A version of menopause exists in most workplaces, a form known as Menopause at work. A woman, around 51, has hot flushes for a while, and then it passes. If that’s the picture your policies are built on, they’re aimed at the wrong moment entirely. They miss the people who need support most.
The part that actually affects work does not start with the last period.
It starts up to a decade before it, in perimenopause.
Moreover, no one, including the women living it and the managers, has been told what Menopause at work looks like.
The transition is long, and it starts early
Menopause itself is a single day: twelve months after your final period, on average around 51. Perimenopause is the years-long transition leading up to it. However, it commonly begins in the early-to-mid forties, sometimes late thirties.
That’s a 7-to-10-year window. It sits squarely over the most experienced, senior years of a woman’s career.
Menopause at work is often overlooked in its early signs. The earliest symptoms are not the ones people expect.
Long before hot flushes, perimenopause’s fluctuating hormones drive neurological changes. They cause brain fog, poor concentration, memory lapses, disrupted sleep, low mood, and anxiety. Stress tolerance also decreases.
Oestrogen influences the brain directly. As oestrogen swings and falls, cognition and mood follow.
Picture that from the inside. A capable, high-performing woman suddenly can’t hold a train of thought in a meeting she’d have chaired in her sleep a year ago. She’s waking at 3am and arriving exhausted. She feels inexplicably anxious and assumes she’s burning out, or losing her edge, or simply failing. She very often doesn’t connect it to hormones at all, because no one told her this is where it begins.
Why nobody was equipped to spot it
This isn’t a failure of individual women or individual managers. It’s the downstream result of a much bigger gap.
For decades, medical training gave menopause barely a passing mention. Women’s midlife health has been chronically under-researched and under-funded relative to its impact. Generations of doctors qualified without meaningful education on perimenopause. As a result, many patients encountered limited understanding from professionals. This gap shaped care and expectations.
So women who did seek help were often told their bloods were normal, offered an antidepressant, or sent away. The system around them lacked the knowledge needed to identify menopause symptoms and offer appropriate care. This gap continues to affect outcomes today.
If the medical world was under-trained, it’s no surprise the working world is too. We’ve asked managers to support something they were never taught to recognise. That’s not a criticism of them, it’s the case for finally giving them the tools.
Why this is a business issue, not a “women’s issue”
The consequences show up on the balance sheet, not just in individual lives. Women in their forties and fifties are among the most experienced, capable and loyal people in most organisations. When the transition goes unsupported, some reduce their hours, some step back from promotions they’d have chased, and some leave the workforce altogether, taking decades of institutional knowledge and leadership with them.
That is an avoidable loss of exactly the talent organisations spend fortunes trying to develop and retain. Framing menopause as a private, individual matter quietly converts a solvable support gap into a retention problem.
What actually helps, and it’s smaller than you’d think
The encouraging part is that meaningful support is affordable. Moreover, three things move the needle more than any glossy policy document.
Trained line managers. This is the single highest-leverage change. A manager who understands that perimenopause can start years before periods stop, who can spot the signs, and who can have a calm, non-awkward conversation and offer a small adjustment, that manager changes someone’s entire experience. Most don’t need a qualification; they need one good briefing and permission to talk about it.
Genuine flexibility. Broken sleep is one of the most common and most disabling symptoms, and it doesn’t respect a 9am start. Flexibility over hours, start times, and where someone works lets a woman having a rough patch stay productive and stay in the role, rather than quietly deciding she can’t cope.
The practical basics, like temperature. It sounds almost too simple, but control over their environment matters enormously to women managing hot flushes and night sweats. A desk near a window that opens, control over the air conditioning, a fan, a uniform that isn’t polyester, not being sat under a spotlight in a hot meeting room. Small, cheap, and they signal something bigger: we see this, and it’s allowed to be talked about here.
The shift that changes everything
The real change isn’t a new policy. It’s a new understanding, that this is a long transition beginning in the prime of a woman’s career, driven by real physiology, that was under-taught to the very people meant to support it.
Get that, and the rest follows naturally. Managers stop misreading a hormonal transition as a performance problem. Women stop suffering in silence and second-guessing their own competence. And organisations keep the experienced, brilliant people they’d otherwise lose.
Menopause at work was never really a women’s problem to solve alone. It’s a leadership one, and it’s an extremely fixable one.
Marleen Konijnenberg is a pharmacologist and Women’s Health & Fitness Coach, and founder of FemVital. She’ll be exhibiting at pause Live! on 10 October, London.
General information, not medical advice.