Women's labor force participation has increased dramatically over the past several decades. Although previous research has documented that a wide array of labor market characteristics affect health, more work is needed to understand how women are impacted by gender-specific employment patterns and exposures. We examine a cohort of 659 employed women from the Baltimore Epidemiologic Catchment Area (ECA) study in the USA. Baseline and follow-up data collected 13 years apart are used to identify associations between demographic, labor market, work organization, and occupational gender inequality with four health outcomes: generalized distress, depressive syndrome, anxiety and fair or poor health. We also use gender-specific data on the workplace to create indicators of occupational gender inequality. We found wide gender inequalities in terms of pay and power in this sample of employed women. Financial strain was associated with all of our mental health outcomes with those reporting financial strain having increased odds of distress, depressive syndrome and anxiety for the 13 years prior to the interview. Workplace factors that were found to be associated with the four outcomes included experiencing a promotion or demotion in the 13 years prior to the interview; working at a large firm; and being a professional. Occupations where women compared to men had lower levels of job strain-domestic workers in private households, machine operator and transportation-showed increased risk for anxiety or fair/poor health. Our findings suggest that measuring the complexities of employment including promotion or demotion history, firm characteristics and even occupational gender inequality can yield important information about associations with health among women.