Leading Through Menopause: Why Senior Women Often Feel They Have to Hide Their Struggles
Somewhere around their late forties or early fifties, some of the most accomplished women in their organisations quietly start to wonder what has happened to them.
They prepare more extensively than they ever used to - not because they know less, but because they no longer trust themselves to remember what they know. They begin speaking less in meetings, not because they have fewer ideas, but because they are worried the right words will not come. They sit through board presentations managing a hot flush, a racing heart and a word that has momentarily vanished, while giving every outward appearance that everything is fine.
Many of the women I work with are exactly those women. Senior. Experienced. Capable. And genuinely unsure whether anyone can know what is going on.
This blog is for them. It is also for the organisations they lead, and for the HR and wellbeing professionals trying to understand why some of their most experienced female talent is quietly stepping back.
Because the intersection of menopause and leadership is not just a personal health story. It is a business story too.
For many women, the biggest leadership challenge of their career isn't learning to lead others. It's trying to lead while quietly wondering what has happened to themselves.
Menopause Often Arrives at the Peak of a Woman's Career
Perimenopause typically begins between the ages of 40 and 51, and can last for several years before the final menstrual period (Hoga et al., 2015). The average age of natural menopause in the UK is 51, though for some women it arrives earlier - including through surgical or medically-induced menopause (NHS, 2022).
This timing matters more than it might first appear. It means menopause frequently coincides with the stage of a professional life that has taken the longest to reach - director level, partner, head of department, senior executive, business owner. Women who are twenty or more years into building expertise, credibility, and influence.
Research by the Chartered Institute of Personnel and Development found that three in five women aged 40 to 60 said menopause had a negative impact on them at work, with the most common effects being reduced concentration, increased stress, and feeling less patient with colleagues and clients (CIPD, 2023).
For most of those women, this is not happening at a junior stage when the professional stakes feel manageable. It is happening in board meetings, client presentations, annual performance reviews, and promotion conversations.
The collision of biological transition and professional peak is not incidental. It shapes everything about how menopause is experienced at work - and, critically, why so many women choose not to name what is happening to them.
Why Senior Women Feel They Have to Hide Their Symptoms
Ask most senior women privately whether menopause has affected their work, and many will say yes. Ask whether they have told anyone at work and far fewer will say they have.
This is not a failure of honesty. It is a rational response to the environment many senior women operate in.
Fear of appearing less capable
Leadership in many organisations is still implicitly associated with certainty, composure, and consistent performance. When a woman experiences brain fog that makes her lose her train of thought mid-meeting, or anxiety that feels disproportionate to the situation, she is not experiencing a reduction in capability. She is experiencing a hormonal shift that is temporary and manageable. But in a culture that does not talk about menopause, she may interpret it as decline - and fear that others will too.
Imposter feelings are amplified
Research has long documented the disproportionate presence of imposter feelings among high-achieving women (Clance and Imes, 1978). Menopause can significantly intensify this. When brain fog, word-finding difficulties, or low confidence arrive alongside hormonal change, the internal narrative - "perhaps I was never as capable as people thought" - can become very loud. This is not a psychological weakness. It is a recognised effect of hormonal fluctuation acting on mood, cognition, and self-perception.
"The women I work with are often brilliant at their jobs. What menopause does is make them doubt that. It does not take capability away - but it can make capability feel very far from reach." Phillipa
Protecting hard-won credibility
Many senior women have spent years navigating workplaces where being taken seriously required a particular kind of self-presentation - composed, consistent, unruffled. Disclosing a menopause symptom can feel like a crack in that professional identity, even when the symptom is entirely normal and temporary.
Being the only woman at the table
Women in senior leadership are often still in the minority at their level. For women sitting as the sole female voice in a leadership team or on a board, disclosure can feel even more fraught. Menopause can be weaponised - consciously or unconsciously - to suggest that women are not suited to sustained senior leadership, and some women are acutely aware of that risk.
Concern about promotion and opportunity
CIPD research found that a significant proportion of women did not inform their manager of the impact menopause was having on them, due to embarrassment or because they felt the issue would not be taken seriously (CIPD, 2023). For women at senior level, the stakes are higher still. Disclosure at the wrong moment, or to the wrong person, can affect how they are perceived when opportunities arise - and they know it.
The result is a performance that takes enormous energy: showing up as though nothing is happening, when a great deal is.
Menopause Doesn't Create Incompetence. It Creates Uncertainty.
This distinction matters, and it is one I come back to repeatedly in my coaching work.
The women I support have not lost their edge. Their knowledge, their judgement, their ability to read a room and make sound decisions - all of that is still there. What menopause can do is make those qualities feel temporarily out of reach. And when a woman cannot access her own confidence, she is likely to conclude that the confidence was never really justified in the first place.
That is the trap. It sounds like self-awareness. It feels like realism. But it is, in most cases, a hormonal effect - not an accurate assessment of capability.
