States Move to Protect Employees with Disabling Menstrual and Menopause Symptoms 

A growing number of states are moving toward the adoption of laws that would require employers to provide reasonable job accommodations, paid leave, or insurance coverage for women with disabling menstrual cycle or menopause symptoms. 

Bloomberg Law reports that some state legislators see a need to close perceived gaps in federally mandated employment protections, including those afforded under the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA). According to a 2024 Department of Labor brief on Menstruation and Menopause at Work, federal laws do not explicitly protect women from discrimination due to conditions related to menstruation, perimenopause, or menopause. 

Under the ADA, a woman must provide medical evidence that episodic symptoms are severe enough to qualify her for a reasonable job accommodation. In response to the evidence, the employer must either grant the accommodation request or prove that it is not reasonable and would create an undue hardship for the company. 

Symptoms that may occur before or during menstruation include pelvic or back pain, cramps, dizziness, headache, migraine, nausea, brain fog, mood swings (e.g., depression, anxiety), and fatigue. Hormonal changes during perimenopause and menopause may cause intense hot flashes, night sweats, sleep disruption, daytime exhaustion, depressive episodes, and cognitive impairments that affect concentration and other safety-related behaviors. 

Why States Are Getting on Board 

Legislative trends that support women’s reproductive health rights have gained momentum since last year when Rhode Island became the first state to require employers to provide reasonable accommodations like temperature controls, flexible schedules, and remote work for women with menopause-related medical complaints. In its 2026 legislative forecast, Littler, a national employment law firm, reported that similar bills were pending in Connecticut, Maryland, Pennsylvania, and Virginia. 

Virginia legislators have since passed SB 258 to prohibit discrimination under the state’s Human Rights Act “for purposes of nondiscrimination in government programs, public accommodation, employment hiring, and reasonable employer accommodation” for symptoms related to menopause. A companion bill, SB 790, if signed by the governor before its April 13, 2026, deadline, will require insurers to cover treatment for perimenopause and menopause. 

Other states with pending legislation include: 

• California: AB 1940 would make menopause a protected condition under the state’s Fair Employment Housing Act. Discrimination, harassment, or failing to accommodate employees experiencing related medical conditions would constitute sex-based discrimination and prohibit employers from taking adverse employment actions.  
• Illinois: SB 2967 would create the Menstrual Health Workplace Equity Act, granting up to 40 hours of paid leave per year for menstrual health reasons, plus a needs-based option to request 40 more hours of paid leave per year or a hybrid work option. It defines a menstrual health condition as symptoms caused by menstruation, endometriosis, polycystic ovary syndrome, or menopause.  
• New Jersey: SB 3057 would require employers to allow employees to work remotely for at least two full days per month to accommodate symptoms arising from qualifying menstrual disorders, unless the employer can show this would create an undue hardship. 
• New York: AB 10270 and SB 9244 would amend workers’ compensation law to provide five days of paid leave for employees while undergoing medical care for menopause symptoms.  

It is not clear whether municipalities will follow the lead of Philadelphia, the first major U.S. city to enact a law (effective Jan. 1, 2027) requiring accommodations when symptoms of menstruation, perimenopause, and menopause substantially interfere with job performance. 

Why This Matters to Employers and Workers 

State legislative trends suggest that reactive, medicalized disability management models may be shifting toward more proactive, condition-based health management strategies. Employment law attorneys say new and proposed state legislation may be particularly applicable to women with symptoms that make it periodically difficult for them to be fully functional at work but are not severe enough to match the ADA’s definition of a “qualifying disability that substantially limits a major life activity.”  

Employers in targeted states are being advised to be prepared for potential upticks in requests for reasonable job accommodations or paid leave related to reproductive health. Women comprise about half of the U.S. workforce, and at least one-third of them are estimated to periodically experience moderate to severe symptoms related to their menstrual cycle or hormonal changes associated with perimenopause (when the cycle tapers off) and menopause (when they no longer have their period). 

