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Jason Resendez is the President and CEO of the National Alliance for Caregiving and Madhavi Vemireddy, M.D., is a family caregiver and the CEO of Cleo

November is National Family Caregiving Month.

Let’s call her Maria. She’s 52, and she hasn't slept through the night in months. She spends her days balancing work with getting her father to his next neurology appointment and refilling her mother’s cancer medications. She’s been having hot flashes and mood swings that derail her workday. She suspects it’s menopause. What she doesn’t know — and what her doctor has never asked about — is that the 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 link between the severity of menopause symptoms and the often invisible caregiving responsibilities millions of women shoulder in midlife. A cross-sectional study of more than 4,000 women between the ages of 45 and 60 found that women providing 15 or more hours of caregiving per week were 77% more likely to experience moderate to severe menopause symptoms than non-caregivers. The finding held up even after researchers controlled for potential confounding factors.

The pattern was clear: Symptom burden was closely associated with caregiving responsibilities, rising steadily from roughly 1 in 3 women at the lowest caregiving hours to 1 in 2 among the most intensive caregivers. The data reveals a cruel irony familiar to many family caregivers: The more care a woman gives, the less she’s able to care for herself, and the harder her own midlife transition becomes.

While eye opening, this shouldn’t come as a surprise given the disproportionate share of family care responsibilities women shoulder in our nation and the low prioritization of women’s health and research over 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. They don’t just take on more of the caregiving responsibilities; they also absorb more of the physical, emotional and financial costs of care. Compared to men, women report higher rates of physical strain, emotional stress and difficulty attending to their own health. And too many are doing it in isolation: Nearly 1 in 4 female caregivers says she feels alone.

These disparities don’t equate to personal failures, they speak to a fundamental breakdown in systemic support for women as they provide care across the lifespan and especially in midlife. At the same time, growing evidence suggests that this is a critical time for clinicians to recognize the role caregiving plays in shaping women’s health.

Hot flashes, sleep disruption, brain fog, mood dysregulation, joint pain — these aren’t just the symptoms of menopause. They’re also the symptoms of chronic caregiver stress. When they occur together, as the Mayo research suggests they frequently do, the compounding effects contribute to the already stark health inequities women shoulder.

Workplace data reinforces this story. According to a Family Health Index report of working caregivers conducted by global family care platform Cleo, menopause symptoms directly tracked with burnout risk scores, and women in midlife faced the highest burnout risk of any group.

Topline findings from Cleo’s nearly 20,000 assessments revealed that 64% of working women in the sandwich generation are at a breaking point with escalating mental health strain, higher healthcare costs, productivity loss and attrition.

Forty-six percent of women ages 40-54 face the highest burnout risk across all age groups marked not just by exhaustion, but by measurable warning signs of health deterioration. Most report a significant decline in self-care and overall health, and more than half screen positive for depression and anxiety on the Patient Health Questionnaire-4 (PHQ-4) alongside increased social isolation.

Check in on yourself: Take a free, confidential self-assessment for depression and anxiety

Employers and health plans can stop this cascade before it starts. Proactive risk assessments that flag employees and members on the path to burnout open the door to timely intervention — guidance, coaching and care that keeps women working, healthy and whole.

Yet in most clinical encounters, women navigating menopause are asked about their hormone levels, not their caregiving responsibilities. They’re offered symptom management tools but not screened for the caregiving load that may be driving or worsening those symptoms, despite the availability of tools like the Caregiver Self-Assessment Questionnaire (CSAQ), a validated screening tool already used in some clinical settings.

As Maria waits to see her clinician, she’s thinking about the prior 48 hours of administering medications and managing her father’s dementia symptoms. She’s exhausted by hot flashes and by the growing demands of caregiving for her parents. If her clinician doesn’t have this full picture, her treatment plan could be incomplete.

Clinicians seeing women in midlife — particularly during menopause consultations, primary care visits and mental health screenings — should routinely ask about caregiving status. How many hours per week? What does the care involve? Is there respite? Is there support? These questions take minutes. The information they yield can reframe everything: the severity of symptoms, the barriers to treatment adherence and the need for referrals to caregiver support resources. Most importantly, women will get better care.

But these issues go beyond the challenges of clinical practice alone. These findings point to a deeper inequity.

Around the world, women spend 25% more of their lives in poorer health than men yet we have invested remarkably little in understanding why. Caregiving 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 intersection speaks to 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 winning meaningful policy gains, and philanthropists like Melinda French Gates are making landmark investments in women's health research.

The tide may be turning, but policy and philanthropy alone won’t help Maria in the exam room. That requires a change in clinical culture and systemic changes from employers and payers.

It can start with a single question: Are you caregiving?