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After the usual round of strategy conversations, my client sat down to write his strategy document. It had been percolating in his head for days. Then, when he sat down, nothing happened.

Strategy and strategic thinking are of the utmost importance…

I’ve been teaching strategic communication at Stanford’s Graduate School of Business (GSB) and coaching executives for almost two decades. Recently, I’m consistently hit with one concern from students and executives alike: With AI taking over, what wi…

Kacy Fleming was presenting in a boardroom when the burning started. It began at her thighs and rose up through her torso as the legal counsel in the room pushed back on her points. She whipped off her blazer even though all she was wearing underneath was a threadbare James Perse tank top.

“I felt totally unprofessional and I didn’t even care because I was so hot,” she says. “I thought it was because I was pissed because so often in corporate environments our emotions are so bottled up they come out through our body.”

Over the next few years, the changes kept coming. Her personality morphed from anxious overachiever to apathetic. Fleming wanted to walk out on her job. Fleming wanted to walk out on her life. “I wanted to disappear,” she says.

It would take three years before Fleming, then the head of global well-being for the pharmaceutical company Takeda, realized she was in the throes of perimenopause and found treatment.

“I was responsible for the well-being of 50,000 people, and I had no idea what was happening to me. I didn’t even know the word perimenopause until I was in it, despite 22 years in healthcare,” she says. “But it almost took my career, my marriage and my life away from me.” Fleming eventually left Takeda. Today she is the founder of The Fuchsia Tent, a company dedicated to helping organizations retain female leaders.

Menopause often hits women just as they’re reaching the zenith of their careers. In the US, the average CEO is hired at age 54; the average age of menopause is 52. Yet, many women may not be making it to the C-suite because menopause is derailing their careers. Currently, only 11% of Fortune 500 CEOs are women—and that’s a record high.

Eleven percent, as it happens, is also the percentage of women who report that their company offers menopause benefits, according to a 2025 survey by benefits platform Carrot Fertility and supplements company Olly. 

In the wake of the response to my online conversation about how corporate America is crushing senior-level moms, I asked senior-level women how menopause had impacted their careers. More than 30 responded. They told remarkably similar stories: struggling silently—and losing confidence in their performance. Most say they are barely hanging on to their jobs. Many have already left.

“For me, early menopause and menopause in general has been a continuation of the ostracization othering that happens to women as they enter key phases of life, such as pregnancy and new motherhood,” writes Moe Carrick, an organizational consultant.

In that same Carrot Fertility-Olly survey, just more than half of women (51%) say that there’s no conversation about menopause at their workplace.  

So, let’s talk about it. 

The double stigma

Women in menopause are being hit with a double stigma at work: the stigma of being old and the stigma of being female. A 2024 survey found almost three in four women have hidden their symptoms at work and one-third have not told anyone about them.

Another study, from 2023, found that 65% of menopausal women said their symptoms affected their work performance. Meanwhile, 1 in 10 women with menopausal symptoms is looking for a job with more flexibility, while 4 in 10 are considering an early retirement.

Menopause is officially associated with 34 symptoms, including feelings of faintness, panic attacks and restless leg. Some of the most common symptoms are hot flashes, which impact up to 87% of women; mood changes, 78%; and sleep problems, 60%. Nearly half—44%—can have memory problems.

“I went through the worst of perimenopause while leading in the people space at a startup that is scaling fast,” Emily Thompson shares. “I experienced brain fog, mood shifts, sleep loss, hair loss but most of all, I experienced anger. A full bodied anger that would take over without warning. I was running performance cycles, leading trainings, traveling to manufacturing sites and presenting to senior leaders while privately wondering if I was losing my edge. I wasn’t. I was perimenopausal.”

Thompson adds, “I decided it was time to leave in-house and go out on my own. I was no longer comfortable in my own skin.” Thompson opened a company to modernize FAA drug and alcohol compliance onboarding for aviation operators.

Menopause symptoms are often most severe during perimenopause and early postmenopause. Perimenopause is the stage before menopause, which can last anywhere from 2 years to 15 and may begin in a woman’s mid-30s. Perimenopause is followed by menopause, which is delineated by 12 months without a period. Postmenopause occurs afterwards and lasts the rest of someone’s life. Symptoms can still occur in postmenopause, but are usually milder. “In general, there can be about 8 to 15 years of symptoms depending on the person,” says Dr. Julia Edelman, a certified menopause clinician and gynecologist, and author of The Savvy Woman’s Guide to Menopause.

During perimenopause, estrogen levels are erratic. The extreme changes can be disruptive to women, especially since estrogen is associated with serotonin, the “feel-good” hormone.

“Some days you feel like you’re 60 and some days you feel like you’re 20,” says Dr. Edelman, “It’s not that the person isn’t coping or they’re not strong; it’s that their physiology is changing temporarily.”

The vast majority of workplaces have been slow to understand this. Only 11% say their company offers menopause benefits, according to a 2025 survey by benefits platform Carrot Fertility and supplements company Olly. Half of women (51%) say that there’s no conversation about menopause at their workplace.