For example: 

• In survey of 1,867 women over age 18, 45% reported menstrual symptoms severe enough to require taking time off from work.  
• In another study, 33% of women over 50 reported moderate-to-severe difficulty coping at work due to menopause symptoms.  
• A study of 32,738 women found 8.9 days per year of lost productivity per person, mainly attributed to presenteeism (working while functionally impaired).   

The Hidden Costs of Stigma 

Despite the number of women who are affected by moderate-to-severe symptoms, studies consistently show that a significant percentage are reluctant to disclose them to their employer. In a 2024 survey of menopausal women, Catalyst, a non-profit organization focused on women’s issues, found 72% of respondents did not report symptoms that were affecting their work performance, citing stigma, personal privacy, embarrassment, or fear of job loss.  

Failure to nurture a workplace culture where women feel supported can be costly for companies. Catalyst reports that menopause alone costs U.S. organizations an estimated $1.8 billion per year in productivity loss. Disabling symptoms that are not reported or alleviated with medical care also increase the risk for work-related accidents and injuries.  

What Can Employers Do? 

WorkCare Vice President and Associate Medicator Director Irene Grace, M.D., M.P.H., is an occupational health physician with many years of experience evaluating employees in leave and absence management and return-to-work scenarios. She encourages employers to recognize the pivotal role of the qualified medical provider who evaluates the extent of an employee’s functional limitations.  

“The medical provider’s role is to translate symptoms into work-relevant impairments. The strength of the medical documentation often determines the outcome,” Dr. Grace said. “The provider’s role is clinical, not legal. Creating a document for treating providers to complete can help ensure that all critical information is provided.”   

The provider should be qualified to: 

• Identify underlying causes and confirm the condition (e.g., endometriosis, perimenopause) 
• Describe functional limitations, (e.g., severity, frequency, affected essential functions) 
• Recommend accommodations, as requested 

The provider should not be expected to: 

• Determine legal disability status 
• Disclose protected health information 
• Enforce an employer’s obligations 

“Education regarding the impact of women’s reproductive health issues in the workplace and available solutions is paramount,” Dr. Grace said. “Employers can facilitate solutions by educating key personnel and establishing a process for addressing the needs of symptomatic employees.”  

Mandatory or optional webinars, lunch-and-learn sessions, wellness communications, small group discussion, and other types of worksite-specific offerings help create positive work environments. Dr. Grace recommends having female personnel available for interactive discussions to encourage women to come forward and minimize lost time. 

More Tips for Safe and Healthy Workplaces 

U.S. Labor Department recommendations include:  

• Temperature controls and ventilation such as fans and open windows   
• Uniforms made of breathable fabric and flexible dress codes for comfort 
• Access to bathrooms, sanitary products, and disposal receptacles 
• Providing telework, flexible scheduling, or shift modification options 

While keeping overall reproductive health in mind, employers are advised to: 

1. Be familiar with and comply with applicable OSHA standards, provisions of the ADA, FMLA, Pregnancy Discrimination Act, Pregnant Workers Fairness Act, and other federal and state laws designed to protect workers’ rights. 
2. Invite employees to collaborate with management on health education opportunities for men and women in the workforce and training all employees on ways symptoms can affect work performance. 
3. Identify accommodations that can be offered without disrupting operations or creating an undue hardship for the business – before they are needed.  
4. Consider voluntary adoption of policies such as allowable time off, paid sick leave, and insurance coverage to encourage retention. 

How WorkCare Can Help 

WorkCare’s occupational health and wellness professionals offer education, physical assessments, and referrals to local medical providers and mental health counselors to help women in the workforce stay fit, productive, and comfortable regardless of where they are on their reproductive health journey.  

We can help your company create a workplace where all employees feel safe and that their health matters. We can customize our best-in-practice solutions for your industry and workforce composition. Learn more.