The menopause cost you won’t find in your absence figures

When organisations talk about the workplace cost of menopause, the conversation often gravitates towards two things: sickness absence and menopausal people leaving work.

Both of these matter enormously, and both are relatively easy to track in HR systems.

However, emerging research published in 2026 suggests there is another dimension that may be just as important, but far less visible. The question HR teams may need to ask is not only who is absent or who is leaving, but also:

What about the people who are still at work, but finding it significantly harder to work at their previous capacity?

This is the issue of presenteeism, and it may represent one of the most under-recognised impacts of menopause on workplace productivity.

What the latest research found

A recent study examining work impairment among women aged 35 to 59 compared experiences between premenopausal and perimenopausal women. The research included 945 women in the United States and explored both labour force participation and self-reported work impairment.

At first glance, labour force participation appears broadly similar. Around 76.6% of perimenopausal women remained in work compared with 78% of premenopausal women. On this measure alone, the difference looks minimal.

However, a different picture emerges when looking at work impairment.

Perimenopausal women reported a work impairment rate of 22.5%, compared with 12.7% among premenopausal women. The gap becomes even more pronounced when symptom severity is taken into account. Women reporting minimal symptoms experienced impairment levels of around 3.4%, while those with severe symptoms reported impairment as high as 33.4%.

One of the most important findings for employers is that a substantial proportion of this impairment was associated with presenteeism rather than absenteeism. In other words, many women were still working, but not necessarily working at their full capacity.

It is important to note that this research is currently a preprint and has not yet undergone peer review. It is also based on a US sample, which may not fully reflect UK workforce conditions.

Even so, it adds to a growing body of evidence suggesting that menopause is not only a health or wellbeing issue, but also a meaningful workforce and productivity issue.

This aligns with wider international commentary. The International Labour Organization has recently highlighted menopause as a growing concern for productivity, retention and gender equality, noting that hundreds of millions of working women globally are currently navigating this life stage.

There is a large space between somebody struggling and somebody leaving

Presenteeism is much harder to see

Absence is relatively straightforward for organisations to measure. Someone is either at work or they are not. Resignations are also clearly recorded and easy to quantify.

Presenteeism does not appear in the same way.

An employee may still be physically present, attending meetings, responding to emails and completing tasks, while simultaneously managing a range of symptoms such as disrupted sleep, cognitive changes, anxiety, headaches, joint pain or hot flushes.

This is not just a theoretical concept. I experienced this personally during a period of menopause-related anxiety. On the surface, I was still “at work” and still delivering what was expected. But internally, I was struggling significantly. The anxiety did not always present as visible distress; instead, it often showed up as a deep and persistent sense of reduced capability. Tasks that were once routine began to feel overwhelming, decision-making became slower, and my confidence in my own judgement started to erode.

From the outside, this could easily have been interpreted as a performance issue, and it was. In reality, it was a health-related cognitive and emotional load that was directly affecting how I was able to function.

At times, this became severe presenteeism. I was present, but operating well below my usual capacity, working longer hours to compensate, and masking the extent of the difficulty in order to maintain appearances. Like many others in similar situations, I did not feel able to step back or disclose what was happening, because in part I thought it couldnt be menopause related as I openly spoke about it, so no self recognition of the situation only intensified the pressure.

The impact of this is not always immediately visible in performance data. Instead, it may show up in more subtle ways. Tasks can take longer to complete. Confidence may begin to decline. Some individuals may withdraw from opportunities, avoid presentations, or hesitate to apply for progression. Others may begin to question their capability in roles they have successfully performed for years.

None of these experiences necessarily trigger a formal HR record. There is no single data point that captures them neatly.

This is where the challenge lies. If organisations only measure menopause through absence and attrition, they risk overlooking what is happening long before either of those outcomes occur.

This is where the productivity conversation needs to change

Much of the current workplace conversation focuses on the cost of losing experienced women due to menopause. That remains a critical issue, particularly in sectors already facing skills shortages and retention challenges.

However, I have started to weave into my sessions how it may be more accurate to think of menopause impact as a broader productivity spectrum rather than a single outcome.

There is the cost associated with someone leaving the organisation.

There is the cost of sickness absence.

There is also the less visible but potentially significant cost of reduced productivity while someone remains in work but is experiencing symptoms that affect their capacity. My own experience of menopause-related anxiety and presenteeism made this particularly clear: being “at work” did not equate to being fully able to work.

Alongside this are wider organisational effects, including changes in confidence, reduced career progression, loss of institutional knowledge, and longer-term implications for gender pay and pension gaps.

From this perspective, waiting for resignation or long-term absence before menopause becomes visible in workforce data is likely to be too late to intervene effectively.

What should HR be looking at?

This issue is particularly relevant as organisations prepare for evolving expectations around menopause support and workplace equality planning.

Recent government guidance on menopause action planning encourages employers not only to implement policies, but also to understand their workforce, engage employees, and evaluate whether interventions are making a meaningful difference.

This creates an opportunity to look beyond absence and attrition data and consider a broader set of indicators.

For example, organisations may wish to explore:

• employee awareness of menopause support and policies

• confidence in accessing support or requesting adjustments

• line manager capability and confidence in having menopause-related conversations

• accessibility and effectiveness of workplace adjustments

• perceptions of psychological safety in the workplace

• engagement and experience data among employees in the relevant age range

• retention patterns and exit reasons

• sickness absence trends over time

• insights from employee networks, Occupational Health and workforce surveys

Not every organisation will need to measure all of these indicators. The most important step is identifying what is meaningful within a specific workforce context and using that to understand whether interventions are having a real impact.

From “what do we offer?” to “what difference does it make?”

A key shift emerging in workplace menopause strategy is moving from provision to impact.

Over recent years, many organisations have rightly focused on building support structures. This has included policies, awareness campaigns, employee networks, Occupational Health pathways, workplace adjustments and manager training.

The next stage is to understand what these interventions actually change in practice.

• Do employees know what support is available?

• Do they feel confident enough to use it?

• Are managers able to implement support consistently and effectively?

• And importantly, does this support enable individuals to remain productive, progress in their careers, and stay in work at a time when they might otherwise have considered leaving?

These are more complex questions than simply tracking absence or turnover. However, they are also more closely aligned with the real experience of employees. I'm not saying you shouldnt track abesence or sickness data you absolutely should, but it needs to form part of a holistic data set that look beyond numbers.

The emerging evidence on presenteeism reinforces a crucial point: the impact of menopause does not begin with sickness absence, and it does not end with resignation. There is a substantial period in between where productivity, confidence and career progression may all be affected.

If organisations are serious about addressing retention and closing what I referred to as the “10% Quit Club,” then this middle space is where attention increasingly needs to focus.

Written by Vicky Mose, founder of Imagine How and workplace menopause consultant. Vicky combines more than 30 years’ experience across education, wellbeing, leadership and regulated organisations with specialist menopause expertise to help employers create practical workplace support