Why Workplaces Should Extend Health Benefits to Include Menopause Care
A Q&A with Midday Founder Ann Garnier on speaking up, getting support, and why the UK is leading the charge on menopause in the workplace
Ann Garnier thinks women over 50 are at their peak, and she wants workplaces to start recognizing this. The former healthcare technology executive is an advocate for keeping these women in the workplace by providing proper support and care for them. Her app, Midday, helps women navigate their menopause journey and even provides telehealth counseling.
Lesley Jane Seymour: So let’s talk about menopause, and what’s going on in the workplace. My reading tells me that providing protection for workplace discrimination against women going through menopause has been going on for a long time in the UK. Can we talk a little bit about when and why that happened?
Ann Garnier: Absolutely. The UK represents the first wave of employer support, and really a call to action to extend the women’s health continuum beyond pregnancy and fertility. So while menopause is not a protected characteristic in the UK, there was an equality act in 2010 around sex, age, and disability. And all those characteristics provide protection against unfair treatment of employees going through menopause.
And now, fast forward to 2022. This summer, there was a call to action in Parliament to amend that equality act for menopause to be a protected characteristic after research showed that the UK is “hemorrhaging talent.” Those are the actual words they used.
So in between those two events, in 2014, a core group of researchers, clinicians and other advocates, took up the mantle of recognizing that menopause has serious impacts on the workplace. So that’s when there were the first national guidelines and a very public launch of what they called Mind the Gap campaign, to raise awareness. And then the government actually did a research study, which found that yes, in fact, there are impacts on the workplace. And it also highlighted stigma, lack of support, and discrimination, which are really key factors driving women out of the workforce.
LJS: And who was leaving, specifically? Was it women 50-plus? Was it women 60-plus? And why did they feel they were hemorrhaging talent? Because here, it doesn’t seem like they care.
AG: Well, I don’t know exactly the demographic of the group that was leading this, but I would suspect it was women 45-plus. And certainly, I’m sure men were involved too. But the reason that they could quantify this as hemorrhaging talent is because they did a research study on it, and It’s quite lengthy and illuminating. So they have the numbers — they know how many women in the UK are exiting because of issues around menopause.
So really it became this very strong call to action for the private and public sector. And then the country’s major water utility, Severn Trent, was from my understanding, the first employer to offer menopause support in the workplace in that 2015/2016 timeframe. We’ve seen other large companies follow suit, and generally what they’re offering is what I’d call v.1 support, which is awesome. So you typically see things like some sort of menopause policy, some that may provide flexible work hours, and one even went so far as providing leave for menopause. Edelman, I think, was the first to provide some paid leave around menopause. You see things like education, training of supervisors to be more sensitive to women going through menopause. And also to be able to have these conversations in the workplace, right? To normalize this and make it acceptable. So I think they really made some very strong strides.
But here in the US, it’s very early days. We’re just starting to see some signals that some employers are interested in this issue, and may provide some support in the workplace. We have over 41 million women over 40 in the US labor force. It’s 55% of the total female labor force, and 26% of the total labor force. Like, this is not a trivial number. Right? And it’s the fastest growing workforce demographic.
LJS: Of course. And as I like to say to everybody, menopause is not a disease. It’s a stage. You can’t outrun it.
AG: No, no, it’s happening. Every woman will go through this. And if you’re lucky, there are 15% of us who will skate through without having any noticeable symptoms. I thought I was one of those people, but I was wrong. One day, somebody flipped a switch. It was like, bam, all those symptoms piled on. So the rest of us, the 85% of us, are left with symptoms that at least to some degree impact our daily lives and overall health. So, it’s interesting, because while you have women of childbearing age who are exiting the workforce, and that accelerated during the pandemic, guess whose butts are in the seats? Us, right? Because we have a lot of reasons why we have to work. We’ve got to put kids through college, we have elder support, we’ve got to save for retirement. And then not to mention the high rate of divorce, and women getting into situations of financial insecurity.
