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Women Are Ready For This Conversation. Are Organizations?
The World Is Rolling Back. This Conversation Is Not.
TLDR: Women are disappearing from leadership at 45-55 because they’re navigating a biological transition without language, support, or anyone in their organization understanding what is happening. That’s the Perimenopause Broken Rung. Women are ready to break the silence on this topic and to have a real conversation about menopause support at work. Are organizations ready for it?
I was nervous walking onto the stage last Friday (2/27). More nervous than I expected to be.
I was standing in front of a room of about 500 women leaders at the San Diego Women’s Week Leadership Conference. Shortly after I started speaking, a hush came over the room. It wasn’t the polite silence of an audience being courteous. It was the kind of silence that happens when something impactful lands.
By the end of the day, four leaders had called out the topic of my talk from the stage — unprompted. Each one said a version of the same thing: this conversation is overdue and I am going to do something about it.
By end of Monday, if I had had any doubt whether I had met the moment, it was quelled. Something had shifted in that room — and I could feel it.
The World Is Rolling Back
The external landscape for women in the workplace is contracting in real time.
DEI initiatives that took decades to build are disappearing from corporate agendas. Workplace protections are being eroded. Programs designed to advance women’s participation and leadership are being quietly dismantled.
The conversation about gender equity — which had been gaining institutional momentum for thirty years — is losing ground in boardrooms and policy chambers simultaneously.
This is real and sobering. It would be dishonest to pretend otherwise.
And yet.
The Silence Around the Struggle
The world has known that many women struggle with the menopausal transition. It has been simultaneously seeing and unseeing it — for generations.
The unseeing has been made possible, in large part, by an enormous silence with a history of complicity that deserves to be understood before it is judged.
The silence is multifactorial, complex, and deeply embedded in all our systems. It has been perpetrated by the unwitting complicity of women who used it as strategy when trying to protect their right to work, or avoid being shamed.
Women have had to fight for the right to work. And once they got it, they were not willing to hand the other side an argument to take it away again. Showing biological vulnerability — anything that could be weaponized as evidence that women didn’t belong — was not a risk any woman who had fought to be in that room was willing to take. The silence was strategy, originally the price of staying.
And then there was shame. Our culture has long been uncomfortable with the physiology of menstruation — it was something to conceal, to manage quietly, to never name in mixed company. Menopause inherited that discomfort entirely. It was culturally unspeakable, passed over in silence from one generation to the next. Mothers did not tell their daughters because they had learned, as their own mothers had learned before them, that this was something you carried alone. We learned to be silent the same way we learned everything else — from the women who raised us.
Medicine didn’t just fail to break that silence. It institutionalized it. Doctors receive less than two hours of menopause training on average. The WHI study in 2002 created two decades of fear around hormone therapy and left women without the gold standard treatment that could have helped them.
The medical system that should have named this transition, prepared women for it, and offered evidence-based support instead sent them home with the message that suffering was “natural” or had to be borne because treatment was dangerous. That abdication didn’t stay in the exam room. It followed women to work — and left organizations with no framework to act and women with no language to name what was happening to them.
Education could have helped. It teaches puberty and pregnancy, then skips perimenopause entirely — as though the third major hormonal transition in a woman’s life simply doesn’t exist.
The result is a silence so complete, so normalized, so thoroughly inherited that it became the water we swim in.
Why This Conversation Is Different
Despite the rollbacks, we are certain of one thing: women’s biology has not changed.
The menopausal transition is still happening to millions of women right now — regardless of what is on the policy agenda, regardless of which programs have been cut, regardless of who is in office. What is changing is the silence around menopause and how it impacts working women.
We are naming — for the first time, with this kind of clarity — a second broken rung, that I call the Perimenopause Broken Rung.
The original broken rung research identified a critical gap at the first step into advancement, where women are promoted at a lower rate than men and the pipeline for female leadership begins to narrow. That finding changed how organizations think about early career gender parity.
But there is this Perimenopause Broken Rung that has not been addressed yet.
It happens between 45 and 55. It is the moment when women who have already cleared the first rung — who have the experience, the institutional knowledge, the strategic depth that takes decades to build — begin to disappear from the pipeline again. Quietly, one woman at a time.
We have attributed that attrition to burnout, work-life balance, or personal reasons. Those are the explanations in exit interviews, but they are not always the real reason.
The real reason — for a significant portion of those exits — is a neuroendocrinological transition happening without language, without support, and without anyone in the organization recognizing what is happening.
