It's Not a Hormone Issue. It's a Leadership Issue.
How a midlife health transition taught me that the best leadership begins with curiosity, not assumptions.
When Perimenopause Changed the Way I Think About Leadership
I still remember the drive to work that day.
I was on my way to a meeting, mentally rehearsing the day ahead, when something unsettling happened. My vision began to narrow. Not blurry-narrow. It felt as though I were looking through a tunnel. I gripped the steering wheel a little tighter, wondering if I was having a stroke.
The episode passed, but the fear stayed with me.
Eventually, I learned it wasn't a stroke at all. It was perimenopause.
Like many women, I thought I knew what to expect. I knew about hot flashes and night sweats. What I didn't know was that perimenopause could also bring cognitive changes, including brain fog, difficulty concentrating, increased anxiety, disrupted sleep, and, in some cases, visual disturbances. Looking back, I realized my body had been sending signals for months. I simply didn't know how to recognize them.
As someone who has spent more than 20 years coaching leaders and organizations, I found myself asking a different question.
If I didn't know this could happen, how many leaders don't know it either?
That's where this stops being a women's health issue and becomes a leadership issue.
Perimenopause and menopause symptoms don't JUST happen outside of work. They happen during board meetings, client presentations, performance reviews, strategic planning sessions, hospital shifts, classrooms, and sales calls. They affect women who are often in the most experienced and influential years of their careers.
Without awareness, it's easy to misinterpret what's happening. Brain fog can look like poor preparation. Fatigue can appear as disengagement. Anxiety may be mistaken for a lack of confidence. A temporary change in performance can become an unfair judgment about someone's capabilities.
The business impact is becoming harder to ignore.
Research from the Mayo Clinic estimates that menopause-related symptoms contribute to approximately $1.8 billion in lost work productivity each year in the United States through missed work alone, with even greater costs when reduced productivity while at work is considered.
At the same time, the policy landscape is changing. Since 2023, more than half of U.S. states have introduced or enacted menopause-related legislation, and in 2025 alone, more than 20 bills were introduced addressing menopause education, workplace awareness, clinician training, accommodations, and access to care.
That tells me something important.
Organizations are beginning to realize that menopause isn't simply a private health matter. It has become part of a broader conversation about workforce sustainability, employee well-being, and retaining experienced talent.
The good news is that leaders don't need to become menopause experts.
They simply need to become better listeners.
One of the greatest mistakes we make as leaders is assuming we know why someone's performance has changed.
One of the greatest strengths we can develop is curiosity.
Instead of asking,
"What's wrong with her?"
Try asking,
"I've noticed you don't seem like yourself lately. Is there anything you need to be successful?"
That single question changes everything.
It shifts the conversation from judgment to support. From assumptions to understanding. From performance management to people leadership.
Organizations don't need complicated programs to get started. They can begin by:
- educating managers about common midlife transitions,
- reviewing workplace policies through the lens of flexibility and inclusion,
- equipping leaders to have supportive conversations, and
- creating a culture where employees don't feel they have to hide what they're experiencing.
These aren't just menopause initiatives-they're hallmarks of good leadership.
Leadership has never been measured by how we manage people on their best days. It's measured by how we support them through life's inevitable transitions.
That day in my car changed more than my understanding of perimenopause. It changed the way I think about leadership.
Today, when I work with leaders, I encourage them to replace assumptions with curiosity because the conversation you've never been taught to have may be the one that keeps your most experienced employees engaged, your culture stronger, and your workplace more human.
Sometimes the most powerful thing a leader can say isn't, "Here's the solution."
It's simply,
"Help me understand."
That one question has the power to open dialogue, strengthen relationships, and uncover challenges that might otherwise remain hidden. It may begin with a conversation about perimenopause or menopause, but it ends with something much bigger: a workplace where people feel seen, supported, and safe enough to bring their whole selves to work.
And that's simply good leadership.
