The U.S. economy is losing $26.6 billion a year due to lost productivity and health expenses resulting from employees who are managing menopause symptoms, according to a new report.

The study from Mayo Clinic, which analyzed responses from over 4,400 women age 45 to 60, found that nearly 11% reported missing work in the previous 12 months because of symptoms such as hot flashes and sleep disturbances.

The annual cost for those missed work days is $1.8 billion, not accounting for reduced work hours, employment loss or early retirement. At least 13% of the women surveyed reported they’d experienced at least one of the above outcomes because of symptoms. Meanwhile, direct medical costs related to menopause cost this age group an additional $24.8 billion annually.

In 2021, a survey of 2,500 women from telehealth company Gennev found that 99% of women in this stage don’t get any menopause benefits at work.

The Mayo Clinic report states that the findings of its survey “highlight a critical need to improve the medical treatment provided to women with menopause symptoms and an opportunity to make the workplace environment more supportive for women going through this universal life stage.”

Women between the ages of 45 and 54 make up 20% of the female workforce in the United States. Women of color are disproportionately affected, with Black women nearly three times as likely to report an adverse work outcome as their White counterparts. Hispanic women also reported higher rates of disruptions than White women.

“Many women in midlife are at a time in their lives when they are experiencing career successes and achieving leadership roles,” according to the report. “That women may opt out of employment, and consequently out of the leadership development pipeline, identifies a potentially unrecognized reason for the leaky leadership pipeline and the paucity of women in senior leadership positions.”

That leaky pipeline is getting worse: Female workers are leaving the top ranks of companies at higher rates than ever. For every woman at the director level who gets promoted, two female directors are choosing to leave their company, according to an October McKinsey & Co. and LeanIn.org report.

In a 2022 survey of female U.S. workers age 40 to 55, nearly a third of respondents said they’d think about shifting to part-time from full-time work, while 22% said they’d consider retiring early. Another survey out of the United Kingdom found 18% of women going through menopause are thinking about quitting their jobs altogether.