Women are not leaving because they have run out of ambition. They are leaving because they have run out of bandwidth — temporarily — and no one has told them that the loss of resilience can be temporary, if timely and properly addressed.
That is the perimenopause broken rung. And once named, it cannot be unnamed.
The Workplace Is the Lever
Of all the systems that could break this silence — culture, medicine, education — the organization is the most powerful.
It is where women spend most of their waking hours during this transition. Where performance is measured and careers are made or lost. Which has the daily proximity to see what is happening in real time, and every incentive to act.
And yet, in our performance culture, the C-suite has been willing to be uninformed. The cost of this transition to organizations has never been calculated as a line item — sometimes it even shows up in exit interviews as “health reasons.” But we have not been ready to ask the real question: is menopause a factor?
The Mayo Clinic puts the annual cost to the US workforce at $28 billion in productivity loss and direct medical costs. I believe that is an extremely conservative figure. It does not account for replacement, training and onboarding costs for exits that were preventable, the loss of velocity in leadership and mentorship pipelines, or the loss of potential when women withdraw due to a significant but temporary biological dip.
A 2024 Bank of America study asked employers why they don’t provide menopause support at work. The answer is striking: employees haven’t asked.
Women don’t ask because they fear reputational risk. And because they don’t ask, they don’t get the support they need. This is the double bind — and organizations, by waiting for women to raise their hands, have made themselves complicit in sustaining it.
Most women moving through the menopausal transition say nothing to their managers or HR. The silence they have inherited keeps them from speaking. There is no precedent to draw on — no way to know how the information would be received, how they would be perceived, whether naming it would cost them something they can’t afford to lose. So they say nothing.
Organizations see no requests for support and conclude there is no need. The silence makes the problem disappear from view. And so the status quo holds — not because no one is suffering, but because suffering has been made invisible.
That is changing.
In June 2025, Rhode Island became the first state in the nation to mandate workplace accommodations for menopause symptoms. Federal legislation is in motion. The direction is clear and it is moving one way. The organizations that build the infrastructure now — the benefits, the policies, the cultural permission — will be ahead of it. The ones that wait will be scrambling to catch up.
The workplace is the lever we have not yet pulled. And the moment to pull it is now.
What Is Changing
We are on the cusp of something that thirty years of well-intentioned initiatives have not delivered, because they were working with an incomplete model.
The incomplete model said: put more women in the pipeline, remove structural barriers, build mentorship programs, and close the pay gap. All of those items are necessary but not sufficient because they don’t account for what happens to women biologically when their careers should be accelerating.
Finally, we are on the cusp of completing the model.
We are approaching menopause support at work differently this time. Not with awareness campaigns or appeals to fairness or diversity scorecards, we are doing it with facts and figures, biology, and a business case that speaks the language organizations respond to. The Mayo Clinic number, the Bank of America study, the pipeline data, the Rhode Island legislation — these are evidence that, in the right hands, can propel action.
What is also changing is that women are no longer willing to be complicit in perpetuating this silence.
For generations, silence was the price of survival. That calculation is changing because women are beginning to understand that the silence is costing them more than speaking up ever could. Every woman who names this transition breaks the chain of inherited silence for every woman behind her.
And when women break the silence with facts and figures, men become part of the solution too. A male CEO in that room — the head of a prominent civic organization — heard the business case and said he was willing to support this cause any way he can, because the argument was complete and the evidence was clear.
When women are confident about the value they bring to organizations and can speak openly about this transition and the support conditions that make a difference, they pave the way for men to engage with this topic as well. This is necessary not only because men are our allies, but because more men are in leadership positions. The organizations will come along. The ones that move first will find that the business case was always there — they just hadn’t asked the right question of their own data.
We are on the cusp of that question being asked. In every organization that matters. By the people with the power to act on the answer.
A Note to the Woman Reading This
You may be in your own version of that parking lot right now, sitting with a loss of resilience you cannot explain. You may be wondering what happened to the person you used to be. Making decisions from a place of depletion that you would make very differently from a place of strength.
Know that the diminishment is temporary. The biology is addressable. The conversation that can save scores of women from making an irreversible decision in the dark is finally happening in rooms that have the power to change things.
You are not alone in this anymore. And the world is finally starting to design for you.
But don’t wait for the world to catch up. Start now.
If you are navigating this transition right now and don’t know where to start — I can help HERE. If you are an organizational leader and this post sparked something for your company, I would welcome a conversation. Reach me HERE. And finally, if you would like to become an advance reader of the book I am working on The Perimenopause Broken Rung (working title), sign up HERE.
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