Essays on the Health and Labor Market Effects of Menopause and Menopause Hormone Therapy

This dissertation explores how menopause and its medical management affect women’s
health and labor market outcomes. Despite the centrality of reproductive transitions in
the life course of women, economic research has largely ignored menopause, a biologically
and socially significant milestone marking the end of fertility. This omission is surprising, given well-established medical evidence that links menopause to increased risks of
health conditions that may impair the ability to work. The dissertation addresses this gap
through two chapters that examine the causal impact of menopause and Menopause Hormone Therapy (MHT) on health and labor supply using two distinct empirical strategies.
The first chapter uses genetic variation in menopause timing as an instrument to estimate
the effects of natural menopause on health and employment. Leveraging polygenic scores
(PGS) for age at menopause constructed from genome-wide association studies (GWAS)
in the Health and Retirement Study (HRS), this chapter estimates an instrumental variables (IV) model that isolates the impact of menopause from age-related and behavioral
confounders, among other empirical challenges. The results show that menopause triggers a significant deterioration in health. This health shock translates into a marked decline in full-time employment among post-menopausal women. The IV estimates suggest
that acquiring an additional menopause-induced health condition reduces the likelihood of
working for pay by 49 to 77 percentage points. Despite the richness of the HRS, it does
not include information on MHT use, a widely used treatment to mitigate menopauserelated symptoms. To further explore this issue, the second chapter studies the role of
MHT, popularly known as hormone replacement therapy (HRT), on health and labor market outcomes. Using the abrupt drop in MHT prescriptions following the 2002 public release of the Women’s Health Initiative (WHI) trial results as a quasi-experimental shock,
this chapter estimates the causal effect of MHT use using a difference-in-differences and instrumental variables framework applied to nationally representative data from the Medical
Expenditure Panel Survey (MEPS) and the Current Population Survey (CPS). The results show that MHT improves physical health significantly, raising physical health scores
by half to a full standard deviation. These health effects, however, do not translate into
large or robust changes in employment or wages. Across multiple specifications, there is no
strong evidence that MHT use significantly affects labor force participation or earnings.