Perimenopause, Menopause, and Work: Finding Meaning and Confidence

Perimenopause is a natural transition in which hormone levels begin to shift out of the reproductive phase. This stage can last for years and eventually leads to menopause and post-menopause. While the process is universal, the symptoms can vary widely. For many women, these changes arrive just as they are at the height of their careers — often experienced, senior employees with valuable skills and networks.

Common symptoms during this stage include hot flashes, night sweats, sleep disturbances, mood swings, fatigue, and difficulties with concentration often referred to as “brain fog.” For some, anxiety or depressive symptoms appear for the first time, while for others, pre-existing struggles with mood or sleep intensify. These shifts can feel shocking and at times debilitating in the workplace.

Research highlights how significant this impact can be. A 2023 study by O’Neill et al. found that about 65% of women reported that menopausal symptoms affected their work performance. Another large study published in Mayo Clinic Proceedings noted that 10.8% of women missed work in the past year due to menopausal symptoms. When sleep problems, anxiety, or depression are present, job satisfaction tends to drop further (BioMed Central).

In practice, this often looks like difficulties concentrating or remembering details, increased fatigue, or a slower pace from day to day. Many women report feeling behind, worrying about mistakes, or fearing that colleagues will notice changes. Others describe hesitating to ask for flexibility, even when breaks or adjustments would help.

Because work is such a major source of identity and meaning, these symptoms can deeply affect self-esteem. Feelings of being “not good enough” often surface, even when the objective performance remains strong. Imposter syndrome can worsen — especially if reliability and clarity have always been personal strengths. Many women worry about being replaced by younger colleagues or judged as “too old.” When energy is spent just getting through the day, it can become harder to feel joy or purpose at work.

This is not just about performance, but also about mental health. During the menopausal transition, women face a higher risk of depression, with one meta-analysis showing about a 40% increase compared to premenopausal women (The Guardian). Anxiety may also rise.

But alongside these challenges is an important truth: the skills, judgment, and experience built over many years remain intact. Even on more difficult days, many women find that their wisdom, problem-solving ability, adaptability, and mentoring capacity still shine through. What you bring to your workplace cannot be erased by hormonal changes — it may simply need new ways to be expressed.

Here are some supportive strategies, drawn from both research and therapeutic practice:

Talk with a health provider. Be open with your doctor or women’s health specialist about symptoms whether they are related to sleep, mood, or physical discomfort.

Nurture meaning outside of work. Hobbies, time with friends, nature, or creative outlets can buffer stress and affirm your identity beyond your job title. Engaging in something non-performance driven is especially important when work feels more draining — it restores joy and balance.

Lean into strengths and experience. Consider shaping parts of your role toward what feels meaningful. Mentoring younger colleagues or sharing expertise can be deeply rewarding. Draw on your network for encouragement and reminders of your value. Your perspective and skills are assets that less experienced coworkers can’t replicate.

Prioritize rest and physical wellbeing. Good sleep hygiene, gentle movement, and balanced nutrition make a real difference. Walking, yoga, or stretching can help with mood and focus, while avoiding late caffeine or sugar spikes reduces anxiety and sleep disturbances.

Manage energy intentionally. Break large tasks into smaller steps. Schedule demanding work during the times of day when you typically feel clearer. Take small breaks to reset — even a few minutes can help. Importantly, recognize that some days will feel harder than others, and that fluctuation doesn’t erase your ability or worth.

Seek therapeutic support. Therapy can provide a safe space to explore both the losses and the possibilities of this life stage. It’s normal to grieve shifts in stamina or mental sharpness, while also creating room for growth and new strategies. A therapist familiar with perimenopause and workplace issues can help address anxiety, depression, self-esteem challenges, and imposter syndrome. Therapy also helps you reclaim agency: deciding what you can control, how to communicate needs, and how to adjust expectations in healthy ways.

Perimenopause and menopause can be difficult, but they are not the end of meaning or capability at work. They are transitions — sometimes messy and uncomfortable — that coexist with deep reservoirs of experience, skill, and perspective. With support, strategies, and recognition of your enduring value, it’s possible to continue thriving in and enjoying your career.

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I’m a former business leader turned therapist, and these days I work with people navigating workplace challenges, adult ADHD, and the ups and downs of life. Want to talk it through? I’d love to hear from you