Study in Mayo Clinic Proceedings highlights a critical need for greater advocacy for more inclusive healthcare policies and support systems for midlife women in caregiving roles

Rochester, MN, January 30, 2025 – Researchers have identified a link between the number of caregiving hours per week a woman performs and menopause symptom burden. A novel study in Mayo Clinic Proceedings, published by Elsevier, found that women caregiving for more than 15 hours a week have significantly increased odds of experiencing moderate or severe menopause symptoms. It sheds light on the adverse health outcomes associated with an increased burden of caregiving.

The majority of caregivers in the United States are women with an average age of 50 years. The duration of caregiving in the United States is about five years, further raising the likelihood that women who are caregivers are likely to experience the menopause transition in the course of caregiving. They are generally having children later in life such that they may have, in midlife, the dual and concurrent commitment to care for their own children as well as an aged adult, known as the “sandwich generation.”

Caregiving can undermine a caregiver’s lifestyle, compromise their ability to focus on their own health, and contribute to higher levels of anxiety, depression, and burnout, with these effects being more pronounced in women than in men. The overlap of caregiving and menopause may impose a disproportionate physical and emotional burden on midlife women. The current study was conducted to assess the association between caregiving status, hours spent caregiving, and menopause symptom severity.

Lead Investigator Stephanie S. Faubion, MD, MBA, Division of General Internal Medicine, Mayo Clinic Women’s Health, Mayo Clinic, Jacksonville, FL, says, "This study demonstrates an association between time spent caregiving and menopause symptom burden in midlife women. Women have many different roles, and during midlife, they may be navigating challenging careers, dealing with menopause, and at the same time may have significant caregiving responsibilities for an aging parent, a partner, or even a child with special needs. It is critical to better understand these links so that we can better support women during this universal life transition."

In a cross-sectional analysis conducted among 4,295 women aged 45-60 years who received primary care at one of four Mayo Clinic locations between March 1 and June 30, 2021, 19.7% self-identified as caregivers and 37.6% reported moderate to very severe menopause symptoms as assessed by the Menopause Rating Scale. The burden of menopause symptoms across all symptom domains increased as the weekly number of caregiving hours increased, and this association persisted when relevant indices of daily stress levels and mental health were taken into consideration: 34.1% in the less than 5 hours/week group, 42.6% in the 5-14 hours/week group, and 50.4% in the 15 hours or more/week group. Further analysis showed that caregiving for 15 hours or more/week significantly increased the odds of having moderate or worse menopause symptoms in at least one symptom domain compared to no caregiving.

Co-investigator Ekta Kapoor, MBBS, Mayo Clinic Women’s Health and Women’s Health Research Center, Mayo Clinic, Rochester, MN, notes, "Menopause and caregiving are two life experiences that commonly intersect, yet their reciprocal influences had not been explored prior to this study. We have major gaps in understanding the menopause experience and how it differs in diverse populations or under different circumstances. This is the first study to examine an association between menopause symptoms and caregiving in midlife women, helping to provide more clarity on the full lived experiences of women in midlife."

Co-investigator Chrisandra L. Shufelt, MD, MS, Division of General Internal Medicine, Mayo Clinic Women’s Health, and Women’s Health Research Center, Mayo Clinic, Jacksonville, FL, adds, "This study is crucial because women in midlife or approaching menopause often juggle caregiving responsibilities for both children and aging parents, finding themselves in the ‘sandwich generation.’ Given the aging US population and likely resultant increases in caregiving burden that can exacerbate menopausal symptoms, women should be aware of effective treatment options available through a menopause provider. Our study highlights the need for greater advocacy for more inclusive healthcare policies and support systems for midlife women in caregiving roles."

The investigators offer the compelling suggestion that caregiver status should be included under the rubric social determinants of health (SDOH); be assessed and documented in the medical record; and be considered for its potential exacerbatory effects on menopause symptoms and its other risks.

Karl A. Nath, MBChB, Mayo Clinic Division of Nephrology and Hypertension, and Editor-in-Chief of Mayo Clinic Proceedings, comments, “Caregiving is essentially altruistic in origin, but it should not be a zero sum game, wherein the beneficent and unfettered provision of care and support then impose a stressful and inordinate burden on the caregiver. In this regard, this study provides needed advocacy for health care policies and support systems that can aid and ease the burdens of the caregiver including those that worsen menopause symptoms.”

Information on menopause-certified clinicians can be found on the Menopause Society website at menopause.org.