Jason Resendez is President and CEO of the National Alliance for Caregiving and Madhavi Vemireddy, MD, is a family caregiver and CEO of Cleo
November is National Family Care Month.
Let’s call her Mary. She’s 52 and hasn’t slept through the night in months. She spends her days juggling work, taking her father to his next neurology appointment, and refilling her mother’s cancer medication. She suffers from hot flashes and mood swings that interfere with her workday. She suspects it’s menopause. What she doesn’t know — and what her doctor never asked about — is that the more than 27 hours a week she spends caring for her aging parents may be making those symptoms worse.
New research from the Mayo Clinic suggests a strong connection between the severity of menopausal symptoms and the often invisible caregiving responsibilities that millions of women take on in midlife. A cross-sectional study of more than 4,000 women between the ages of 45 and 60 found that women who provide care for 15 or more hours per week were 77% more likely to experience moderate to severe menopausal symptoms than women who did not provide care. The finding persisted even after the researchers controlled for possible confounding factors.
The pattern was clear: symptom burden was closely related to caregiving responsibilities, rising steadily from about one in three women with the lowest hours of caregiving to one in two women with the most intensive caregiving hours. The data reveals a cruel irony familiar to many caregivers: The more care a woman provides, the less able she is to care for herself and the more difficult her own transition to midlife becomes.
While insightful, this should come as no surprise given that women in our country bear a disproportionate share of family caregiving responsibilities and that women’s health and research have been given low priority across generations.
According to the National Alliance for Caregiving and AARP, 63 million Americans provide ongoing care for a family member or friend, and 61% of them – or 38 million – are women. Not only do you take on more caregiving tasks; They also absorb more of the physical, emotional and financial costs of care. Compared to men, women report more frequent physical strain, emotional stress, and difficulty taking care of their own health. And too many do this in isolation: almost one in four female carers say they feel alone.
These inequalities do not equate to personal failure, but rather indicate a fundamental breakdown in systemic support for women providing care across the lifespan and particularly in midlife. At the same time, increasing evidence suggests that this is a critical time for physicians to recognize the role of nursing in shaping women’s health.
Hot flashes, sleep problems, brain fog, mood disorders, joint pain – these aren’t just the symptoms of menopause. They are also symptoms of chronic caregiving stress. When they occur together, as the Mayo research suggests, the compounding effects add to the already severe health disparities faced by women.
Workplace data backs up this story. According to a Family Health Index report on working caregivers conducted by global family care platform Cleo, menopause symptoms were directly tracked with burnout risk scores, and midlife women were at the highest risk of burnout of any group.
Key findings from Cleo’s nearly 20,000 assessments found that 64% of working women in the sandwich generation are at breaking point due to increasing psychological distress, higher healthcare costs, loss of productivity and turnover.
46 percent of women ages 40 to 54 are at the highest risk of burnout across all age groups, characterized not only by exhaustion but also by measurable warning signs of deteriorating health. Most report significant declines in self-care and general health, and more than half of respondents screened positive for depression and anxiety on the Patient Health Questionnaire-4 (PHQ-4), along with increased social isolation.
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Employers and health insurers can stop this cascade before it begins. Proactive risk assessments that identify employees and members on the path to burnout open the door to timely intervention – guidance, coaching and mentoring that keeps women employed, healthy and holistic.
Yet in most clinical encounters, menopausal women are asked about their hormone levels rather than their caregiving responsibilities. They are offered tools to manage symptoms but are not screened for caregiving burden that could be causing or exacerbating those symptoms, although tools such as the Caregiver Self-Assessment Questionnaire (CSAQ), a validated screening tool already used in some clinical settings, are available.
As Maria waits to see her doctor, she thinks about the last 48 hours of administering medication and treating her father’s dementia symptoms. She is exhausted from hot flashes and the increasing demands of caring for her parents. If your doctor doesn’t have this complete picture, your treatment plan may be incomplete.
Physicians caring for midlife women—particularly during menopausal consultations, primary care visits, and mental health evaluations—should regularly ask about care status. How many hours per week? What does the care include? Is there a breathing space? Is there support? These questions take minutes. The information they provide can redefine everything: the severity of symptoms, the barriers to treatment adherence, and the need for referrals to caregiver support resources. Most importantly, women receive better care.
However, these issues go beyond the mere challenges of clinical practice. These findings point to deeper inequality.
Across the world, women spend 25% more of their lives in poorer health than men, yet we have invested remarkably little in understanding why. Nursing has shaped women’s lives for centuries, and menopause has been a recognized health transition since the 19th century. That research is only now beginning to examine their intersections shows how long women’s health has been an afterthought.
That is starting to change.
Organizations like HealthyWomen and the Society for Women’s Health Research are making significant political gains, and philanthropists like Melinda French Gates are making groundbreaking investments in women’s health research.
The tide may be turning, but politics and philanthropy alone won’t help Maria in the exam room. This requires a change in clinical culture and systemic changes from employers and payers.
It can start with a single question: Are you nursing?