“I remember one point with a corporate sponsor that I was giving a keynote for. I told him that I would need water on stage and that I would appreciate having somewhere that I could remove a layer during the keynote in case I had a hot flash because I was in menopause,” Moe Carrick shares. “He looked at me with incredulity. . . . In that whole audience there might’ve been 5 women out of 500 so I knew that I was speaking about something that he had no idea about.”

Treat it

Treatment is the most effective way to help women with menopause.  A 2025 Mayo Clinic study found that while over 75% of women have menopausal symptoms, only 25% are receiving treatment.

In fact, menopause treatment has regressed. Two decades ago, around 40% of menopausal women used hormone replacement therapy (HRT), one of the most effective treatments for menopause symptoms. However, after a study came out in 2002 showing it was associated with breast cancer and heart disease, use levels dropped. While new studies have found that benefits of HRT exceed the risks if HRT is started soon after menopause, today less then 5% of women use it.

It doesn’t help that there’s a shortage of care providers. Every year an estimated 1.3 million women enter menopause in the United States, but fewer than 20% of primary care physicians receive menopause training, while the U.S. has only about 4,100 specialists certified by the Menopause Society, a nonprofit that offers menopause training.

Telehealth companies like Midi and Maven, which can prescribe HRT, are stepping in to fill the care gap. Midi has developed a menopause care protocol to train nurse practitioners, while Maven helps providers get certified by the Menopause Society.

Over half of women between the ages of 35 and 54 say health insurance coverage for menopause is the best way an employer could help them, whether it’s through a specialist or making a company like Midi or Maven accessible. Yet in 2023, only 25% of companies with over 200 employees offered menopause benefits, according to the Wall Street Journal.

Covering menopause treatment makes economic sense for employers. Missed work days due to menopause cost employers an estimated $1.8 billion a year, while turnover costs employers an estimated $1 trillion, according to Gallup. Gallup also finds it can cost an organization 150%-200% of an employee’s salary to replace them. Treatment can give women their lives back—and have a positive impact on a company’s bottom line.

“I’m very comfortable speaking in public, but all of a sudden the next sentence would go away,” says Paige Dunn, interim CMO of Respin Health. “At the same time my sleep started to get very disrupted. It became very normal to wake up at 2 or 3 in the morning and have a very hard time going back to bed. I was exhausted and I had no idea why.”

“I got lucky because I was working for a startup in the longevity space,” she continues. “I met with a telehealth doctor and got a low-dose HRT pill. Within 10 days my sleep was corrected. I felt like a new person. I wasn’t having brain fog, I wasn’t having sleep issues, I was more prepared, more articulate, more energized, and excited, never dreading work.”

Accommodate it

It often takes time for people to understand they need treatment and to find the right treatment, if, they do manage to find a treatment that works. In the meanwhile, they may need accommodations.

“During perimenopause, the brain does shift how it processes data, so you have to be patient with yourself, and it is helpful to not try to multitask in a way that many leaders do,” says Dr. Edelman. “Focus on one task at a time, so you’re basically slowing the transition between tasks. That can be more helpful than it sounds.”

Kacy Fleming asked to work remotely two days a week as she tried to figure out what was happening to her body. “I was terrified. I practiced and I practiced, with my partner and with my mom. I never disclosed what exactly was happening. What I said was, I am having horrible digestive autoimmune challenges. We need to get to the bottom of them, and I need to see a specialist two days a week. I promise you I will work harder than anyone you’ve ever seen work, but I need to be able to be home those two days. If not, I’m going to have to take leave, because I have to take care of my health first. I can’t be good for you or for the company when I’m feeling this off.”

Her advice to others who want to ask for flexibility or accommodations is: “You’ve got to practice. . . . You don’t have to say what’s going on with you, but you need to talk about how it’s affecting your performance and what the solution you’re proposing is going to do to enhance your performance, and how that’s the win-win for the company.”

Fleming got her two days off and was eventually promoted. When her new boss wanted her in the office five days a week, she stuck to her guns. “I remember saying, ‘I don’t come in two days a week,’ and there was pushback from a new leader. I said, ‘This is how I work best.’”

Talk about it

Ten years ago, Jessica Boyd was diagnosed with breast cancer. At 26, she entered medically induced menopause as part of her treatment. Her most prevalent symptoms are insomnia, brain fog, and hot flashes brought on by stress. Today Boyd works remotely as a director of communications, content and community at the Institute for Supply Management, where she’s been for eight years. She credits this to an understanding boss who is also going through menopause.

“She checks in on me between meetings,” Boyd says. “She’ll ask how things are going. How can I best support you?”  Boyd felt comfortable telling her boss about her diagnosis, because her boss has also been vulnerable with her: “She shares about how she has ADHD, and how it impacts her work style…[which was] helpful for me to understand her . . . and then have the conversation, ‘Okay, well, this is my life story,’” Boyd says. “Having that conversation sparked other conversations.”

