Shifting attitudes on menopause drive lawmakers to push for new protections

When Jacqueline Perez started experiencing symptoms of menopause in her early 50s, the brain fog was so severe, she thought she had early-onset dementia.

Perez, who founded a website dedicated to normalizing aging for women, said she gained more than 30 pounds and struggled with depression for months before she found a health provider who tested her hormone levels and recommended hormone replacement therapy for low estrogen.

That was nearly a decade ago, and in the years since, Perez said the culture around menopause treatment has changed dramatically.

“We still have a long way to go, in my opinion, but I think at least we’re on the path,” she said.

Menopause refers to the time when a woman stops having menstrual periods, which typically occurs between the ages of 45 and 55, according to the National Institute on Aging. The associated changes in hormones can cause hot flashes, night sweats, joint problems, bone density loss, insomnia, mood changes and more.

Lawmakers and advocates alike told Stateline the topic of menopause used to be taboo, but there has been a generational shift in recent years that has led to more legislation in statehouses around the country, providing more access to treatments and preventive care as well as more educational opportunities for healthcare providers.

Claire Gill, founder and president of the National Menopause Foundation, started the nonprofit in 2019 and said over the course of the past seven years, public awareness of the issue and interest from clinicians has noticeably increased.

And in November, the U.S. Food and Drug Administration removed its most severe “black box” warning from hormone replacement therapy for menopause and perimenopause after new research that the presumed risks of cancer, stroke and dementia from its use, once thought to be high, came from a flawed study. In the months since, the demand for the therapy has led to a nationwide shortage of certain products such as the estrogen patch.

Gill said more than 60 pieces of legislation related to menopause have been introduced nationwide this year, and 26 states have enacted a menopause-related law since 2019. There tend to be four categories of the legislation: mandating insurance coverage for treatments, workplace accommodations, awareness campaigns and healthcare provider education.

The subject is bipartisan: Lawmakers in liberal-leaning Illinois, Oregon and Washington have approved bills requiring insurance coverage, but so has conservative Louisiana.

Gill said the insurance conversation is especially significant, because bone density tests are only covered in existing laws when a person reaches the age of 65 and is eligible for Medicare. But women lose up to 20% of bone density in the first five years after menopause, which happens at an average age of 52. That’s a big gap that puts a woman at increased risk for fractures.

“I’m excited that we’re taking time and focusing more on the role that estrogen plays from head to toe in women, and not just looking at it as, ‘Oh, women get hot flashes,’” Gill said. “It’s so much more than that, and we can do more to protect our hearts and our brains and all of our organs — and prevent hot flashes.”

Getting providers to listen

In June 2025, Democratic state Sen. Lori Urso sponsored a bill that made Rhode Island the first state to require workplace accommodations, such as a modified work schedule, for menopause and its related conditions. It was added to the same part of employment law about women who are pregnant or nursing.

Urso said she had a challenging time personally with menopause, and she wasn’t sure she was going to be able to continue functioning at the necessary level to keep doing her job. When she introduced her bill in committee last year and detailed why symptoms could make it difficult to work, several of the men who were present at the hearing followed her out of the room, stunned by what they’d heard.

Menopause coverage bills meet mixed fates in state legislatures

“They said, ‘Oh my god, I had no idea about any of this,’” Urso said.

In the year since, Urso has watched a flurry of bills spread to other states. Many of them, including another bill from Urso that’s under consideration this year, would mandate insurance coverage for treatments related to menopause and perimenopause, the years leading up to menopause when some symptoms can start.

Others are proposing bills similar to Urso’s workplace accommodations law, with the aim of instituting more education requirements for doctors, directing health departments to conduct a public awareness campaign, or telling agencies to study the issue and make recommendations.

“I don’t think I invented something, I think I just made it okay, and helped open up a necessary dialogue out there,” Urso said.

Urso’s bill to mandate insurance coverage is still pending in the Rhode Island Legislature, but others have already made it law, including in New Jersey.

A new generation

Democratic Assemblywoman Heather Simmons said she was looking at legislation in other statehouses around the country and found the insurance mandates to be inconsistent. She decided to draft a version for New Jersey that she wanted to be the most comprehensive bill in the country, covering hormonal, non-hormonal and preventive treatments for perimenopause and menopause on state-regulated insurance plans.

It was signed into law in January, passing alongside another bill that allows healthcare providers to earn continuing education credits for menopause-related topics.

Although Simmons said her healthcare providers are generally very good and her insurance is excellent, she faced an uphill battle when going through menopause. She said she would ask about symptoms and whether they could be related to menopause, and her providers would shrug their shoulders. Not for a lack of caring, she said, but lack of knowledge.

“I’m just so grateful that my generation and the generations that follow me are saying no, we deserve better than that, we can do better than that,” Simmons said. “We’re not afraid to talk about it anymore.”

Simmons’ bill also includes behavioral health services for those diagnosed with depression or other conditions, and counseling for those who don’t have a formal diagnosis. It also covers pelvic floor therapy, and bone health screenings and treatments.

Her next step, she said, is to make sure that insurance carriers can’t deny testosterone prescriptions for women who need it just because it’s an off-label use.

Testosterone was a hormone replacement therapy that Pennsylvania Democratic state Rep. Melissa Shusterman needed to help her feel like herself again.

Shusterman has introduced four bills this session related to perimenopause and menopause, including insurance coverage for preventive  care for hip fractures and a joint government study to review workplace policies for state employees. Four other related bills are pending from other representatives, including one that would mandate Medicaid coverage for menopause treatments.

“All of this is going to help women in the long run, which means mothers are happier, women are happier and partners are happier, and that makes us healthier as a society,” Shusterman said.

Advocates like Gill, who is also CEO of the Bone Health & Osteoporosis Foundation, say their goal is to stay committed to pushing the boulder up the hill when it comes to passing more laws and creating more awareness of this phase of life. Too many women still think they have dementia or cancer before they realize it might be perimenopause, she said.

Gill noted the entire budget for women’s health research under the National Institutes of Health has long been about 10% of its total budget — that includes juvenile and post-menopausal ages. The gap in health research was already wide, she said, and amid cuts to federal agencies and projects under President Donald Trump’s administration, a recent report from the Washington Post showed a 31% decrease in projects funded in 2025 that contained the word “women.”

“There’s always been a need to increase that (budget) … and now we’re cutting the dollars,” Gill said.

“The important thing is that there are both immediate and long-term things that can be done at the local, state and federal level that can bring about not just better quality of life and symptom treatment for women, but also longer-term health benefits for women,” she said.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.