The Trump administration has exacerbated an already dismal status quo for women’s health. In the United States today, women die from avoidable causes more than in any developed country. Our maternal mortality rates are among the highest worldwide, exponentially worse for Black women. All the while, the National Institutes for Health (NIH) continues to slash grants that address disparities by race, sex, or gender, outright barring words like “women” and “diversity” from funding proposals.

Yet, in statehouses across the country, lawmakers seem to be delivering on at least one area crucial to women’s well-being: menopause care. How is it that this issue of all the issues has broken through as a matter of public policy? As a writer, lawyer, and advocate whose work centers on the politics of periods, from first to final, I’ve seen firsthand how menopause can defy partisanship and win political support. The momentum menopause advocates have built offers important lessons for all of us at a time when it can feel like all hope is lost.

A decade ago, I helped to develop a legal and policy blueprint for dismantling the “tampon tax” in the then-40 states charging sales tax on menstrual products. More than half (22 states) have since passed laws axing the tax, as municipal, state, and federal jurisdictions, including the first Trump administration, moved to mandate free pads and tampons in public facilities like schools, jails, and prisons. The mechanics of menstruation seem to evoke an oddly potent combination of empathy and engagement among lawmakers—I once teamed up with a male Republican lawmaker to write publicly about it—opening the door to uncommon bipartisan agreement. We all bleed red.

Unlike the above menstrual policies, which were all but nonexistent in this country prior to 2015, there is a well-documented history of active neglect of midlife women’s health on Capitol Hill, no matter the party in charge. While women have long been disregarded in medical research, it was the 2002 press conference about the Women’s Health Initiative, the first-ever and to this day largest NIH-funded study of postmenopausal women, which caused a cascade of misinformation and harm that lingers still today.

It took another two decades for a “menopause moment—marked by viral headlines and celebrity spokespeople—to coalesce. This moment has morphed into a burgeoning movement, driving the demand for modern, evidence-based care, treatment, and medical education, and leading to a rare opportunity in 2024 to win a trifecta of congressional action, regulatory reform, and federal research dollars. President Biden signed an executive order in March of that year, directing $12 billion to midlife and menopause research funding, as Congress introduced a related suite of bipartisan, bicameral bills. But by the time November came and went, it seemed unlikely that momentum would survive the second Trump administration. (It has, sort of: The now-ousted commissioner of the US Food and Drug Administration succeeded in his short tenure in scrapping outdated warnings on menopause hormone therapy that have long impeded its usage.)

By the eve of Inauguration Day, a multidisciplinary group of advocates and physicians joined forces to publish a Citizen’s Guide to Menopause Advocacy, a collection of policy proposals and mobilization strategies that would be viable at the state level, in particular. These quickly took hold; within weeks, headlines dubbed the rapid rise in menopause policy “the new tampon tax.” Even in some of the most polarized and gerrymandered legislatures—from Louisiana to Ohio and Texas, each of which has rolled back healthcare in the most diabolical ways—lawmakers stepped up to try to deliver something, anything, to constituents in the name of menopause.

Last July, CNN reported that the state-level policy strategy had morphed into a “national movement.” And now, one year later, more than half the states, red and blue alike, have introduced at least one bill focused on improving menopause care. Since 2024, more than 60 bills have been introduced in total, 15 of which are now law. (The organization I lead at New York University School of Law, the Birnbaum Women’s Leadership Center, tracks these policies; my forthcoming book, When in Menopause: A User’s Manual & Citizen’s Guide, provides a road map for winning these and more reforms.)

To be sure, it may well be that for some of the conservative lawmakers who aim to deliver on menstruation and menopause, while otherwise wreaking havoc on democracy, they are only in it for cheap grace. But all this momentum opens the door to reshape the national conversation about equity in women’s health—a string of verboten words, I know—in light of the array of state policies gaining traction.

Private insurance and Medicaid coverage: A 2025 study conducted by GoodRx found that one in five women delayed or passed up menopause treatment due to financial concerns and only 26 percent have insurance coverage that includes menopause hormone therapy, leaving most to pay entirely out of pocket. Neither Medicaid nor Medicare have a mandate to include menopause care, shutting out huge swaths of the population.

To date, Illinois, Louisiana, Maryland, New Jersey, Oregon, Utah, and Washington have enacted laws to change this for all or state-employed women in those states; California passed legislation too, only to be vetoed by Governor Gavin Newsom, thanks to pressure from the insurance industry. Newsom subsequently wrote limited coverage provisions into the state budget.

Improved education for doctors (and patients): A lack of menopause physician training and overall education has led to vast gaps in care. All specialties—ob-gyns and internists, certainly, as well as endocrinologists, orthopedists, neurologists, cardiologists, and oncologists—need to be aware of how hormonal changes affect every major organ system in the body, and how menopause is experienced differently among Black women and women of color, LGBTQ people, those who go through early or premature menopause, and cancer survivors. Yet the majority of clinicians are taught nothing on the topic.

There are attempts in the private sector to change this dynamic. The Menopause Society has launched the NextGen Now Initiative, a training program designed to reach 25,000 healthcare professionals by 2028. Telehealth companies and nonprofits are also developing innovative, well-funded models to help close the care gap.

But neither of these is a substitute for the systemic change catalyzed by public policy, which can better incentivize medical education and public information that is accurate, up to date, and nuanced. Among the states that have new laws in effect to those ends are California, Maine, Maryland, and New Jersey.

Protection against workplace discrimination: As menopause goes mainstream, so too has the concept of “menopause-friendly” workplaces. Accommodations and benefits are becoming more common, making it increasingly urgent to rectify the lack of federal protection from discrimination on the basis of menopause (which is not affirmatively covered under adjacent laws like the Americans With Disabilities Act, the Pregnant Workers Fairness Act, or the Family and Medical Leave Act).

States and municipal governments are uniquely positioned to do so. Rhode Island became the first to extend its fair employment practices pertaining to pregnancy and pregnancy-related conditions to include menopause and menopause-related conditions. Philadelphia’s City Council has done the same, and the citywide policy will go into effect in early 2027. Washington Governor Bob Ferguson recently issued the first-ever menopause-focused statewide executive order calling for a full study on menopause and the workplace.

All of this progress is meaningful—in part because it shines a light on systemic failures in our healthcare system for the millions who enter menopause every year. It also presents a ripe opportunity to broaden the media and policy drumbeat around menopause and women’s health, and begin to spell out the need for even further-reaching reforms.

I’m especially keen to see states leverage public university funding for medical research that will bolster and, if needed, replace federal dollars. Given the anti-DEI chokehold on NIH grants, this could be a game changer for so many health issues, extending well beyond menopause.

Improving transparency in pharmaceutical supply chains is another much-needed intervention, in light of the latest menopause crisis: a sharp decline in the availability of commonly used hormone treatments—estradiol patches and progesterone pills. As manufacturers deflect responsibility, blaming the disruption on increased demand (which is not the case) and production shortages, patients are going without essential medication and no one is being held to account.

Among the lessons I’ve gleaned after a decade in the period policy trenches, first is that meaningful healthcare reform need not begin and end at the federal level; we all must remember at the ballot box that it absolutely matters who is in leadership in statehouses, in city councils, and at public agencies and institutions. And second, we should always be open to unexpected inroads for progress. No surprise to me: Menopause, as it happens, is now that catalyst.