60% of American women have no estate plan. No will. No healthcare proxy. No updated beneficiary designations. Just 21% have beneficiary designations that are current — even though those designations override a will in every state.

At the same time, roughly a quarter of the U.S. workforce is currently in some phase of the menopause transition. Peak earning years. Peak asset accumulation. Peak exposure to exactly the financial risks that proper estate planning is designed to prevent.

That’s the Menopause Tax™ operating at the planning level. And it is costing women more than they know.

THE WEALTHY FIGURED OUT SOMETHING MOST WOMEN HAVEN’T

Protection requires structure. Structure requires timing.

Here’s what wealthy families understand that most of us don’t hear until it’s too late: estate plans built during a crisis are worth less than the ones built before one. The families who protect and transfer significant wealth do it during the accumulation phase — before illness, before divorce, before cognitive decline forces the conversation. They build frameworks that function even when the person at the center cannot.

Those frameworks are available to every woman reading this. You don’t need a family office. You need a financial advisor, an estate attorney, and a clear understanding of what’s at stake.

Women in their 40s and early 50s are sitting inside one of the most consequential planning windows of their financial lives. Most have built something real. Most don’t yet have the structure to protect it.

WHAT THE ULTRA-RICH ACTUALLY DO

1. Build the structure before you need it.

Start here: an updated will, a durable power of attorney for finances, a healthcare proxy, an advance directive, and a full review of every beneficiary designation you have. That last one matters more than most women realize. A beneficiary designation on a retirement account or insurance policy takes legal precedence over a will. The ex-spouse named in 2014 will inherit the IRA. The will you updated last year won’t change that.

Now add this: research from the University of Pennsylvania published in Human Brain Mapping confirms that estrogen fluctuations directly affect the prefrontal cortex — the part of the brain that handles complex decision-making, future planning, and weighing long-term tradeoffs. Perimenopause is not the time to start building a financial protection structure. It is the time to already have one.

2. Use trusts as a financial tool.

When structured correctly, irrevocable trusts remove assets from the taxable estate, so heirs receive more. A life insurance policy held inside an irrevocable life insurance trust (ILIT) passes a tax-free lump sum to heirs entirely outside the estate and outside probate. Special needs trusts protect disabled dependents without disqualifying them from government benefits. Charitable gift trusts reduce taxes while honoring philanthropic commitments.

For women who are caring for an aging parent, a child with a disability, or both — and many of us are doing both at once — each of those obligations has a corresponding trust structure that protects the person you’re supporting and your estate at the same time.

3. Use permanent life insurance as a wealth-building vehicle.

Most women think of life insurance as a death benefit. The ultra-wealthy think of it as a tax-advantaged growth account. A permanent life insurance policy — specifically whole life or indexed universal life — builds cash value over time that grows tax-deferred and can be accessed tax-free through policy loans. For a woman in perimenopause who is still 15 to 20 years from retirement, a policy structured correctly right now produces a compounding asset that serves her during her lifetime and her heirs after it. The earlier the policy is funded, the more time the cash value has to grow. But for the woman who has maximized her retirement accounts and is looking for the next tax-advantaged vehicle, this is where the wealthy have been parking money for decades.

The Menopause Tax™ takes from us in three directions: care costs, career costs, and compounding costs. Estate planning gaps belong to that third category. Five years of deferred decisions — made while managing symptoms, career transitions, and the caregiving load most midlife women carry — produce losses that investment returns cannot fully undo.

The women who will look back at this decade with financial security built it during it. The window is open right now.

What you do with that is yours.

Dr. Kim Derezil, MD | WMCP® | Founder, Meno & Money™ — the only platform at the intersection of perimenopause medicine and financial strategy for high-performing professional women. Assess your Menopause Tax™ risk at carecostworkshop.netlify.app.

3 Things the Ultra-Rich Do to Protect Wealth…