The Hidden Cost of Perimenopause: Why Companies Are Losing Their Best Leaders
A recent Fast Company investigation gathered testimony from more than 30 senior women whose perimenopause symptoms affected their performance, their confidence, and, in many cases, whether they stayed in their jobs at all. This isn't an isolated anecdote — it's a problem of biological timing that coincides almost exactly with the moment women reach the highest levels of leadership.
A timing problem: the transition arrives just as women reach the top
According to The Menopause Society (formerly NAMS), the average age of natural menopause is around 51-52, with the perimenopausal transition typically beginning several years earlier. That age range overlaps with the stage at which many women hold, or are positioned to reach, senior leadership roles. The result is a structural overlap — not a coincidence — between the period of greatest professional demand and the period of greatest hormonal instability.
The symptoms are real, not perceived: neuroscientific evidence
For years, symptoms like brain fog and difficulty concentrating during perimenopause were attributed to subjective perception or stress. The review by Greendale, Karlamangla, and Maki, "The Menopause Transition and Cognition" (JAMA, 2020), documents with objective neuropsychological testing that working memory and cognitive processing speed genuinely decline during the menopause transition — a measurable, not imagined, decline that in most cases resolves once the transition is complete. In other words: struggling to concentrate in a boardroom during these years is not a failure of character or professional commitment. It's a documented neuroendocrine phenomenon.
The problem isn't that women lose leadership capacity during perimenopause. It's that organizations have no visibility into a transient biological process they mistake for a permanent performance decline.
The economic and talent cost, already documented
This isn't only an individual problem — it carries a measurable organizational cost. The study by Faubion et al., "Impact of Menopause Symptoms on Women in the Workplace" (Mayo Clinic Proceedings, 2023), of nearly 5,000 U.S. women, found that those with moderate-to-severe symptoms were significantly more likely to reduce their working hours or leave their jobs entirely, with an estimated cost of billions of dollars annually in absenteeism and associated medical spending in the United States alone.
In the UK, the Chartered Institute of Personnel and Development's (CIPD, 2023) survey on menopause in the workplace found that around 10% of women who have experienced menopause symptoms have left a job because of them. And according to the 2025 Carrot Fertility and Olly survey cited in the Fast Company report itself, only 11% of women say their company offers menopause-specific benefits — the same figure, not coincidentally, as the share of women leading Fortune 500 companies.
What organizations can do: evidence-based interventions
The good news is that this problem has evidence-based levers. The Menopause Society's position statement on hormone therapy (2022) confirms that, for most symptomatic women under 60 or within ten years of menopause, the benefits of hormone therapy outweigh the risks — making timely diagnosis and treatment access a talent-retention lever, not just an individual clinical matter. CIPD itself recommends manager training to recognize symptoms, flexible scheduling policies, and reasonable workplace adjustments — low-cost measures with documented impact on retention.
What's missing in most organizations isn't willingness — it's visibility: a way to identify early that a performance dip has a transient, addressable hormonal cause, rather than letting it be mistaken for a performance problem until the person has already decided to leave.
From anecdote to data: the role of continuous monitoring
At IKI Health Group, we work precisely on that layer of visibility: translating daily data on sleep, emotional wellbeing, and physiological patterns into clinical indicators that help identify the perimenopausal transition and its symptoms early, so that a woman — and her care team — can act before the impact becomes a derailed career.
Eleven percent of women have access to menopause benefits. Eleven percent of Fortune 500 CEOs are women. That coincidence should make us uncomfortable.
Menopause isn't an HR problem that can be solved with a single isolated policy. It's a public health issue with a measurable talent cost and a clear scientific evidence base for what works. The question for executive and HR teams is no longer whether perimenopause is affecting senior women's leadership in their organization — it's how many leaders have already left the room without anyone knowing why.