Back in February, shortly after Dr. Mary Claire Haver and I published the Citizen’s Guide to Menopause Advocacy, I wrote an essay entitled “Is This the One Issue That Can Transcend Political Lines?” for Katie Couric Media readers. In it, I proclaimed, “We have to get serious about mobilizing the menopausal masses — the legions of everyday people failed by our nation’s dismal investment in and delivery of women’s mid-life healthcare. Menopause reforms would improve the lives of 75 million individuals, while boosting the economy and helping families. In fact, these may be among the only women’s health matters that can transcend the political gridlock over the next few years.”
Five months later, let the record show that the essay’s headline was right on the money: A burgeoning movement is making waves at all levels of government.
Menopause legislation — state by state
The Citizen’s Guide deliberately zeroed in on priorities that already enjoyed bipartisan or private sector support at the state level — such as upgrading public education about menopause, improving training for healthcare providers, and ensuring access to menopause treatments.
The result? More than two dozen bills introduced across 15 states, red and blue alike. As of July 2025, the following states have officially passed menopause laws: California (continuing medical education opportunities for providers); Illinois (mandatory insurance coverage for menopause treatments and a dedicated Menopause Awareness Week); Louisiana (mandatory insurance coverage for menopause treatments); Maine (state health department educational resources); Rhode Island (workplace protections); and Washington (support for accessing treatment).
When legislative sessions come to a close by the end of the month, we will update the Citizen’s Guide (and KCM article) with links to every bill introduced this session, and whether or not it passed, so you can see where your state stands.
All told, this progress shows tremendous potential. Getting laws on the books is just one marker of success. It’s just as important that lawmakers are willing to step up and speak out on the issue. And while it can take years for bills to cross the finish line, simply having the language on record has value: snippets of provisions, even full text, often find their way into budgets, and hearings yield compelling testimony.
For the record, this is exactly what happened — twice! — with regard to legislation to make menstrual products more affordable and accessible. Recycled language turned up in two bills that went on to become the law of the land: The First Step Act of 2018 (a federal criminal justice law that mandated pads and tampons be provided in federal prisons) and The CARES Act of 2020 (the first pandemic stimulus package made menstrual products eligible for pre-tax allowances under Flexible Spending and Health Savings Accounts). Notably, both are the only federal menstrual equity laws in the nation’s history. Meaning that change can also happen in unexpected times and places.
Movement on the federal level
This week, the Food and Drug Administration will hold a two-hour briefing with medical experts to focus on menopausal hormone treatments. The session is open to the public and will be live-streamed; you can sign up and watch it here.
Among the issues addressed will be the decades-old labeling requirement for estrogen products, a.k.a. the “black box warning.” The Citizen’s Guide argues the FDA should eliminate the warning on packaging for vaginal estrogen — which is the most effective treatment for genitourinary symptoms of menopause and can improve and even save women’s lives.
New York Times health and wellness reporter Jancee Dunn described her first foray with vaginal estrogen: “When I brought the tube home from the pharmacy, I was alarmed by the all-caps warning emblazoned on the box, alerting users of the risks of ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, BREAST CANCER, AND PROBABLE DEMENTIA. (Probable dementia?).” For many women, after reading that label, they throw the prescription right in the trash. For doctors not trained in menopause care — translation, the vast majority, including OB-GYNs — many refuse to prescribe it at all.
According to Citizen’s Guide contributor Rachel Rubin, MD, who is among those presenting at the FDA, eliminating the warning would also save our healthcare system billions. She says, “As women get older, they become more susceptible to frequent urinary tract infections. We have excellent data, spanning many decades, showing that vaginal estrogen products reduce the risk of future UTIs by more than 50 percent — which means less pain, fewer urgent care visits and hospitalizations, and even reduced risk of death, due to sepsis.” Dr. Rubin is part of a team that published a 2024 report showing that if Medicare patients regularly received vaginal estrogen, the program could save between $6 billion and $22 billion per year.
In 2014, physicians filed a citizen petition to counter the FDA requirement, which the agency denied. Last year, the effort was reignited by the nonprofit Let’s Talk Menopause through a campaign called Unboxing Menopause.
The general public must be aware of this history, given the current state of U.S. federal health agencies, particularly the FDA. The advocacy community will hold the FDA to a fair, transparent process at this week’s hearing and thereafter.
These are challenging times for women’s health, no doubt. We must keep mobilizing to ensure progress on an issue as important and far-reaching as menopause care.
