The hidden productivity toll of perimenopause: symptom-driven work impairment during women's peak earning years

Perimenopausal women, often in the peak-earning years of their careers, make up a significant proportion of the workforce, with women aged 40-49 accounting for approximately 21% of the U.S. female workforce. Previous studies have revealed perimenopause to be associated with psychological, vasomotor, somatic, and cognitive symptoms that affect women's quality of life, yet its workplace and economic consequences remain under-explored. We examined work impairment by symptom severity and across reproductive stages in a cross-sectional survey of U.S. women aged 35-59 (n=945), using the Work Productivity and Activity Impairment questionnaire and Menopause Rating Scale. We then estimated associated productivity losses using a human capital approach. Perimenopausal women were equally likely to remain in the labour force as premenopausal women (76.6% vs. 78.0%) but reported substantially higher work impairment (22.5% vs. 12.7%). Work impairment rose from 3.4% among women with minimal symptoms to 33.4% among those with severe symptoms and was driven predominantly by presenteeism rather than absenteeism. Somatic and psychological symptoms showed the strongest associations with work impairment, whereas urogenital symptoms were not significantly associated. The observed work impairment translated into an estimated annual productivity loss of approximately $6,061 per woman in perimenopause and a societal burden of $56.7 billion in the United States. These findings suggest that perimenopause is a substantial but under-recognised workplace health challenge that requires tailored, symptom-matched, workforce support. Keywords: perimenopause, symptom burden, work impairment, productivity loss.