Women’s health care company Bonafide polled more than 2,000 U.S. women ages 40–64 for its fourth-annual State of Menopause report, the results of which were published Monday. More than three in four women (76%) reported having no workplace accommodations for menopause, a biological milestone over 1 million women nationwide experience each year, according to the National Institute on Aging (NIA).

These data reflect a decrease in already minimal support; nearly a third of respondents (31%) in Bonafide’s inaugural 2021 survey reported feeling at least “slightly supported” by their employer.

In this year’s survey, just over half of women (51%) said they want increased workplace accommodations. Empathy from colleagues and increased time off are just two ways companies can help meet the needs of employees going through menopause, the report says.

“The days of suffering in silence are over,” Dr. Alyssa Dweck, a practicing gynecologist and Bonafide’s chief medical officer, tells Fortune. “If you’re on crutches or you’re in a wheelchair, it’s very reasonable to make sure the elevator is working if you work in a tall building.

“So if you’re suffering with hot flashes and night sweats and they’re interfering with your work or they’re interfering with your productivity, why wouldn’t it make sense to give simple options to make people more comfortable?”

Women say menopause has impacted job performance

While temporary, a woman’s odyssey to menopause is hardly brief. Perimenopause, also called the menopausal transition, usually begins between the ages of 45 and 55, and can last seven to 14 years, according to the NIA. Not all women experience symptoms, but some face a range and combination of symptoms, from hot flashes and painful sex to depression and trouble sleeping. Formally, menopause marks one year after a woman’s final period.

In other words, the pinnacle of a woman’s career may overlap with years-long, unavoidable changes to her mental and/or physical health. Nearly one in two women (49%) polled by Bonafide said menopause has impacted their job performance. It’s worse among women under 50, about 76% of whom said their job performance has suffered.

“The women who were a little younger, 40 to 49, felt a little bit more helpless and less seen and less appreciated, I suppose, in the workplace, and were very interested in having more accommodations made to make their day-to-day lives more comfortable,” Dweck says.

Dweck wasn’t surprised by the age discrepancy, which she says has a clear culprit: technology. It’s not that the older women surveyed don’t feel the same impacts of menopause in the workplace, she says; rather, they may be used to a “grin and bear it” culture.

Women under 50, Dweck says, “grew up using cycle apps to monitor their flow. They grew up with much more tech as it involved fertility. So, naturally, they’re also going to be much more tech-savvy and interested when it comes to symptoms during the menopause journey.” Bonafide reports women under 50 are four times more likely to use a mobile app, wearable technology, or digital health care platform to manage their menopause symptoms.

Nearly half of all respondents (48%) said they believe women experiencing menopause are seen as less productive or emotionally stable in the workplace. And in addition to fielding workplace discrimination such as ageism, misogyny, and wage gaps, more than two in five women (42%) said menopause symptoms have inhibited their career ambitions.

Failing to address these concerns could have devastating consequences on companies’ bottom lines and the U.S. economy—women 16 and older accounted for 47% of the workforce in June—aside from stymieing women’s professional trajectories. Last year, a Mayo Clinic study estimated menopause contributes to $1.8 billion per year in lost work time in the U.S., a figure that skyrockets to $26.6 billion when medical expenses are included. The institutional knowledge that female employees of a certain age bring to the table is also at stake.

“These are the women who have already climbed quite a bit at their jobs…they may have many people working under them,” Dweck says. “Why would any employer want to get rid of or lose a super productive person who’s already fully trained and very valuable to the workforce at that job?”

After all, unless a company has an all-male workforce, Dweck says, each of its employees who menstruate will hit perimenopause sooner or later.

What can companies do to support employees experiencing menopause?

Let’s Talk Menopause, a national nonprofit advocating for menopause education and research, advises companies to incorporate these best practices to support female employees:

• Create an employee resource group
• Designate an executive as the menopause point person
• Make physical accommodations, such as fans and cool rooms
• Offer flexible work hours and locations

While the subject of menopause is becoming less taboo—Bonafide reported a 12% increase from 2023 in the number of women who openly discuss menopause with friends and family—it’s understandable that not every woman feels comfortable addressing her associated needs at work. When in doubt, talk to HR, Dweck says. Companies may also consider providing educational resources or telehealth sessions with a menopause coach, and relaxing the dress code during the warmer months.

Employees going through menopause, Dweck says, would be likely to be “more loyal, thoughtful, and engaged if they had that perception that their bosses really cared about them, even on such a simple level.” 

For more on navigating menopause in the workplace:

• Menopausal women say they are unsupported at work. Here’s how employers can step up
• How to manage (and normalize) menopause at work
• Maven CEO: Menopause shouldn’t be an invisible tax on women in the workplace
• Failing to accommodate worker menopause costs the U.S. economy more than $25 billion a year