Female Health Doesn't Start at Midlife

There, I said it.

I've been thinking about that a lot lately as I've watched two stories dominate conversations about women's health. The first is Melinda French Gates' recent announcement of a $215 million commitment to women's health through her organization, Pivotal. The second is the resurfacing of a report from the McKinsey Health Institute that found closing the women's health gap could add as much as $1 trillion to the global economy annually by 2040.

Before I go any further, I want to be very clear about something. I think this is wonderful news.

Any dollar going towards women's health is a dollar that wasn't there before. Every conversation that shines a light on women's health is a conversation worth having. For generations, women's health has been underfunded, understudied, and too often dismissed. Seeing major investments, major headlines, and serious conversations about women's health feels long overdue.

At the same time, I can't stop thinking about the women who seem to be missing from much of this conversation.

When we talk about the impact of women's health on careers, productivity, and the economy, the focus right now is often on menopause and perimenopause. That focus makes sense. Research shows that many women leave the workforce, reduce their hours, or consider early retirement because of unmanaged menopausal symptoms. Stanford economist Petra Persson has even coined the term "the menopause penalty" to describe the financial consequences women experience during this stage of life. These are important issues that deserve attention, research, and support.

But I find myself wondering about the women who never made it to that point in the first place.

What about the woman whose endometriosis went undiagnosed for years? What about the woman struggling with chronic migraines that began in adolescence? What about the woman navigating autoimmune disease throughout her twenties and thirties, or the woman who spent years searching for answers to symptoms that no one could explain?

As a female health educator and advocate, these are the women I encounter over and over again. Their stories are everywhere once you start paying attention. Many of them have spent years trying to get diagnosed, years trying to be taken seriously, and years trying to build lives while carrying health burdens that most people around them cannot see.

That's why one particular finding in the McKinsey report stood out to me more than the trillion-dollar headline.

The report found that only 5% of the women's health burden comes from reproductive and maternal health. The remaining 95% comes from what the report refers to as "everything else." That category includes conditions such as endometriosis, migraine, breast cancer, PMS, and PMDD, all of which disproportionately affect women and often begin long before midlife.

When I read that statistic, it immediately brought me back to the women I see every day in these conversations. It reinforced something I've been thinking about for a long time: the women's health crisis is not simply a menopause crisis. It is a lifespan crisis.

Women's health challenges don't suddenly appear when estrogen begins to decline. For many women, those challenges begin decades earlier. They shape educational opportunities, career paths, relationships, finances, and quality of life long before menopause enters the picture.

When we discuss the economic impact of women's health, we often talk about women leaving the workforce during midlife. That is a very real problem, and it deserves attention. But I think there is another question worth asking. How many women never had the opportunity to fully participate in the workforce because their health challenges began years earlier?

How many women spent their twenties and thirties pursuing diagnoses instead of pursuing opportunities? How many adjusted their ambitions around symptoms they couldn't control? How many quietly made career decisions based not on what they wanted to do, but on what their health would allow them to do?

Those women are part of this story too.

I think about this personally because I am one of them.

I am 43 years old and entering perimenopause. Like many women my age, I am experiencing symptoms that have given me a much deeper understanding of why this stage of life is finally getting the attention it deserves. But I have also spent decades dealing with chronic health issues, and my relationship with healthcare did not begin when I entered perimenopause.

It began much earlier.

I have also had hormone-positive breast cancer, which adds another layer to this conversation. Hormone replacement therapy is discussed frequently right now, and for many women it can be incredibly helpful. I am genuinely glad those options exist. At the same time, women with a history of hormone-positive breast cancer often face a different reality, and navigating perimenopause without those options can be challenging. That doesn't diminish the importance of the current menopause conversation. If anything, it highlights how much more there is still to learn and understand about women's health.

This is why I view Melinda Gates' recent investment as both exciting and hopeful. Every investment in women's health opens doors that have been closed for far too long. Every new study, every new conversation, and every new funding initiative creates opportunities for progress.

My hope is simply that as this momentum continues to grow, we continue to widen the lens through which we view women's health.

I hope we continue talking about menopause and perimenopause. I hope we continue investing in research that improves the lives of women in midlife. But I also hope we remember the women who have been struggling for years before they ever reach that stage. The women with chronic illnesses, autoimmune diseases, reproductive disorders, migraines, cancers, and complex conditions that have shaped their lives long before menopause became part of their story.

Women's health is not confined to a single diagnosis, a single age group, or a single life stage. It touches every decade of a woman's life, and if we are truly committed to closing the women's health gap, then our conversations, our research, and our investments need to reflect that reality.

I am grateful that this conversation is finally happening. I am grateful for every dollar being invested in women's health. Most of all, I hope that as awareness grows, we continue expanding our understanding of which women we're talking about until the answer includes all of us, across every decade, every diagnosis, and every condition that has quietly shaped women's lives for far too long.