Perimenopause and Leadership: Staying in the Room When It Matters Most

The Leadership Attrition Problem No One Is Talking About

The pipeline of women in senior roles has been a focus of corporate diversity efforts for years, and yet a significant leak in that pipeline goes largely unacknowledged. Women who are most likely to be stepping into their peak leadership years, those in their mid-to-late forties and early fifties, are also the women most likely to be navigating perimenopause. For some, the symptoms are manageable. For others, they are severe enough to quietly redirect a career that was otherwise on a strong upward path.

Surveys conducted in the UK, where public conversation on this topic has moved further than in most countries, have found that a significant proportion of women in senior roles have considered leaving or actually left their jobs during perimenopause. The reasons they cite are not simply physical. They describe losing confidence in their own judgment, fearing that they are being perceived as less capable, and pulling back from high-visibility opportunities to avoid exposing symptoms they cannot fully control.

This is a real problem with real costs. Organizations that lose experienced senior women at this stage lose decades of accumulated knowledge, relationship capital, and institutional memory. And the women themselves lose something that took a long time to build. The first step toward changing this is naming what is actually happening.

Cognitive Symptoms vs. Actual Leadership Capability

One of the most disorienting aspects of perimenopause in a leadership context is the gap between how capable you feel and how capable you actually are. Brain fog, word-finding difficulties, and the sense that your mental sharpness has blurred can feel devastating when your job depends on appearing composed, decisive, and authoritative. But the way cognitive symptoms feel in perimenopause is a poor predictor of your actual performance.

Research consistently shows that the cognitive effects of perimenopause, while real, are modest for most women. Tests of objective cognitive function tend to show much smaller declines than subjective reports of how bad women feel their memory or concentration is. This gap exists partly because dropping estrogen affects your perception of your own cognition, not just cognition itself. You become a harsh and unreliable critic of your own mind.

For leaders, this matters enormously. The decisions you are making, the relationships you are managing, the strategic judgment you are applying are most likely still intact even when a meeting leaves you feeling like you fumbled. Keeping a record, even informally, of projects you completed well, feedback you received, and decisions that landed correctly during a difficult symptom period gives you evidence to push back against your own distorted internal narrative.

The Paradox of Maximum Experience and Minimum Confidence

It is one of the more painful ironies of perimenopause that it often coincides with the moment you have the most to offer. You have spent years or decades building expertise, navigating difficult people and situations, developing judgment that only comes from experience. And then, at exactly the moment when that investment should be paying the highest dividend, your confidence is undermined from the inside.

This paradox is worth sitting with rather than dismissing. Your confidence is not the same as your competence. Competence is the actual collection of skills, knowledge, and experience you carry. Confidence is a feeling about that competence, and it is highly susceptible to hormonal fluctuation. Perimenopause does not erase what you know how to do. It temporarily makes it harder to feel secure about it.

Some women find that externalizing their track record helps. Writing down your professional wins, keeping praise and feedback somewhere you can re-read it, and deliberately reviewing your experience before high-stakes situations gives you access to evidence that your feeling of inadequacy is not the full picture. Therapy, particularly approaches that work with cognitive patterns, can also help you separate the hormonal confidence dip from a realistic assessment of your actual capability.

Using Perimenopause to Clarify What Matters

Perimenopause has a way of burning away what is not essential. The patience you once had for performative work, for meetings that could have been emails, for leadership styles that prioritize appearance over substance, tends to thin. This is not always comfortable, but it can be clarifying.

Many women describe perimenopause as a period when their tolerance for misaligned values dropped sharply. Work that used to feel tolerable started to feel intolerable. This often reads as irritability or difficulty, and sometimes it is. But underneath it, there is frequently a clearer picture of what matters and what does not. That clarity is a leadership asset if you can channel it.

Leaders who know what they stand for, who can say clearly what the priorities are and hold to them under pressure, are not leaders who please everyone. They are leaders whose teams tend to trust them because the direction is consistent. If perimenopause is helping you get clearer about what you actually believe and what you actually want to build, that clarity, expressed thoughtfully rather than reactively, is one of the more valuable things you can bring into a senior role.

