Melinda French Gates on Menopause, Midlife, and the $600 Million Push to Fix Women's Health

Melinda French Gates learned about navigating perimenopause the way most of us do: through chats with friends. And if this is how one of the country's most influential philanthropists (who's spent over two decades funding women's health) gets some of her health information, then consider it the latest example that the whole system needs an overhaul.

The gap between what women go through and what the healthcare system actually knows how to treat has become one of French Gates's advocacy platforms, which she anchors with substantial monetary gifts. The reasons, French Gates says, are rooted in statistics: Women spend an average of nine years in poor health, often while they work and raise families. And poor health is, in part, due to lack of funding. As French Gates points out: For every dollar the world spends on medical research, just 5 cents goes to women's health.

Gates is spending real money to close that gap. This week, the philanthropist and Pivotal founder announced $215 million in new funding for women's health. This gift expands focus from contraception and maternal care into midlife, menopause, and mental health. Money will go toward research, access to care, and community-based solutions, helping ensure women have the information and support they need. 

We talked with French Gates about why midlife uniquely matters as a woman’s health issue, what "optimization culture" gets wrong about women's health, and what she'd tell a woman who tries to "ask her doctor" only to emerge with even more questions for the group chat.

1. Through Pivotal, you’ve donated more than $600 million to women’s health over the last two years. Now you’re putting $215 million toward midlife and menopause, including mental health access. How do you hope women will feel these initiatives in their day-to-day lives?

For women to be able to fully step into their power and potential, we need to stop neglecting their health. I hope that all women, regardless of what stage of life they are in, can go to their healthcare provider and have their symptoms taken seriously. I hope everyone can get effective treatments for the conditions they face and receive care that considers their mental health as well as physical health. These sound like obvious things to expect from our healthcare — but we’ve seen that for so many women, they’re not a given.  

2. You've said you want results "in years, not decades" when it comes to research that will move the needle on women's health. What does that actually look like, and why has it been so consistently deprioritized? What's one thing you want to understand better?

We know that women’s health is chronically underfunded and underresearched. Menopause is a place where you can really feel that gap. 

It isn’t just about feeling uncomfortable. Menopause is a huge collection of symptoms that can be truly debilitating — and do lasting damage. To take just two examples: Insomnia has been linked to a higher risk of diabetes, and hot flashes to a higher risk of heart disease. Yet there’s been so little research into solutions, and so little training for clinicians. I was shocked to learn that only one-third of OB-GYN residency programs in the US have a curriculum in menopause. I spoke to an OB-GYN last week who told me that during her entire residency, she only had one lecture about menopause. Just one!  

I’m focused on how we can change that. One of the organizations I’m partnering with is the Menopause Society, which is working to expand training and certification so that more OB-GYNs, primary care providers, nurse practitioners, and mental health professionals understand menopause — and so that every woman can get knowledgeable care that meets her needs.  

3. You've framed the research gap as both moral and economic — closing the women's health gap could add more than $1 trillion to the global economy annually by 2040, according to McKinsey. And, even within women’s health circles, it’s been a struggle to have resources dedicated to menopause, specifically. What shifts the culture around it?

We’re seeing the start of a culture shift right now. More women are sharing their stories and asking each other about what they are going through. You can find lots of books and podcasts on perimenopause and menopause now. Conversations that used to happen quietly are now happening out in the open. 

It’s great to see women demanding better. That’s how so much important change gets started. Now it’s time to channel the momentum from that cultural moment and give women a medical moment. They deserve accurate information backed by science, public policies that take menopause seriously, and, of course, high-quality care. The good news is, we’re starting to see some progress take shape. I’m optimistic that the tide is turning. 

4. For something like menopause, that invisibility has been documented for decades. What's different now that makes you believe it can be prioritized on both a practitioner and policy level? 

This moment can be a turning point if we collectively decide to make it one — philanthropists, medical professionals, business leaders, and policymakers, too. It’s going to take a broad coalition to make progress on women’s health, and progress is long overdue. 

There’s no path to gender equality in a world that neglects women’s health. When women can step into their full power — when they can make decisions, control resources, and shape policies and perspectives — it lifts everyone around them. But it’s hard for women to step into their power if they’re not healthy. When their health holds them back from participating at their full potential, that takes a staggering toll — not just on them but on entire communities and countries. We’re simply not going to make real progress for society unless we treat women’s health as the urgent moral issue that it is.

5. It’s a common phrase: “Ask your doctor” about symptoms. But for conditions like perimenopause, healthcare professionals often don’t have answers yet. We’re really proud to see our readers do their own research and advocate for themselves. But it's not easy. What do you tell a woman in her 30s or 40s who goes in with symptoms and comes out with nothing? What do you wish you'd known about self-advocacy earlier? 

I completely understand what she’s going through. I’ve gone through menopause, and many of my friends have, too, and I don’t think any of us had all the tools and knowledge we needed — even those of us with access to high-quality medical care. A lot of what I learned about menopause came not from doctors but from my friends. 

I’m determined it will be different for the next generation of women. But until then, I think about what an OB-GYN and pain specialist I met recently told me. She said, “Words give something importance.” We all have to speak up with our practitioners. It’s not a guarantee we’ll get a solution, but it gives us a far better chance. 

6. A lot of us have grown up believing that if we just optimized hard enough — the right supplements, the right therapist, the right morning routine … we could manage our health. What's the thing that optimization culture gets wrong about women's health, and why do you think that is?

You’ll never find me saying that it’s a bad idea to pay attention to healthy habits. I’m someone who exercises regularly, goes to therapy, and tries to eat well (though that still includes chocolate). Still, no amount of healthy habits can make up for the gaps in the healthcare system. You can do everything “right” and still fail to get diagnoses and effective treatments for the health problems you face. That’s not a personal failure — it’s a systemic one.

For too long, men’s bodies have been treated as the default and women’s as an afterthought. That means there’s still too much we don’t know about how conditions show up in women, and how to treat them. If you have heart disease, you want doctors who understand how symptoms present in women. If you’re having a baby, you want clinicians who are skilled at addressing the risks you face. If you’re in pain, you want the tools to get out of it. 

The answer isn’t to optimize more. It’s to build a better system that provides for all those needs. After all, the right care at the right time can change everything for women — and for everyone around them.

This interview has been edited and condensed for clarity.