Treating menopause as an ending rather than a new stage of life carries costs that ripple through society.
Melinda French Gates announced last week a historic $215 million commitment to women’s health, including a $10 million gift to the Menopause Society. It is a beautiful and necessary act of generosity.
It arrives on the same day a new Mayo Clinic study showing hormone therapy use among menopausal women has dropped to a historic low of 1.7 percent—even as evidence of its safety has grown.
We are moving backward and forward at the same time.
Somewhere in that contradiction sits a question we have not yet been brave enough to ask: What if we have been solving the wrong problem?
Consider the economic and societal cost of what we are missing: A Mayo Clinic study estimated $1.8 billion lost annually in the U.S. from workdays missed due to menopause symptoms alone.
But behind that number is a human cost that rarely enters policy conversations: the cost of women who quietly step back from leadership and social productivity, accepting that their most valuable years are behind them, combined with the highest rate of suicide among women occurring between the ages of 45 and 64.
These are not unrelated facts. They are two faces of the same crisis, what happens when women are told, at the moment they feel their capabilities are actually sharpening, that they are becoming less. This cost is enormous and invisible.
Women over 50 represent roughly 70 million people in the U.S. and Canada, a formidable economic, civic and social force. Yet they remain dramatically underrepresented in every seat of power despite being 51 percent of the population.
The crises before us—climate, poverty, political violence, the erosion of democratic norms, the fraying of community—are precisely the complex, long-horizon, cooperation-dependent problems that these women evolved to solve. The cost of their absence is not theoretical. It is playing out in front of us.
The question we have not been asking: Why do women live such long post-reproductive lives—the only land mammals that do—and is there a reason for it?
The standard medical framing of menopause is reproductive decline, that modern medicine lets women outlive their reproductive capabilities.
But this assumption is rooted in a misunderstanding of average lifespans.
New science, told in the documentary ‘Wise Women: Humanity’s Untold Origins,’ proposes that menopause is not decline but an evolutionary transition into the leadership and wisdom phase of a woman’s life.
For most of human history, life expectancy was dragged down catastrophically by infant mortality and death in childbirth. Women who survived those dangers routinely lived well into their post-menopausal years. Evolutionary anthropologists have understood this for decades. Menopause is not an accident of modern longevity. It has been a part of the human design for a very long time. Medicine’s foundational assumption about it is simply wrong.
New science, told in the documentary Wise Women: Humanity’s Untold Origins, proposes that menopause is not decline but an evolutionary transition into the leadership and wisdom phase of a woman’s life. Data from anthropology, evolutionary biology, genetics and neuroscience, points toward our post-menopausal female ancestors being the social architects of human civilization as far back as 1.8 million years ago. Menopause, this science suggests, did not happen to women. It helped make us human.
What does that mean for medicine, for politics and for society if we finally understood post-menopausal women that way?
The momentum around that question is growing.
In late 2025, Sen. Lori Urso (D) sponsored a landmark legislation making Rhode Island the first state in the nation to explicitly add menopause and its related medical conditions to the state’s Fair Employment Practices Act.
Eight other states are following suit with similar workplace protection bills, and 26 states in total are considering some form of menopause-related legislation. The message across the board: Women’s health is economic health.
French Gates put a spotlight on the fact that women’s health has been inexcusably underfunded. The questions to add to that conversation: What would medicine look like if it saw menopause not as nature’s mistake, but as evolution’s investment? What would our economy look like? What would our communities look like? What problems might we finally solve?
The science exists. The economic case is clear. And the legislative momentum is building. What is missing is the cultural shift that allows medicine, policy and society to see post-menopausal women not as a problem to manage, but as a resource we cannot afford to waste.