Boundary-Setting as a Leadership Strength

One of the significant shifts that perimenopause often catalyzes is a reduced tolerance for overextension. Where you may once have accepted every meeting request, taken on every additional responsibility, and said yes as a default, the symptoms of perimenopause, particularly fatigue and anxiety, tend to make that pattern unsustainable. You are forced, often for the first time, to say no.

For women who have built careers partly on being accommodating, collaborative, and broadly available, this shift can feel like failure. But for an organization, a leader who knows how to say no, who protects the time and energy needed to do the work that matters most, is a more effective leader than one who is stretched across too many surfaces to go deep on any of them.

Practicing this explicitly, deciding in advance what your non-negotiables are before the week starts, delegating more than feels entirely comfortable, and communicating your priorities clearly to your team, is a form of leadership modeling. It shows the people around you that sustainable work is possible. It is also, practically speaking, how you protect your energy during a period when you cannot afford to pour it in every direction at once.

Advocating for Organizational Change from the Top

If you are in a senior leadership position and navigating perimenopause, you have access to a form of leverage that most of your colleagues do not. You can name the issue publicly, ask for institutional change, and signal to every woman in your organization that this is something the leadership cares about.

This does not require you to describe your personal symptoms in detail or to make your struggle a matter of public record. It can be as simple as supporting a menopause policy initiative, asking HR what support exists for perimenopausal employees, or saying in a leadership meeting that you have been reading about this issue and think the organization should address it. Leaders who raise this issue, particularly those who do so with some personal directness, normalize it in ways that filtered communications from HR simply cannot.

The business case is easy to make. Keeping experienced senior women in the workforce longer, reducing absenteeism, avoiding the costly process of replacing people who leave because their symptoms were not supported, these are measurable bottom-line issues. When leaders frame it that way, conversations that were previously awkward or seen as niche suddenly find traction with finance, with the board, with the parts of the organization that respond to numbers.

Practical Strategies for Leading Through Peak Symptoms

The abstract work of reframing your experience matters, but so do the concrete logistics of getting through hard weeks. There are practical things you can do to protect your performance during the periods when symptoms are heaviest.

Over-preparation is your friend. When you know that word-retrieval is unreliable, prepare more than you usually would. Have notes. Use slides that support rather than embarrass you. Practice out loud before presentations. Build in more buffer time before high-stakes conversations so you can review context rather than retrieve it cold. If you have a trusted deputy or executive assistant, loop them in on key details so that they can support you in real time without you having to carry everything alone.

Protect sleep as fiercely as any other strategic resource. The cascading effects of sleep disruption on judgment, emotional regulation, and cognitive performance are well established. If your symptoms are disrupting sleep significantly, that warrants a conversation with your doctor about treatment options. Hormone therapy, low-dose antidepressants, and other approaches can make a real difference to sleep quality, which has a real downstream effect on your leadership performance. You are allowed to treat this like the health issue it is.

What Staying in the Room Makes Possible

When you stay in your leadership role through perimenopause, imperfectly and with whatever accommodations and strategies you need, you do something that matters beyond your own career. You become evidence that it is possible. Younger women in your organization see a senior woman making it through a difficult transition without disappearing. That visibility changes what they think is possible for themselves.

You also accumulate something during this period that cannot be replicated any other way: the experience of leading while compromised. Of making good decisions when you feel terrible. Of maintaining relationships and credibility and organizational trust through a period that is genuinely hard. That is a kind of resilience and wisdom that gets baked in at a very deep level.

Perimenopause does not have to be the thing that ends your leadership chapter. For many women, it is the beginning of the most honest and grounded version of their leadership, stripped of the need to perform certainty they do not feel, and clearer than ever about what they are actually there to do.

Medical Disclaimer

This article is for informational and educational purposes only and does not constitute medical or professional advice. Perimenopause affects every woman differently, and symptoms can range from mild to severely disruptive. If perimenopause symptoms are affecting your quality of life or professional functioning, please consult a qualified healthcare provider who can discuss treatment options suited to your individual health history.