing, workers can access "a comprehensive midlife program that is designed to address menopause and peri-menopause health care needs," a company spokesperson said.

The aerospace giant partners with Maven and provides menopause education.

Other sizable employers listed a more general slate of benefits.

T-Mobile extends comprehensive health plans, with "access to flexible benefits designed to meet a wide range of health and well-being needs," such as paid leave and mental health care, according to a spokesperson.

The telecommunications company hosted an internal menopause awareness session last year "to encourage conversation around this important life stage," the spokesperson said.

Starbucks offers paid parental leave and other family-planning benefits, though it lacks a menopause-specific program.

Suzy Jackson, a digital health specialist based in North Carolina, said menopause benefits are "definitely still lacking."

"It's a ways behind the fertility and pregnancy space, for sure," she added.

While the U.S. is home to powerhouses of innovation, it falls flat in providing overall benefits, Jackson said in a phone interview.

However, menopause benefits can attract new talent and drive down attrition, Jackson said. Companies can take financial blows when they aren't proactively investing in the health of workers experiencing menopause.

The Mayo Clinic projected that the U.S. loses $1.8 billion annually due to workdays missed because of menopause symptoms. "All those missed days cost money, as well as real productivity loss," Jackson said.

The problem is "especially acute" because individuals experiencing menopause are typically in their 30s to their 50s — the same time they're often taking on senior roles, she said.

What's next

Employers are gradually embracing care for menopause, though it took years to reach this point.

ŌURA's Angelo started her career in Seattle at Microsoft in 2001 and worked there for 15 years. She led the senior women's networking group and recalled hearing members discuss exhaustion, elevated stress levels and poor sleep at group dinners.

"This wasn't a factor of women burning out or women not being capable," she said in a phone interview.

"As I look back now, that was really a factor of women in their 40s and early 50s really probably struggling through a change in their health that they didn't have words for."

That change: menopause. Back then, "no one wanted to even utter the word," Angelo said.

The overarching belief was, "if I say something, especially in a workplace, it's only going to work against me," she said. "So women just kept quiet about it."

Employers initially offered standard health care for primary care, preventive care and prescriptions. Then, workplaces expanded into fertility benefits as a "retention tool" for young women, Angelo said, followed by maternal and family care.

Although menopause care has only recently taken off, it's slowly growing in popularity.

Soon after the founding of Gennev in 2015, other menopause-focused companies like Elektra Health, Evernow and Stripes Beauty went live, Angelo said.

They all stood at the forefront of a new — and increasingly profitable — frontier.

In 2024, the global market for menopause care products was valued at almost $18 billion, and it's expected to hit $24 billion by 2030, per business consulting firm Grand View Research.

It lists North America as the largest menopause market.

The U.S. government recently lifted one barrier around menopause products. The U.S. Food and Drug Administration approved the removal of "black box" warnings — "specifically, risk statements related to cardiovascular disease, breast cancer and probable dementia" — from six hormone therapy products in February, according to a news release published last month.

Doctors had pressed federal officials to reverse course on the labels, raising the argument that the warnings were based on antiquated data.

Particular advantages exist in Washington state for modernizations around menopause care, Angelo said.

"We've got women's health-focused investors here in Seattle now, funding these innovations," Angelo said. "That's the big change."

Moving forward, Seattleite Rachel Bjork, 54, wants to spread the word about menopause — and eliminate its stigma in office culture.

The extent that she knew about perimenopause was hot flashes. Bjork wasn't aware of other symptoms like anxiety and sleeping troubles until she was in the thick of it.

Even those who will never experience it could benefit from education around menopause, she said.

"People being more aware of that in the workplace might be helpful," said Bjork, who works as a compliance specialist in the biotechnology industry. "I just don't think that kind of subject should be taboo.

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