The sixth round of the National Family Health Survey, or NFHS-6, was released on 29 May 2026. It covers 6.79 lakh households. It tracks maternal health, child nutrition, immunisation, and family planning in detail. It mentions menopause zero times.
Over 150 million Indian women are aged 40 to 59. They are invisible in the country’s flagship health survey.
This is not an oversight. Survey questionnaires are designed around explicit priorities. Every indicator that enters the instrument displaces another. The Ministry of Health and Family Welfare chose what to measure. Menopause did not make that list. That is a governance choice, not a technical omission.
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The numbers India is not collecting
The average age of natural menopause for Indian women is 46.2 years, with a standard deviation of 4.9 years. This is four to five years earlier than the Western average of 50 to 51 years. A 2025 meta-analysis of 34 studies across 12 Asian countries, covering 1.57 million women, confirmed India’s pooled mean at 46.37 years, the lowest among major Asian economies.
The rural-urban gap compounds the disparity. Urban women in India experience menopause at around 49 years. Rural women reach it closer to 46.5 years. The women with the least access to healthcare go through the transition earliest. They are also the least likely to be asked about it.
The perimenopausal transition, marked by irregular cycles, hot flashes, sleep disruption, joint pain, and cognitive changes, begins in Indian women at an average age of 44.7 years. Symptoms affect work capacity and quality of life for up to a decade before menopause is complete. These are not marginal health events. They are population-level patterns affecting tens of millions of women in their peak working years.
What the economic evidence from other countries shows
A Mayo Clinic study published in 2023 surveyed 4,440 employed women and found that menopause symptoms cost US employers $1.8 billion annually in lost work time alone. When medical expenses are included, the figure rises to $26.6 billion per year. Thirteen per cent of women surveyed reported at least one adverse work outcome directly tied to menopausal symptoms: missing work, cutting back hours, quitting, retiring early, or losing a job.
A multi-institution working paper published by the Institute for Fiscal Studies in March 2025, with researchers from University College London, Stanford University, the University of Bergen, and the University of Delaware tracked women over four years following a menopause diagnosis using Norwegian and Swedish administrative data. Average earnings declined by 4.3 per cent across the period, deepening to 10 per cent by the fourth year. The effect was concentrated among women without university degrees and those in manual or routine-intensive jobs. Graduate women experienced no statistically significant earnings penalty.
Petra Persson, the Stanford economist and co-author, has noted that exact magnitudes cannot be extrapolated to the United States. That caveat only sharpens the question for India. Women in Scandinavia, with universal healthcare, stronger labour protections, and higher formal workforce participation, still face a 10 per cent earnings drop by the fourth year after menopause onset.
The Indian figure, for a workforce concentrated in agriculture, domestic work, and the informal sector, with no equivalent health infrastructure, would be worse. No one knows by how much. India does not collect the data.
The workers with no policy cover
India’s female labour force participation rate for women aged 15 and above stood at 41.7 percent in the 2023-24 PLFS annual report. Participation rates are higher for women in middle age. PLFS data analysed by CEDA Ashoka University shows that women aged 40 to 44 had the highest labour force participation rate of any age group at 50.5 per cent in 2022-23, the latest year for which age-disaggregated figures are publicly available.
Many women enter or remain in the workforce at this stage as childcare demands ease. They work in sectors with few accommodations for health-related absences: agriculture, garment manufacturing, teaching, nursing, domestic work, and anganwadi services.
These are precisely the sectors where a 10 per cent earnings reduction or early labour market exit has the greatest impact on household income. The workers are already at the lower end of the earnings distribution. For them, a decade of unmanaged symptoms is not a personal inconvenience. It is an economic event with no institutional record and no policy response.
What the survey asks and what it skips
NFHS-6 asks women aged 15 to 24 about menstrual hygiene. It asks married women about contraceptive use and fertility preferences. It tracks anaemia across age groups. It records height, weight, and blood pressure. It does not ask a single question about menopause. Not about age of onset. Not about symptom type or severity. Not about treatment-seeking behaviour. Not about work impact.
The annual Periodic Labour Force Survey does not capture this either. The National Health Profile does not list menopause as a condition or a cause of morbidity. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana does not include menopausal health services as a covered benefit in its hospitalisation packages.
This data vacuum has direct policy consequences. The Ministry of Health cannot budget for menopause care at public facilities without prevalence estimates. The Ministry of Labour and Employment has no basis to recommend workplace accommodations without economic data. The Indian Council of Medical Research has not commissioned a single large-scale study on menopause prevalence or its economic impact in India.
The pattern is self-reinforcing. Without data, there is no policy demand. Without policy demand, there is no data collection.
The NFHS mandate is not a valid defence
The Ministry of Health might note that NFHS is aligned with the global Demographic and Health Surveys framework, which focuses on women of reproductive age and child health outcomes. That is accurate as a description of the inherited design. But NFHS-6 already moved beyond that framework. It now tracks health insurance coverage, women’s digital inclusion, and bank account ownership. These are not reproductive health metrics. They were added because they became policy priorities. Menopause was not added because it has not been treated as one.
Several governments have started to treat it differently. The United Kingdom appointed a Menopause Employment Champion in 2023. Australia’s Fair Work Commission has recognised menopause as a workplace health and safety concern. Japan’s 2024 health policy guidelines included menopause screening for women over 40. India has no policy conversation of this kind, in part because it has no data to anchor one.
Three changes that do not require legislation
The next NFHS round needs three additional questions: age at menopause, symptom burden using a standardised tool such as the Menopause Rating Scale, and whether the respondent sought treatment or missed work due to menopausal symptoms. The PLFS should include a module on work-limiting health conditions that explicitly covers menopause. The ICMR should fund a prevalence and economic impact study comparable to what the Mayo Clinic and the IFS-Stanford team have produced.
None of these changes require legislation. They require a decision about what the health establishment considers worth counting.
The exclusion of menopause from NFHS-6 is not a technical gap. It is a signal about what the state values. India’s most comprehensive household health survey measures what it prioritises. For 150 million women between the ages of 40 and 59, the message is unambiguous: their health at this life stage does not merit national data.
Until the survey counts them, policy will not see them. And until policy sees them, the cost to their earnings, to their workforce participation, and to the economy will remain unmeasured and unaddressed.
Sagari Gupta is an independent public policy researcher and writer with over eight years of experience across think tanks and government, including NCAER, the Institute for Human Development, and the Ministry of Consumer Affairs. Views are personal.
(Edited by Asavari Singh)