This article provides information on the movements into and out of paid work by mid-life women. This is a group whose representation in the paid workforce is growing as population ageing proceeds and as educational qualifications expand. It is also a group that will be critical to any labour supply response to the economic challenges posed by population ageing. However, current understandings of the needs and circumstances of mid-life women in paid work are limited. To help address this knowledge gap we use data from the first five waves of the Household, Income and Labour Dynamics in Australia survey (2001–2005) to identify the causal influences of health, care and other factors on the ability of mid-life women to remain in and re-enter paid work. The results show that poor health and/or substantial care roles have a negative impact on the employment chances of this group. However, importantly, there is asymmetry in these health and care effects, in that improvements in health and/or reductions in care roles do not increase the chances of returning to paid work. This finding indicates that many mid-life women who experience poor health and/or undertake large care roles face substantial long-term negative consequences for their employment chances and, thus, their retirement and pre-retirement incomes.