"I thought I'd finally reached my limit. That I'd been promoted beyond what I could actually handle. It took working with Phillipa to understand that what I was experiencing was hormonal - not the truth about my ability." - coaching client
Women often describe this to me as feeling like they have lost something, without being able to name what. They have not lost anything. Their experience, skills, and leadership instincts remain intact. What changes is the hormonal environment that makes those things feel accessible. Understanding that difference - the gap between feeling less capable and being less capable - is often where the work of recovery begins.
If you recognise this experience, the post on when menopause makes you doubt your ability to lead explores this in more depth. There is also more on rebuilding career confidence during menopause for women navigating this in a professional context.
The Hidden Cost of Masking Menopause at Work
Masking menopause symptoms is not a neutral act. It has a cost - to the woman, and to her organisation.
Decision fatigue and cognitive load
Managing symptoms in real time while simultaneously attempting to conceal them occupies significant mental bandwidth. A woman managing a hot flush during a board meeting, or compensating for word-finding difficulties in a client presentation, is doing two things at once. Over time, that additional cognitive load compounds.
Burnout
When women are managing the physical and emotional demands of menopause without support or adjustment, while maintaining the performance expectations of senior roles, burnout is a foreseeable outcome. . If you are unsure whether what you are experiencing is menopause, burnout, or both, the post on menopause or burnout at work may help you make sense of it. Research suggests that unmanaged menopause symptoms can negatively affect attendance, performance, and retention, particularly in demanding roles where support or flexibility is limited.
Presenteeism
Presenteeism - being physically present but not operating at full capacity - is consistently identified as one of the most significant costs of unmanaged menopause in the workplace (CIPD, 2023). For senior leaders whose strategic thinking, stakeholder relationships, and decision-making directly affect organisational outcomes, even a modest reduction in effectiveness carries a disproportionate business cost.
Avoiding visibility
Several women I have worked with have described consciously declining speaking opportunities, stepping back from board presentations, or avoiding situations where they might lose their train of thought publicly. For women at the stage where visibility matters most for career progression, that withdrawal is costly - not just professionally, but in terms of their sense of identity and purpose.
Leaving leadership altogether
When experienced women leave - or quietly downgrade their aspirations - at the exact career stage where they have most to contribute, organisations lose institutional knowledge, leadership depth, and diversity of perspective. The cost is rarely tracked, but it is significant.
Why this matters for your organisation
Organisations routinely invest substantially in leadership development, succession planning, and gender equity initiatives. Many have spent years trying to build more representative senior teams. Yet menopause - which directly affects the retention and performance of women at the exact level those programmes are designed to reach - rarely features in that investment.
The women most likely to be affected are the same women leadership pipelines are designed to support: experienced, high-performing, and in their forties and fifties. Ignoring menopause in that context is not a minor oversight. It undermines the return on every other retention and development investment an organisation has made.
For a broader picture of what unmanaged menopause costs UK employers, the post on the hidden cost of menopause at work in the UK sets out the evidence in detail.
Leadership Doesn't Make Menopause Easier
Seniority might seem to provide a buffer - the confidence built over a career, or the autonomy that comes with a senior role, making menopause more manageable professionally. In practice, the opposite is often true.
The demands of senior roles do not step back to accommodate what is happening hormonally. They intensify. But the scenario below is probably more familiar to many senior women than any amount of research.
Picture this. You are presenting next year's strategy to the Board. You have prepared extensively - more than you usually would, because you are not fully trusting yourself at the moment. Halfway through your presentation, a hot flush starts. Your heart rate rises. The room feels suddenly, unreasonably warm. A word you have used thousands of times simply disappears - and you know it, even if no one else does. You recover. You keep going. Nobody in the room notices. But for the rest of that meeting, part of your attention is not on the strategy. It is on that missing word, on the flush that is still fading, on whether anyone saw, on whether this is getting worse. Afterwards, instead of feeling good about a well-prepared presentation, you feel rattled. And you tell no one.
That is not a failure of leadership. It is what happens when a significant physiological transition meets a high-stakes professional environment, with no support and no room to acknowledge it.
Senior women face this kind of moment regularly. Consider what it actually looks like to:
Lead a difficult meeting while managing a hot flush that is impossible to ignore, in a room with no cooling, with people waiting for you to hold the space
Present major strategy to a board when brain fog means the words that are usually instinctive have temporarily gone
Make high-stakes decisions - on restructuring, resource allocation, risk - on four hours of broken sleep, week after week
Manage a team through uncertainty or conflict while your own anxiety is heightened and every interpersonal dynamic feels amplified
Navigate the additional scrutiny that often accompanies being a senior woman, while simultaneously feeling less certain of yourself than you have in years
For women who have experienced surgical or medically-induced menopause - including following cancer treatment - the onset can be sudden and the symptoms more severe, with very little time to prepare professionally.
Hot flushes deserve particular mention given how frequently they arise in professional settings. They are among the most common and most visible symptoms of menopause. If this is a specific challenge for you, there is more detail in the post on managing workplace temperature and hot flushes and practical guidance on how to reduce hot flushes more generally.