“Most of the things I’ve explicitly requested are time and flexibility,” she continues. “I need . . . 30 minutes and then I compensate another time, or I can call out ‘Hey, I’m in the grip’ (which is what we jokingly call [menopause symptoms]) if . . . it is going to impact how I show up. [My boss] is wonderful. It’s why I’ve stayed in the workplace as long as I have.”

Sarah Chavarria, CEO and president of Delta Dental of California, made it a point to talk about menopause once she started going through symptoms. “I started noticing that if I mentioned ‘I’m having this headache that kind of mimics my cycle,’ that it would prompt someone else to say, ‘Oh, I get those.’ I saw as a leader that I could introduce a topic that was welcomed by the women around me, but also by the men around me who have women in their lives,” Chavarria says. “I started saying, ‘Yep, today’s that down day, I’m gonna take my Dramamine and soda and let’s see if we can push through.’ That gave other people the opportunity to say, ‘Yeah, I’m not feeling okay today.’”

“I started showing up on town halls, talking about my experience and why it mattered for us to think about the impact that menopause has on our female workforce and on our male workforce who support women,” Chavarria says. “People would just hug me or put little emojis on the Zoom call and say thank you so much for making it okay to talk about this.”

In fact, talking about menopause can be seen as a leadership quality. In one study, Alicia Grandey, a professor at Pennsylvania State University, asked 240 workers to imagine they were in a meeting with a colleague going through a hot flash, fanning herself and wiping off sweat. They studied participant reactions when the women said she was just warm, versus when she explained that she was warm because she was going through menopause.

“When the woman openly disclosed that her symptoms were caused by menopause, she was seen as more confident, stable, and leader-like than when she claimed to be ‘just warm,’” Grandey writes. Interestingly, Grandey found the woman was rated as less leader-like when a colleague explained she was going through menopause. “This suggests . . . self-disclosure is critical,” Grandey adds.

Normalize it

When Saad Alam was 10, his mother, a Pakistani immigrant, went into perimenopause after having a hysterectomy. “She was climbing the corporate ladder very quickly, but she had these horrible symptoms, hot flashes during the middle of the day, cognitive problems, struggling to find words very often,” Alam says. “I remember being 10 and just looking at her and feeling helpless. Later, I asked what it was like, and she said: ‘It was one of the loneliest times in my life, and you don’t know what else to do other than push through it.’ She didn’t have family in America or a lot of American friends. I remember always thinking I want to help women with access to care and destigmatizing the topic.”

In 2019, Alam founded Hone Health, a longevity company. Hone recently added menopause to its accommodation and leave policies.

“In addition to the conditions and disabilities that are explicitly covered by the ADA [Americans with Disabilities Act],” the policy states, “Hone recognizes the importance of allowing women experiencing symptoms of menopause or perimenopause flexibility and accommodations to their work arrangements, so we encourage employees to talk with People Ops to see if they may qualify for an accommodation.

“Employees are empowered to take time off when they need it—whether that time is for a family emergency, medical reason, menopause-related needs, planned vacations, or just a day to recharge,” Alam says.

Mentioning menopause in company policy may not seem like a big move, but it helps to destigmatize menopause and sends the signal to employees that it’s normal, and it’s all right to talk about it and take time off for it.

“Since we’ve codified it, I’ve been in meetings where someone will say, ‘Oh, I’m sorry, it’s menopause brain fog, I can’t come up with what I’m trying to say right now,’” says Tracey Middleton, Hone’s senior editorial director. “I think women are feeling noticeably more comfortable talking about it in mixed settings too.”

Menopause is the future

By 2030, the youngest members of Gen X will be 50, well into their menopause years. Like death and taxes, menopause comes for all of us eventually. If you have ovaries, menopause is your present or your future. If you love someone with ovaries, watching them go through menopause is your present and your future.

Last year Rhode Island became the first state to mandate that employers provide reasonable accommodations for women going through menopause. More recently, Melinda French Gates announced that she would be increasing her investment in women’s health to $600 million, including funding for menopause and midlife care.

But Rhode Island and Melinda French Gates can’t carry us all. It rests on employers to cover treatment and flexible policies. It rests on managers to understand what their employees are going through and create environments where people can laugh over a brain fog stumble and move on instead of worry about being seen as less capable.

Yet, employers—who have been quick to reshape their workforces and policies for AI’s Faustian promises—are still unprepared to deal with this fact of life, and women are paying the price.

“Two years ago, I held a top 100 leadership position at a Fortune 30 company,” Spencer Milus shares. “Despite being a registered nurse and a healthcare industry expert, I struggled significantly with perimenopause symptoms. Because I . . . lacked access to proper care, I ultimately left the high-powered career I had spent 20 years building. . . . I have been receiving expert treatment for a year now and realize that I never would have left my role had I received the right care at the time. The lack of research in women’s health is the greatest failure of the last 100 years of modern medicine.”

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