Medical professionals recognize at least 34 symptoms associated with perimenopause and menopause—including hot flashes and night sweats, joint pain, brain fog, heart palpitations, anxiety, migraines, and sleep disruption. Until recently, menopause was largely absent from workplace policy and employment law in the United States. That is changing rapidly.
Some state and local governments have enacted express menopause workplace protections and accommodation requirements, and Congress has recently considered, but not yet codified, menopause-specific employment and benefits legislation. As we mark Menopause Awareness Month this October, employers should assess their legal obligations and evaluate whether their workplace policies and benefits are keeping pace.
Existing Federal Protections for Menopause at Work
Even where menopause is not explicitly named in a statute, existing federal and state laws may already provide protections. Title VII, for example, prohibits discrimination on the basis of sex. Because menopause is a condition linked to sex, adverse employment actions motivated by menopause, or harassment related to symptoms such as hot flashes, could give rise to claims under Title VII and its state counterparts.
Similarly, while menopause itself is not a disability, severe symptoms like debilitating hot flashes, chronic sleep disruption, or cognitive difficulties could, in some circumstances, substantially limit one or more major life activities. Where that threshold is met, employers should consider accommodation obligations under the Americans with Disabilities Act and analogous state disability laws.
The Pregnant Workers Fairness Act requires covered employers to provide reasonable accommodations for known limitations related to pregnancy, childbirth, and "related medical conditions." Whether that language encompasses conditions associated with the end of fertility, including perimenopause and menopause, remains an open question, though employee advocacy groups have pressed for such an interpretation.
State Workplace Accommodation Laws
Although the federal statutes do not expressly address menopause, several states and localities have filled the gap. For example, Rhode Island's Fair Employment Practices Act requires employers to provide reasonable accommodations for menopause and related conditions. Accommodations may include more frequent or longer breaks, job restructuring, modified work schedules, or light duty assignments. Employers must also provide written notice to new employees and to any employee within ten days of the employee notifying the employer of a menopause-related condition.
The Illinois Menopause Equity and Care Act, effective January 1, 2027, amends the Illinois Human Rights Act to prohibit employment discrimination on the basis of menopause-related conditions. The act also requires employers to provide reasonable accommodations. In addition, the act amends the Illinois Insurance Code to require that individual and group accident-and-health insurance policies or managed care plans amended, delivered, issued, or renewed on or after January 1, 2028 cover medically necessary hormonal and non-hormonal therapy for menopausal and perimenopausal symptoms, subject to certain limitations. In addition, certain group health insurance policies must cover annual menopause and perimenopause health visits for covered individuals, subject to exceptions for health savings accounts.
Effective January 1, 2027, an amendment to the Philadelphia Fair Practices Ordinance will prohibit discrimination on the basis of perimenopause and menopause (among other things). The ordinance requires employers to provide reasonable accommodations. As with other reasonable accommodation mandates, employers need not provide accommodations that constitute an undue hardship.
Impact of State Health Insurance Coverage Mandates
As the patchwork of state law menopause-related protections grows, employers and plan sponsors must stay aware of health insurance mandates too. For employers with fully insured group health plans, the plans must comply with state menopause coverage mandates. Employers sponsoring self-insured health plans that are not subject to state law may choose to voluntarily adopt menopause-specific coverage among growing employee expectations and competitive pressures.
Effective January 1, 2027, Maryland will require health insurers and health maintenance organizations to provide insurance coverage for evaluation and management of menopause and menopause-associated conditions. Louisiana requires every health insurance issuer offering coverage in the state to cover medically necessary care or treatment for menopause and perimenopause. Notably, insurers may not impose prior authorization, step therapy, or fail-first requirements on hormone replacement therapy prescribed to treat menopause and perimenopause symptoms.
The New Jersey Menopause Coverage Act establishes a comprehensive mandate requiring covered health insurance carriers to cover medically necessary treatment for perimenopause, menopause, and related symptoms. The law applies across major insurance vehicles regulated in the state, including individual and group health policies, health maintenance organizations, small employer health benefits plans, and plans administered under the State Health Benefits Commission and the School Employees' Health Benefits Commission. The act generally took effect on April 9, 2026, with certain plan provisions effective as of January 1, 2027.
Pending State and Local Legislation
In addition to the enacted laws described above, several states have menopause-related legislation pending. New York has four pending menopause bills, including a bill to provide five days of paid leave per month per year and treating menopause as a disability. California's and Virginia's governors recently vetoed menopause protections that would have required health insurance coverage for menopause and perimenopause treatment. Colorado and Florida legislatures also considered menopause benefits in 2026.
As employment protections and health insurance mandates continue to expand, the topic of menopause is sure to gain more attention. Whether driven by legal obligation, talent retention, or both, employers should review their anti-discrimination and accommodation policies and evaluate their benefits offerings.
If you have questions about menopause workplace accommodations, employment law, or employee benefits, please contact the authors or any other attorney in Venable's Labor and Employment Group.