The High Cost of Perimenopause

by WV Marshall

When looking at a universe of expenditures for medical conditions, much remains unknown about how the direct costs related to perimenopausal symptoms compared with costs of other ailments common among women. However, three studies seem to all agree on one thing: There is a cost, whether it is financial, emotional, workplace or societal.

The objective of one study, published in 2017, was to compare the economic costs of menopausal symptoms with 15 other health conditions among menopausal women ages 45 to 65 in the United States who had not had a hysterectomy. The undertaking was sponsored by Pfizer Inc., and supported by the National Institute of Mental Health of the National Institutes of Health, which published the study and the results.

Researchers noted that while menopausal symptoms often are temporary, they can be long in duration (between seven and 10 years, and potentially lasting a lifelong for some women) and often become sufficiently difficult that women seek medical intervention. The research indicated the annual direct health care costs of menopausal symptoms, excluding prescription drug costs, were similar to or greater than annual direct costs associated with conditions such as osteoporosis, disorders of lipid metabolism, esophageal disorders, influenza, asthma, anxiety disorders, essential hypertension, and headaches, including migraines.

Among the study’s findings:

Perimenopausal and postmenopausal symptoms are costly and negatively affect quality-of-life issues, personal and intimate relationships, and productivity. The mean annual per-patient direct cost of menopausal symptoms was $248, excluding the cost of prescription medications. The mean annual per-patient direct costs of the comparator conditions ranged from $26 for osteoporosis to $3,440 for cataract. The direct cost of care for perimenopausal symptoms was significantly higher than the costs associated with osteoporosis, lipid metabolism disorders, and esophageal disorders.

Treating moderate-to-severe vasomotor symptoms (hot flashes and night sweats) with hormone therapy may be cost-effective in younger menopausal women.

Women with more severe menopausal symptoms often sought healthcare treatment for these symptoms, the study indicated. “In a cross-section U.S. population–based survey of 4,402 women aged 40 to 65 years, approximately 60 percent said they had consulted a healthcare provider regarding menopausal symptoms, and the proportion who had sought such care increased with age,” the study indicated. A majority of survey participants reported using some type of treatment such as hormone therapy or an alternative therapy.

Researchers cautioned, however, that this information could represent limited estimates of the affected number of women, because it is likely that some women either don’t seek help from their healthcare provider, or mention some symptoms and not others in discussions with their providers.

Also, perimenopausal symptoms levied an increased economic burden via direct costs of healthcare/emergency room visits, prescriptions and over-the-counter medications, lab work and pain management.

This study’s researchers noted that a 2007 analysis found the total health outlays for menopausal symptoms were estimated at $3 billion annually in the United States.

In a 2015 analysis, the annual direct costs of untreated hot flashes and night sweats were estimated at $1,346 per person, while the annual indirect costs – mainly because of absenteeism – were assessed at $770 per person.

Other indirect costs may include the loss of productivity at work or at home, increased energy use for air conditioning and laundry, and hygiene-related personal costs.

In an analysis conducted in 2013 that compared women who had no menopausal symptoms with those who did, “women with menopausal symptoms had $1,343 higher overall direct costs, $457 higher prescription drug costs, $48 more sick leave costs, 0.27 more sick leave days annually, lower hourly productivity rates by 2 units of work, and lower annual productivity rates by 2600 units of work.”

The researchers of the 2017 study suggested that future studies should evaluate whether treatment of bothersome menopausal symptoms is cost-effective from a societal perspective and whether it reduces indirect costs and improves health-related quality of life. Although there are costs incurred from treating menopausal symptoms, not treating them may prove even more costly.

Besides being a burden on the wallet, menopausal symptoms can be a burden on work.

A 2017 study conducted by Britain’s Government Equalities Office reported that one in 10 women in their early 50s reported suffering “severe symptoms” from menopause that affected their work. The most common culprits: lack of sleep, hot flashes/flushes, migraine headaches, mood swings and emotional outbursts.

Rejuvage reported more than 3.5 million female workers are over age 50 in the UK and the average age of the menopause is 51.

It said the government report, assuming 174,000 women would experience severe menopausal symptoms that affect their ability to work, estimated their absence in the workforce would “cost the economy at least 7.3 million pounds in absence-related costs. … [But] this estimate failed to include other costs like ‘symptom-related lateness for work, lost productivity due to medical appointments during working hours [and] women who reduce their working hours due to symptoms’.”

The report concluded that companies and their managers must do more to support menopausal employees and understand the effects menopause can have on the workplace, the economy and society.

Sam Smethers, chief executive of the Fawcett Society, the UK’s leading organization advocating for gender equality and women’s rights, told Rejuvage, “This report reveals that there are more women over-50 in the workplace than ever before but they are suffering in silence with menopausal symptoms.”

In the United States meanwhile, a team from Yale School of Medicine released a review in 2014 that found the drop in the use of hormone therapy spurred a widespread but preventable side effect: millions of women quietly enduring the most common menopausal symptoms.

In the study, the research team found that moderate to severe hot flashes – aka vasomotor symptoms – are not treated in most women. Women with VMS endure much more than just feeling hot; other frequently experienced symptoms include fatigue, sleep disturbance, depression, anxiety and impaired short-term memory, the study said.

“Not treating these common symptoms causes many women to drop out of the labor force at a time when their careers are on the upswing,” said Dr. Philip Sarrel, professor emeritus of obstetrics, gynecology and reproductive sciences, and psychiatry.* “This also places demands on health care and drives up insurance costs.”*

Sarrel and his team culled data on health insurance claims to compare more than a half-million women, half experiencing hot flashes and half not, then calculated the costs of healthcare and work loss over a 12-month period. The team found that women who experienced hot flashes had 1.5 million more healthcare visits than women without hot flashes. Costs for the additional care was $339,559,458. The cost of work lost was another $27,668,410 during the 12-month study period.

Hot flashes at one time were readily treated with hormone therapy or alternative approaches. However, after findings in the Women’s Health Initiative Study were published in 2002, there has been a sharp drop in the use of hormone therapy due to unfounded fears of cancer risks, according to Sarrel.

“Women are not mentioning it to their health care providers, and providers aren’t bringing it up,” Sarrel said. “The symptoms can be easily treated in a variety of ways, such as with low-dose hormone patches, non-hormonal medications, and simple environmental adjustments such as cooling the workplace.”