And then of course, we’re living longer than ever. So there’s a lot of reasons why women have to remain in the workforce, and for an even longer period of time. You know, the average woman will spend at least 18 years of her working career in the menopause life stage. And for some women that will extend as long as 20 to 24 years. That’s a lot of time spent in the workforce while you are experiencing symptoms that interfere with your work. And that’s really, to me, I think such, well, I don’t even think shame is an adequate word to describe it. Because, you know — you’ve reinvented yourself. And I started Lisa Health and have done all of this awesome work. You know, women over 50, we’re at the peak, we’re powerful.
LJS: Totally! And well, the more that you research it, and the more that you learn, you see that this is the time of your life when you’re less encumbered, and you can really perform. My best work was done in my late 50s. And it’s because you don’t care anymore. I laugh thinking back on one of my first jobs, as a copywriter at Vogue. And I used to walk into the room where there were six of us. I mean, it’s a laugh now — six people writing fashion captions? I mean, who has that kind of money? But I used to be afraid, like if somebody didn’t like me, or if they said that I was wrong, or I sat down and they didn’t say hello, what would I do? You’d spend all that time worrying about it. And now you’re like, screw them. I could care less what they think. They would be invisible to me.
LJS: And it’s so freeing.
AG: You know, I think women have confidence throughout their life. But I think in this life stage, your confidence just really magnifies and then empowers you to do so many amazing things, personally and professionally. But when I think about how many women, because of what they’re dealing with around menopause symptoms, or even chronic disease, it just, it’s like, bordering on criminal neglect that we have not better supported women clinically, from a mental health perspective, and then you know, doing the things in the workplace that we need to do to set them up for success.
LJS: Right. So let’s talk a little bit about what you do. So people understand what your background is. Talk a little bit about Lisa Health and your history?
AG: Sure. Well, I’ve been a healthcare executive, my entire career focused on healthcare technology, actually, and how we can use technology to improve outcomes and access to care for very complex conditions. And along the way, I led the development for some of the earliest tech-enabled products to improve outcomes for high risk pregnancy, preterm birth, and fertility. So after helping a lot of other people start and grow their companies over the years, and people saying, ‘Hey, when are you gonna start a company? I totally want to come and work for you.’ I decided it was time. And I really wanted to tap into that passion for women’s health. But I was personally beyond my reproductive years, and what was really interesting to me was what was happening to women’s health over 40. And so I was doing a deep dive into the space, looking at, what are the things that are facing women? And menopause, obviously, just stood out as such a clear, underserved market, massive market, clear unmet need, and it just coincided with my own menopause transition.
And then as I said earlier, those symptoms really just piled on overnight. And boy, there’s nothing like experiencing a problem firsthand to say, ‘Wow, if it’s this hard for me, and I’m this, like super knowledgeable, empowered healthcare consumer, what is this like for most women, right? So I started reaching out and talking to women — of course, this was a few years ago, and nobody was talking about it — and found out that women like me were really struggling. It was impacting my productivity, it was impacting my ability to be my best self, professionally and personally. And I think, because I’m just a very high-achieving person, I was like, I’m not putting up with this for a minute.
So because I do have the ability to tap into world-class experts, and, I know how to do a deep-dive into the scientific literature, I ultimately was able to sort of solve for my own symptoms and restore my sense of well-being, and my ability to perform at the level that I’m used to. But I know that for many women, it’s very challenging, that they spend years, just through trial and error, trying to figure it out. They’re just, they’re desperate. I mean, the calls I’ve had with women, the conversations over a glass of wine, it’s heartbreaking. And they’re spending a lot of money.
One woman was like, ‘well, I might as well just burn the money, because nothing has worked.’
LJS: Oh no.
