The second annual Menopause in the Workplace Survey from Carrot Fertility, a fertility care platform, found the overwhelming majority of women surveyed face challenges at work due to menopause symptoms and don’t feel that they can speak up about them. And more, they fear their employers will see them as less efficient. The survey, shared exclusively with Fortune, laid bare how aging women contend with daily challenges related to menopause and the long-held stigma around it. 

“We have a major gap in the healthcare system for not just women who are of reproductive age, but women who are at post-reproductive age and are in many cases your most valuable managers and leaders and employees,” Tammy Sun, CEO and founder of Carrot Fertility, tells Fortune. 

In the survey of 2,000 working American and British women who are in perimenopause or menopause, 80% say managing symptoms at work is a challenge. Nearly three-fourths of respondents (72%) say they feel uncomfortable or self-conscious at work when they have a symptom like brain fog. About one-third of women, particularly women of color, fear how their menopause symptoms could impact their career growth. 

“We see now and we can prove that people will also bear a disproportionate burden in their post-reproductive journeys,” Sun says. 

Ageism and a fear to speak up

Beyond dealing with unpredictable symptoms, older women in the workforce don’t feel protected by their employers. The majority of women surveyed who had to take time off of work due to menopause did not share the reason with their employer at least some of the time. The survey found the top reasons women do not seek support for managing menopause at work are the perception of being unable to work to the same caliber, the stigma around it, and being unsure who could help. It fuels a larger crisis of confidence for women often at the pinnacle of their careers—one that could be avoided if the narratives around aging shift, experts say. 

The survey shed light on how ageism is a driving force behind the silence around menopause in the office. Nearly half—47%—of women surveyed face ageism at work. Older workers who say they are discriminated against because of their age can feel the need to work harder to prove themselves so they don’t lose their jobs.

According to a 2020 University of Michigan national poll on healthy aging, women make up a large cohort of the 40% of adults who report sometimes or often experiencing three or more forms of ageism every day, including ageist messaging and interpersonal reactions. 

“There’s a much higher bar for women to appear younger,” Heather Tinsley-Fix, a senior advisor of employee engagement at the AARP, previously told Fortune, which only discourages women from seeking menopausal care. 

Time for employers to step in 

With the growing availability of employee-sponsored fertility benefits and accommodations, Sun says the same options should be available for menopause care.

“When it comes to workplace policies that can support people going through menopause, I think it really just aligns with what employers are already searching for, which is a flexible solution,” she says. “The inclusion of post-reproductive, age-inclusive fertility benefits, is an important step and an important signal that employers send.” 

Benefits can include access to platforms providing support groups, resources, trained nurses, and ob-gyns. 

“Women of every age have equal value and deserve high quality health care over the course of their entire life,” Sun says. 

Women also say they want more flexibility and support. Over half of the women surveyed said changing their work routine could help, such as flexible or reduced hours. A vast majority of the women, 90%, say public awareness and discussions about menopause would also serve as support. 

“These women are speaking up. The data is showing itself to be very clear,” Sun says. “There is much more open conversation happening around this topic today than there was 12 months ago, and 12 months before that, and 12 months before that.”