Midlife Crisis: HRT Safety Warning and Economics of Menopause

• In Event: Lightning Session: Health Policy

Abstract

Women's labor force participation (LFP) in the United States rose steadily through the late twentieth century but has exhibited diverging trends across age groups in recent decades. While participation among younger women has stagnated, LFP among midlife women (ages 45–64) has increased significantly, making them one of the fastest-growing segments of the workforce. At the same time, menopause—a near-universal biological transition occurring during these years—remains understudied in economic analysis, despite its documented effects on health, productivity, and employment outcomes.

This paper examines how a major health information shock—the 2002 Women’s Health Initiative (WHI) findings—affected the labor supply of midlife women. Prior to 2002, Hormone Replacement Therapy (HRT) was widely used to manage menopausal symptoms and was believed to confer long-term health benefits. The WHI findings, which linked HRT to increased risks of cardiovascular disease and breast cancer, led to a sharp decline in HRT use following widespread media coverage and subsequent FDA warnings. This sudden shift in medical guidance provides a quasi-experimental setting to study how changes in access to symptom-relieving treatment influence labor market behavior.

To quantify exposure, I construct a continuous measure of treatment intensity based on each woman’s predicted probability of being peri- or post-menopausal. These probabilities are estimated using biological and demographic data from the Study of Women’s Health Across the Nation (SWAN) and mapped onto individuals in the Current Population Survey (CPS). Using a two-way fixed effects framework, I exploit the timing of the WHI announcement and FDA warning to estimate differential changes in labor supply among women with varying degrees of menopausal exposure.

The results show that the WHI-induced decline in HRT use led to economically meaningful reductions in labor force participation among women more likely to be undergoing menopause. At average exposure levels, LFP declines by approximately 10–18 percentage points among peri-menopausal women and 10–12 percentage points among post-menopausal women, representing substantial reductions relative to baseline participation rates. Effects are larger in magnitude for peri-menopausal women but more persistent for post-menopausal women.

These findings highlight menopause as an important and previously underappreciated determinant of labor supply and demonstrate that health information shocks can have significant economic consequences beyond direct clinical effects. By framing menopause-related health changes as a productivity shock, this paper contributes to the literature on health and labor markets and underscores the broader economic implications of gender-specific biological processes.

Author

• Nikita Dhingra, Georgia State University
  Presenting Author