Exhaustion, brain fog, night sweats, heart palpitations. These are some of the well-known physical discomforts – and straight-up pains – of menopause.

What’s often overlooked are the costs, which come with their own kind of pain. They span the gamut from lost wages and missed career opportunities to the day-to-day expenses of coping with hot flashes and lack of sleep.

Insurance claims for hormone replacement therapy, one of the most common treatments for menopause symptoms, soared 228 per cent for women aged 45-54 in the past five years, Manulife data found, as new research drove changing attitudes toward the treatment and the risks it may have been associated with.

Estrogen and progesterone patches, gels and pills can cost between $240 and $1,800 annually, while only B.C. and Manitoba have sweeping coverage for HRT, leaving many women to rely on private insurance and out-of-pocket expenses.

But, as my colleague Tavia Grant wrote this week, the steepest costs come from what are often preventable setbacks during women’s peak working years. For today’s newsletter, I asked her to help unpack the biggest ways menopause takes a toll on personal and national finances.

It’s important to remember that menopause is not a disease – it’s a natural life stage experienced by half the population.

But between perimenopause – which typically starts in a woman’s 40s (or earlier) – and menopause itself, there are dozens of symptoms, and the majority of women will experience them at some point: frozen shoulders, night sweats, difficulty sleeping, brain fog, irregular periods.

The consequences for the economy, labour market and individuals are huge. One estimate, from the Menopause Foundation of Canada, puts it at $3.5-billion a year. This includes $237-million in lost productivity and $3.3-billion in lost income for women, due to a reduction in hours or pay, or leaving the work force altogether.

Many women have fears about speaking with their employers or asking for accommodations. Untreated symptoms may drive some to cut their hours, avoid promotions, change careers or drop out of the labour force altogether. This has severe consequences for their financial security and retirement savings.

That said, it’s hard to quantify the exact impacts. Women’s labour-force participation rates drop in their late 50s, and menopause could be one factor among several, which can include having to care for aging parents, stress and other health issues.

As of last year, the work-force participation rate for women in Canada aged 55 to 59 years was 73.3 per cent, compared with 82.8 per cent among men of the same age, according to Statistics Canada data.

There are many reasons for this gap. Menopause – and the stigma and stereotypes around menopause – could be just one of them.

One study called the Menopause Penalty found a lasting drop in earnings and employment after a menopause diagnosis. Research in Britain showed that the number of menopause symptoms a woman faces is tied to lower employment rates.

HRT or menopausal hormone therapy is not covered in every province. (Only three provinces and one territory have signed deals with Ottawa.)

Some can access treatment through private insurance, but many are having to pay out of pocket. Others may not be able to afford to do so, and are going without treatment or other supports such as non-hormonal prescription medications.

Britain recently became the first country in the world to write menopause into employment law. As of next year, large employers must have action plans that support people experiencing menopause.

Australia just started its first-ever national campaign on addressing issues related to menopause, with the federal government expanding services covered for women.

Change is afoot in Canada. A parliamentary committee is now studying the labour force effects of menopause and perimenopause and will be making recommendations to government.

Some employers are stepping up efforts. Sun Life, for example, has started offering menopause training to break down misconceptions and supports such as flexible, hybrid work days to its employees globally.

Workplace changes don’t have to be expensive or unduly complicated. As Aimee Debow, a Toronto-based educator who helps companies start dialogue around menopause, told me in a recent interview: “It’s such a small investment to invest in a woman’s health who’s going through menopause – and the payback is huge.”

How have menopause symptoms weighed on you, emotionally, medically or financially? How are you covering the expenses and how much has it impacted your life? Drop us a line using this form.