Anxiety is another symptom that can be particularly difficult to navigate in leadership roles - both because it is invisible to others, and because it can feel deeply personal rather than hormonal. The post on menopause and anxiety at work explores this in more detail.
What Good Organisations Do Differently
Not every organisation handles this badly. Some have recognised that menopause is a workplace issue - not a private health matter to be managed invisibly - and have built cultures and structures that reflect that.
They create psychologically safe cultures
In a psychologically safe workplace, people are not afraid that disclosing a health challenge will damage their standing. For senior women, psychological safety is not just a cultural nicety - it is the condition that makes disclosure possible at all. Organisations that invest in it report stronger retention, higher engagement, and greater leadership diversity (Frazier et al., 2017).
They train managers - at every level
ACAS guidance on menopause in the workplace is clear: employers have a legal duty to make reasonable adjustments for employees whose menopause symptoms amount to a disability under the Equality Act 2010 (Equality Act 2010; ACAS, 2023). Beyond legal compliance, managers who understand menopause are better placed to have supportive conversations, recommend appropriate adjustments and avoid inadvertent discrimination. That includes senior managers, who often receive the least training on this. Find out more about menopause manager training and what it covers.
They offer genuine flexibility
Flexibility is not simply remote working. It includes the ability to adjust hours around disrupted sleep, to take breaks without explanation during difficult symptom days, and to access quieter or cooler workspaces when needed. For senior leaders, this often requires a cultural shift as much as a policy one - because inflexibility at the top sets a precedent throughout the organisation.
They include leadership coaching in their support offer
EAP referrals and occupational health access are useful starting points. But for senior women, specialist coaching that addresses menopause alongside leadership - confidence, decision-making, visibility, team dynamics - offers something more targeted. It meets women where they are, at the specific intersection of biological change and professional responsibility.
They implement menopause policies with real substance
A menopause policy that exists only on an intranet does not change culture. Organisations getting this right make their policies visible, ensure line managers can action them, and review them regularly. CIPD guidance on menopause policies offers a strong framework for what good looks like (CIPD, 2023).
They normalise the conversation
When senior leaders - women and men - speak about menopause openly as a workplace issue, it signals to everyone in the organisation that this is not a taboo subject. That normalisation is arguably the highest-leverage change an organisation can make, because it shifts the culture at its root.
If you are an HR leader or people professional exploring how to build this kind of support in your organisation, find out more about the workplace menopause support services available through The Menopause Health Coach.
You Don't Have to Lead Through Menopause Alone
If you have recognised yourself in any part of this, something important is worth saying directly.
Menopause does not erase decades of knowledge, judgement, or leadership experience. It can, however, make those qualities feel temporarily out of reach. And when that happens - when the confidence and clarity you have built over a career feel suddenly unreliable - the temptation is to push harder, prepare more, perform better, and tell no one.
That approach takes an enormous toll. And it is not the only way through.
The aim isn't to get through menopause. It's to come out the other side still leading with confidence - without having to hide what you experienced to do so.
Working with a specialist menopause coach gives you a space to understand what is happening physiologically, separate the symptoms from your assessment of your own capability, rebuild confidence that the transition may have eroded, and develop practical strategies that work within the specific demands of your role. Not generic wellness content - something built around where you actually are.
Nutrition also plays a meaningful role in how menopause is experienced day to day. The Fuel & Live Well programme and Fuel & Move Well programme are both designed to help women build habits that support them through hormonal change - not fight against it.
Feeling like you have to keep everything together? You don't have to navigate menopause while carrying the weight of leadership on your own. If menopause is affecting your confidence, decision-making or wellbeing at work, coaching can help you understand what's happening, rebuild your confidence, and develop practical strategies that work in your role. Book a free Clarity Call to explore how we could work together.
References
ACAS (2023) Menopause at work. Available at: https://www.acas.org.uk/menopause-at-work (Accessed: 10 June 2025).
CIPD (2023) Menopause in the workplace: Employee experiences in 2023. London: Chartered Institute of Personnel and Development.
Clance, P. R. and Imes, S. A. (1978) 'The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention', Psychotherapy: Theory, Research and Practice, 15(3), pp. 241–247.
Equality Act 2010 (c. 15). London: The Stationery Office.
Fawcett Society (2022) Menopause and the workplace. Available at: https://www.fawcettsociety.org.uk/menopauseandtheworkplace (Accessed: 10 June 2025).
Frazier, M. L., Fainshmidt, S., Klinger, R. L., Pezeshkan, A. and Vracheva, V. (2017) 'Psychological safety: A meta-analytic review and extension', Personnel Psychology, 70(1), pp. 113–165.
Hoga, L. A. K., Rodolpho, J. R. C., Gonçalves, B. G. and Quirino, B. (2015) 'Women's experience of menopause: A systematic review of qualitative evidence', JBI Database of Systematic Reviews and Implementation Reports, 13(8), pp. 250–337.
NHS (2022) Menopause. Available at: https://www.nhs.uk/conditions/menopause/ (Accessed: 10 June 2025).
