Changing attitudes towards menopause are prompting lawmakers to push for new protections

When Jacqueline Perez started experiencing menopause symptoms in her 50s, her brain fog was so bad 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 finding a doctor who tested her hormone levels and recommended hormone replacement therapy for low estrogen levels.

That was almost a decade ago, and Perez says the approach to treating menopause has changed dramatically in recent years.

“In my opinion, we still have a long way to go, but I think we are at least on the right track,” she said.

According to the National Institute on Aging, menopause is the point at which a woman stops menstruating, which usually occurs between the ages of 45 and 55. The associated hormonal changes can cause warm flashes, night sweats, joint problems, loss of bone density, insomnia, mood swings, and much more.

Both lawmakers and advocates told Stateline that the topic of menopause was once taboo, but in recent years there has been a generational shift that has led to more legislation in statehouses across the country, providing greater access to treatment and preventive care, as well as more educational opportunities for health care providers.

Claire Gill, founder and president of the National Menopause Foundation, founded the nonprofit organization in 2019 and said public awareness of the issue and clinician interest have increased noticeably over the past seven years.

In November, the U.S. Food and Drug Administration removed its strictest black box warning on hormone replacement therapy for menopause and perimenopause after new research found that its presumed risks of cancer, stroke and dementia, once thought to be high, were based on flawed research. Over the following months, demand for this therapy led to nationwide shortages of certain products, such as the estrogen patch.

Gill said more than 60 menopause-related pieces of legislation have been introduced across the country this year, and as of 2019, 26 states have introduced menopause-related legislation. There are typically four categories of regulations: requiring insurance for treatment, workplace accommodation, awareness campaigns, and education for health care workers.

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

Gill said the conversation about insurance is especially vital because existing regulations cover bone density testing only after a person reaches age 65 and is eligible for Medicare. However, women lose up to 20% of their bone density in the first five years after menopause, which happens on average at the age of 52. This is a gigantic difference and puts a woman at increased risk of fractures.

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

Getting suppliers to listen

In June 2025, State Senator Lori Urso of the Democratic Party sponsored legislation that would make Rhode Island the first state to require workplace accommodations, such as modified work schedules, for menopause and related conditions. It has been added to the same section of labor law relating to pregnant or breastfeeding women.

Urso said she had personally experienced menopause and was unsure if she would still be able to function at the level necessary to do her job. When she introduced her bill to committee last year and explained in detail why her symptoms could make it hard to work, several men at the hearing followed her out of the room, stunned by what they heard.

Menopause insurance bills face mixed fate in state legislatures

“They said, ‘Oh my God, I had no idea about that,’” Urso said.

Since then, Urso has seen a flurry of bills spread to other states. Many of them, including another Urso bill being considered this year, would require insurance for treatment related to menopause and perimenopause, the years before menopause when certain symptoms may appear.

Others are proposing bills similar to Urso’s workplace accommodations bill that seek to impose more educational requirements for doctors, require health departments to conduct a public awareness campaign, or direct agencies to study the problem and make recommendations.

“I don’t think I came up with anything, I think I just made everything OK and helped create the necessary dialogue,” Urso said.

Urso’s bill requiring insurance is still pending in the Rhode Island Legislature, but others have already passed it, including New Jersey.

New generation

Democratic Assemblywoman Heather Simmons said she looked at legislation in other statehouses across the country and found insurance mandates inconsistent. She decided to draft a New Jersey version of what would be the most comprehensive bill in the country, covering hormonal, non-hormonal and preventive treatments for perimenopause and menopause under state-regulated insurance plans.

It was signed into law in January, along with another bill that allows health care providers to earn continuing education credits on menopause-related topics.

Although Simmons found her doctors were generally very good and her insurance was excellent, she faced a hard task during menopause. She said she would ask about her symptoms and whether they might be related to menopause, and her doctors would shrug. Not for lack of care, she said, but for lack of knowledge.

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

The Simmons Act also covers behavioral health services for people diagnosed with depression or other conditions, and counseling for people who don’t have a formal diagnosis. It also includes pelvic floor therapy and examination and treatment of bone health.

Her next step, she said, is to make sure insurers can’t refuse to prescribe testosterone to women who need it just because it’s being used off-label.

Testosterone was the hormone replacement therapy that Pennsylvania Democratic Rep. Melissa Shusterman needed to aid her feel like herself again.

Shusterman introduced four perimenopause and menopause bills this session, including hip fracture preventive care coverage and a joint government study to review workplace policies for state employees. Other representatives have four other related bills pending, including one that would require Medicaid coverage of menopause treatment.

“All of this will help women in the long run, which means mothers will be happier, women and partners will be happier, and that will make us healthier as a society,” Shusterman said.

Supporters like Gill, who is also CEO of the Bone Health & Osteoporosis Foundation, say their goal is to continue to be involved in pushing the rock uphill when it comes to passing more laws and raising awareness about this stage of life. Too many women still think they have dementia or cancer before realizing it may be perimenopause, she said.

Gill noted that the National Institutes of Health’s entire budget for women’s health research has long accounted for about 10% of its total budget – including adolescent and postmenopausal age. She said the health research gap is already huge, and with cuts to federal agencies and projects under President Donald Trump’s administration, recent report from the Washington Post showed a 31% decline in the number of projects funded in 2025 that included the word “women.”

“There has always been a need to increase this (budget)… and now we are lowering prices,” Gill said.

“What’s important is that both immediate and long-term actions can be taken at the local, state and federal levels that can provide women with not only better quality of life and symptom management, but also long-term health benefits for women,” she said.

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