AG: Right? We know women are spending thousands of dollars out of pocket. So I just became motivated. And I knew that technology could ultimately make a huge difference. I mean, really transform this life stage. Right. So I just thought, ‘well, I’m just going to do what I do,’ and I developed a tech-enabled platform to really guide women using AI and sensor technology. These are technologies being widely used in healthcare to improve outcomes for almost every other health condition. So why should 3.8 billion women be left out of that technology movement? It’s grossly unfair, especially with the complexity of this life stage. So I created and launched the Midday app with my cofounder, Dr. Max de Zabotti. And we just launched that in July in collaboration with the Mayo Clinic and SRI International. So we’re super excited to be the first science-backed, evidence-based platform for menopause and healthy aging.
LJS: Wow. And what can I find when I go there? Am I going to be able to do telehealth and get diagnosed and get HRT or get whatever I need?
AG: Sure. Well, so we call it a comprehensive platform for menopause. We know that many women want holistic support and therapeutic strategies. But we also know that many women may be interested in hormone therapy and want to talk to a qualified physician about their prescription options. So we have the whole continuum. When you sign up for Midday, one of the things we do is assess where you’re at on your menopause journey. We have a highly granular, science-backed algorithm, because we found actually the number one question is, where am I at? A lot of women don’t know. And so with that, along with some other information, we can really personalize this journey. And if you want to go on a 100 percent holistic path, we have several evidence-based strategies, like immersive meditation, or paced respiration. But then we also partnered with the Mayo Clinic to provide virtual care. So you can request an appointment with a top expert in menopause and learn about your options for prescription therapies. We also have, in the app, a tool that was developed by Mayo Clinic experts to support you and your understanding of whether or not hormone therapy may be right for you. So right in the app, you can understand whether or not you’re even eligible for hormone therapy, and then follow up with the Mayo Clinic experts. So really, between all of those features, our education, we have a product marketplace, it’s really feature-packed. And I forgot to mention, we have integration with wearables. So we’re able to, passively, with user permission, access data that we can then contextualize through the lens of women in midlife. If you go to a lot of apps, you know, for wearables, they’re really built for people in their 20s and 30s. They’re not built for women in their 40s, 50s, 60s, 70s. So we’re able to, say for example, look at sleep through a whole new lens for you as a woman in midlife, which I think is very exciting.
LJS: Well sleep, we know sleep is the big, huge, gigantic issue. And everything I read, I do a newsletter for Covey, so I’ve read all the, you know, the research that comes out. And it’s just very clear that if you don’t get your sleep at midlife, your future is really in trouble.
AG: For sure.
LJS: So let’s finish talking about the US. What do you think is coming in? Do you hear anything coming legislatively? Do you hear? I mean, I can’t remember where exactly, but I did pull down a piece recently that said in the US, it sounds like some companies are finally waking up to this idea. Have you seen anything concrete?
AG: Yes, we’ve had a number of groups reaching out to us about this topic. I think they’re in the learning mode, because it’s so new. Because when you think about these very large companies, for example, they already have their benefits plan set for 2023. They work much further ahead.
But that said, I think you could see some big companies surprise us, because several like to be innovative. And let’s not forget that many of the decision makers around benefits at these companies are women over 40. Because if you reach that very senior C-suite level, you’re typically in your 50s, maybe even 60s. So I am hopeful. I’m hopeful that they get it right, like you don’t have to do a lot of education because they’ve experienced this particular issue on their own.
LJS: So what do you suggest that women who are reading this do? If they’re having symptoms, if they’re in the office, dare they bring it up? I mean, I think a lot of women are afraid to even let anybody know that they’re older, right? And if you bring it up, you’re gonna sound like a big old baby, and somehow admit weakness and it could be damaging to you. So instead, you just sit up there and pour sweat or you can’t sleep and you work anyway. How do you handle it? Do you have some tips and tricks?
