Hormones at Work: Causal Evidence on Menopause, Medication, and Women’s Labor Market Outcomes

A growing body of anecdotal evidence suggests that menopause costs women a substantial reduction in earnings and superannuation, and could adversely affects their employment, job security, career progression and retirement decisions. Hormone Replacement Therapy (HRT) is widely regarded as the most effective treatment for menopausal symptoms. Yet, access to HRT has been limited. Following a highly influential but later-discredited 2002 study linking HRT to increased risks of cancer and cardiovascular diseases, treatment rates has decreased worldwide. Although global use of HRT has increased substantially since the 2017 reversal of clinical guidelines, uptake in the Netherlands remains strikingly low: only about 4.5 percent of women aged 40 - 60 receive HRT, compared with 15 percent in the United Kingdom and 20 percent in Belgium. This suggests that Dutch women are likely to be under-treated of menopausal symptoms in the Netherlands. This thesis aims to provide causal evidence for the Netherlands on how experiencing menopause, and how inequality in access to care, affects women’s labor market outcomes. Using rich Dutch administrative data, we exploit quasi-random variation in propensity to receive HRT prescription based on local physician’s willing to prescribe HRT. Because doctors vary in prescribing behaviors, depending on the propensity of local doctors to prescribe HRT, women with similar symptoms may (not) receive treatment based on the area in which they live. This creates a plausibly exogenous variation in treatment assignment, which enables us to study the causal impact of access to care on women’s career. A subsequent PhD project would continue this research by continuing to study how menopause and unequal access to care shape women’s wellbeing and labor market outcomes, for example by studying the role of workplace arrangements in mitigating menopause related problems.