A client of mine, a VP at a logistics company, told me she rehearsed her sentences before every meeting. Not because she didn’t know the material. She knew it cold. She rehearsed because she couldn’t always find the words in real time anymore, and she was terrified someone would notice.
She never told her boss all of the extra work she did to ensure she delivered.
That’s the pattern I see over and over in my coaching practice. Women in their 40s and 50s, at the height of their expertise, quietly managing hot flashes in client meetings, brain fog during board presentations, and sleepless nights before big decisions, all while performing as if nothing has changed. Nobody told them to hide it. They just knew, somewhere in their bones, that this wasn’t something you brought up at work.
The same way menstruation was shamed from our earliest experiences, so is menopause in our current life. The cultural expectation to remain competent, composed, and endlessly resilient can make women feel they have to suffer in silence. We built entire professional norms around a body that doesn’t get tired, doesn’t get hot, doesn’t forget a word mid-sentence. Perimenopause breaks that fiction wide open, and instead of updating the norm, we ask women to keep performing it.
Here’s what makes this especially frustrating. The symptoms themselves are common enough to be unremarkable. According to a survey highlighted by the Health Action Alliance, 90 percent of women over 35 experience menopause symptoms that affect their quality of life and their ability to succeed at work. Catalyst’s 2024 global survey found that 91 percent of respondents had experienced at least one moderate to severe symptom. This isn’t a rare medical event. It’s a near-universal transition happening to roughly half the workforce, and we still treat it like a secret that a woman is keeping from her colleagues, rather than a shared reality an entire generation of professionals is navigating at the same time.
So why does it stay hidden? Because we’ve made real progress normalizing conversations about mental health and burnout at work, and menopause got left out of that shift. Managers now get trained to recognize signs of stress, to ask, “How are you doing?” to point an employee toward an EAP. Nobody trained them to have the same conversation about hot flashes interrupting a presentation or insomnia making a nine a.m. meeting feel impossible. The managerial skill set exists. It’s just never been pointed in the direction of menopause.
The data on that gap is stark. Bank of America and the National Menopause Foundation found that 76 percent of HR benefit managers say they discuss menopause with employees. Only 3 percent of employees say that conversation has actually happened. That 73-point gap isn’t a communication glitch. It’s a signal that the conversation employers think they’re having, and the conversation women feel safe having, are two completely different things.
Now here’s where I want to be direct, because this is where the conversation usually goes wrong. This is not a women’s issue. It’s a business issue, and treating it as a private, personal matter is exactly what’s costing companies their most experienced talent.
Think about who is affected. Women in their late 40s and early 50s are frequently the people holding institutional knowledge, running teams, owning client relationships, and sitting one or two rungs from the C-suite. When nearly 9 in 10 of them say symptoms are affecting their work, that shows up in productivity, in absenteeism, in who applies for the next promotion and who quietly decides it isn’t worth the exposure. It shows up in your leadership pipeline whether or not anyone names it out loud. And when these women leave, they don’t just leave a seat empty. They take fifteen or twenty years of client relationships, institutional memory, and mentorship capacity out the door with them, which is the kind of expertise that takes years to rebuild and sometimes never fully returns. Replacing a senior leader is expensive. Replacing what she knew is often impossible.
And yet, despite how common this experience is, support remains almost nonexistent. A survey from benefits consultant NFP found that only about 5 percent of U.S. employers offer menopause-specific benefits. Flip that number around. Roughly 95 percent of companies have nothing in place for a transition that affects nearly all of their female employees at some point in their careers. That’s not a gap. That’s a blind spot the size of half the world.
So, what does it actually look like to close that gap, without asking women to disclose anything they don’t want to?
Start with language, not policy. A manager doesn’t need a woman to say the word menopause to create room for the conversation. Simple, universal language works better anyway. “Let me know if you need flexibility this week” or “we can adjust the meeting time if that helps” applies to caregiving, illness, and menopause symptoms all at once, without requiring anyone to explain which one it is. Normalizing flexible language protects privacy while still opening the door.
Next, train managers the same way you’d train them on any other health-related conversation. They don’t need to become clinicians. They need enough awareness to recognize that a change in focus, energy, or confidence might have a physical cause, and enough comfort to respond with support instead of suspicion. That’s a training investment, not a policy overhaul, and it costs far less than losing a senior leader who quietly checks out.
Then, look at your environment before you look at your benefits package. Temperature control, breathable options in dress code, quiet space to reset during a rough afternoon. These are inexpensive, universal, and require zero disclosure. They help every employee managing a hard week, not just the ones going through perimenopause.
Finally, put someone visible in leadership on record talking about this. Silence at the top guarantees silence everywhere else. One senior leader saying, “This is something many of us are navigating, and we want you supported through it,” does more to shift culture than any benefits brochure sitting unread in an onboarding packet.
I think about my mother telling me how she would always go to the bathroom and bend up and down to try and trigger a hot flash so it occurred in private rather than when she was in front of people. I think about that VP rehearsing her sentences before every meeting. The VP wasn’t failing at her job. She was succeeding at it under conditions nobody had bothered to name, let alone support. The symptoms didn’t push her toward the door. The silence around them did, one unspoken meeting at a time.
We don’t need every woman to announce what she’s going through. We need workplaces that make it safe if she chooses to, and functional if she doesn’t. Until we build that, we’ll keep losing exceptional women at the exact moment they have the most to offer, and we’ll keep calling it something other than what it is.
About the Author:
Nicole Johnston is a global senior Sales & Marketing FMCG/CPG executive who established innatePOWER to help guide and support women to overcome obstacles and achieve their full potential. She is also the author of Taboo Topics: Things Women Should Talk About, But Don’t.