AG: For sure. Well, I’ve been on several panels around this topic, and you know, when the question comes up at the end, ‘what’s the number one thing you would do to really create change?’ And all the panelists universally say, ‘well, we have to start the conversation.’ I think, generally, the conversation about menopause has been started; we’re seeing a lot more conversation about it. But to your point in the workplace, has that conversation really been taking place? I think that has to happen. But if women feel uncomfortable, like there might be ageism, that–
LJS: –There is ageism. We know it exists, yeah.
AG: Right. Then, you know, I think companies like mine can help drive this issue to the forefront. We have a white paper coming out that really lays out the business case and what you can do as an employer. I will say that, when you think about implementing menopause support in the workplace, I think the way you have to think about it — because women have concerns about coming forward, which are legitimate — you should have access to a confidential benefit. Say you have a mental health benefit at your company, right? You don’t have people walking around waving their hands saying, ‘Hey! I’m depressed. I’m anxious!’ or confiding in their supervisor. They know they have a confidential benefit that they can access when they need support. And hey, if you want to raise your hand and shout to the rooftops that you’re a menopausal woman, you should be able to have that conversation. People should be able to feel comfortable, and others may have to be trained to be receptive to that. But at the same time, if you don’t want to do that, you should be able to access a confidential benefit and get the support you need.
LJS: Interesting. Yeah. I just can see it as being, I mean, women are terrified. I have had friends who let their hair go gray, and then they get back to the office. And the reception is clearly affecting their ability to perform. Then they go back to their old hair color, and things go back to normal.
AG: Yes, it’s so sad.
LJS: It’s taboos.
AG: But companies like ours can help. You know, we can’t be prescriptive, but we can provide some best practices, and some guidance around how best to support women in the workforce and get women the support they need. We do know that there are very few physicians trained in menopausal care, and that makes a digital health platform really the ideal solution. I mean, how many women do you know that have a smartphone and know how to use it? Right? So this idea that women in this life stage aren’t going to use technology or don’t know how to use technology, like isn’t that the most insulting and ridiculous thing I have heard in a long time. And believe me, it comes up.
LJS: Oh it’s infuriating, I know. Well, is there anything else that you want to tell us, specifically about what to do and how to advocate possibly for your business?
AG: Yes. So you can download Midday from the App Store. So any woman can access it. And I think it’s affordable — an annual subscription is $78. That’s about $6.50 a month, which is a bargain!
LJS: Oh that’s fabulous! Good job.
AG: You do have access to virtual care, but it is an additional cost. But Mayo Clinic takes most insurances, so there’s a very good chance that your insurance would cover the virtual care visit.
LJS: So what do you do about advocating for the issue in your job? Like, should you be talking to your HR person and saying we need to discuss this? Or what are some words of advice for people who know this is an issue, and maybe they are in management?
AG: Well, first of all, talk amongst yourselves, with your family, your partner, friends, clinicians, etc., just to get comfortable having the conversation. I think we need to take menopause out of the shadows. And then, with your employer, you may not feel comfortable talking to your supervisor or your coworkers, but there’s always confidential access to HR, especially in benefits. They’re always looking for employee input. I mean, how many surveys do they send out, right? They’re trying to understand what the workforce wants, so I think they genuinely are very open and interested.
Here in the US, we’re not seeing much action on the legislative front. But I do think we need government to support us. And I think we definitely want to make sure that we don’t get classified as having a disease, but really, that it’s a normal life stage that every woman will go through. So there are initiatives like that to protect older workers, for example, the Protecting Older Workers Against Discrimination Act, which was passed in Congress in 2021, but hasn’t been passed by the Senate. So definitely, we need to lobby our congresspeople. And then I think we should start demanding more from our health plans. And we are the chief healthcare decision makers, right, and wield the greatest economic power of any other groups. So I think we need to use that power and influence to get the support and solutions we want. You know, many services, solutions, and drugs are not reimbursed, or they’re really cost prohibitive. So we need to recognize that all women should have access to affordable care and pricing for menopause.
*This Q&A was edited for clarity.