The perimenopause conversation your organisation isn't having

Women in their 40s are often at the peak of their professional capability. They have the experience, the relationships, the institutional knowledge, and the judgement that takes years to build.

They are also, statistically, the most likely to be navigating perimenopause in silence — inside organisations that have no idea it is happening.

What is actually going on

Perimenopause can begin in the early 40s and its symptoms — brain fog, sleep disruption, anxiety, mood changes, loss of confidence — are real, variable, and not widely understood in workplace contexts.

In my therapy room, I hear about the experience from the inside. Women tell me, consistently, that they are managing it alone. Not because they want to. But because the culture has never signalled that this is a conversation that can happen.

What organisations are missing

When a woman's performance dips during perimenopause, it is rarely identified for what it is. She may be perceived as lacking focus, or less driven than before. Her confidence — which perimenopause can genuinely shake — may be read as reduced ambition.

Women recalibrate their visibility, pull back from opportunities, and sometimes eventually leave — having never told anyone what was actually happening. Organisations lose experienced, capable people. And they don't know why, because it never made it into an exit interview.

What can actually help

The organisations making progress on this are creating conditions where the conversation can happen. They are equipping managers — particularly those with no lived experience of perimenopause — to respond with curiosity rather than discomfort. They are looking honestly at whether their flexibility policies work in practice for women managing variable symptoms.

If a woman in your organisation is struggling with perimenopause right now — and statistically, several are — would she feel able to say so? Would she trust that it wouldn't change how she was perceived?

If the honest answer is no, that is worth understanding. And worth changing.

Natalie McCandless is a BABCP-accredited CBT psychotherapist and workplace consultant. She works with organisations through the Women at Work Listening Project. nataliemccandless.com/working-with-me-organisations.