“It’s Probably Just Stress”: What Women Leaders Should Know About Perimenopause

“It’s probably just stress.”

A high-performing woman hears it from a doctor with 15 minutes on the clock. She hears it from a partner who means well. Most often, she hears it from herself, at 3 a.m., awake again for no obvious reason.

Sometimes it’s true. Stress is real, and leaders carry plenty of it. But if it’s wrong, it may be the most expensive sentence she’ll hear, because it ends the conversation before anyone has looked at the data.

The most expensive sentence a high-performing woman hears

As someone who signs paychecks, I’ll add the business view. The women this happens to, from their late 30s into their early 50s, are often the most experienced people on the team. They’re running the departments, carrying the client relationships and training the next layer of leaders.

And they’re often the people most practiced at pushing through. That’s a strength at work. It’s a liability when a real change gets explained away for years.

I’m the founder of The Vitality Collective, not a clinician, so this isn’t medical advice. It’s what I want every woman on my team, and every leader who manages one, to know.

What perimenopause is, and when it starts

Menopause itself is a single point in time: a full year without a period. Perimenopause, also called the menopausal transition, is the stretch leading up to it, when hormone levels shift and cycles start to change.

According to the National Institutes of Health, most women start the transition in their late 40s, but it can happen earlier or later. The American College of Obstetricians and Gynecologists notes that estrogen production can begin to fluctuate in the 30s and 40s. The transition can last several years.

Why it hides: symptoms come and go

Can perimenopause symptoms come and go? Yes, and that’s exactly why they’re so easy to file under “stress.” Hormone levels can vary a lot during the transition, and symptoms can show up, ease off and come back.

Common signs include:

• Cycle changes: cycles that get longer or shorter, skipped periods and flow that’s lighter or heavier than usual
• Hot flashes and night sweats: sudden waves of heat, sometimes at night
• Sleep disruption: trouble falling or staying asleep, or waking much earlier than usual
• Mood changes: irritability, anxiety or low mood
• Brain fog: forgetfulness and trouble concentrating

Some women have few or mild symptoms. Others have many, and they can be severe. A rough month followed by a good one makes it easy to decide it was the quarter-end crunch.

Now look at that list the way a high performer looks at a dashboard. Sleep, focus and recovery are the inputs you already track. One can also feed another: NIH notes that hot flashes can interfere with sleep, and poor sleep makes everything else feel harder. If those inputs are shifting, it’s worth noticing. Not as a verdict on anyone’s performance, but as a signal worth looking into.

If low mood is persistent, raise it with a licensed clinician. If you’re having thoughts of harming yourself, call or text 988 now. In an emergency, call 911.

Why one blood test rarely settles it

Can perimenopause show on a blood test? Usually not on its own. Because hormones swing during the transition, a single test can look normal.

ACOG says most women probably don’t need hormone testing: an ob-gyn can usually tell based on age, symptoms and changes in periods. Testing may be offered to women younger than 45 who have changes in menstrual bleeding, especially if they’re younger than 40. NIH puts it even more plainly: no test can confirm when you’ve begun the transition.

Labs still have a job, though. They can help rule out other causes of similar symptoms. A 2023 practitioner’s toolkit for menopause care, published in the International Menopause Society’s journal Climacteric, lists checking for thyroid disease, iron deficiency and type 2 diabetes when fatigue, mood changes or feeling hot are part of the picture.

The business case, for leaders and employers

This isn’t only a personal health question. A 2023 study of employed women aged 45 to 60 receiving care at Mayo Clinic found that menopause symptoms were linked to adverse work outcomes, including missed work, and that the odds rose as symptoms got more severe. The authors called for better treatment and a more supportive workplace.

I’m not a lawyer, and this isn’t legal or HR advice. But from where I sit, a few things help, and none of them is complicated:

• Normalize the conversation. If “perimenopause” can’t be said out loud on your team, people will keep saying “stress” instead.
• Offer flexibility where the work allows. A rough night shouldn’t have to be hidden behind a 7 a.m. meeting.
• Make care easy to reach. Benefits and resources that make it simple to see a clinician who takes symptoms seriously.

You’d never let a top performer’s output slide for two years without asking what changed. Ask about the work and what support would help, and let her decide what, if anything, she shares about her health.

What a real workup and conversation look like

You don’t need to diagnose yourself. You need to show up to the right conversation with better information:

1. Track it for a few weeks. Log symptoms, sleep, energy and cycles the way you’d track any performance metric. Patterns that “come and go” are much easier to see on paper. If you use AI to organize your notes, use it the way I described in Your AI Is Not Your Prescriber: as an analyst that helps you build questions, not as the one making the call.
2. Ask about labs that rule out other causes. Thyroid and other common culprits belong in the conversation. Your clinician decides what’s right for you.
3. Ask about options, hormonal and non-hormonal. For many women, hormone therapy is the most effective treatment for hot flashes and night sweats, and it has been shown to prevent bone loss. Its risks differ by type, dose, duration of use, route, timing of initiation and whether a progestogen is used. For women younger than 60 or within 10 years of menopause onset who have no contraindications, The Menopause Society’s position statement describes the benefit-risk ratio as favorable for bothersome hot flashes and night sweats. It’s less favorable when therapy starts later, because of greater absolute risks of heart disease, stroke, blood clots and dementia. That guidance is written mainly about hormone therapy around and after menopause. For women still in perimenopause, who may still be having periods and may still need contraception, the options and how they’re used can look different, so it’s worth asking a clinician how it applies to you. Most of that research is on FDA-approved hormone therapy, so it’s fair to ask your clinician what’s being prescribed and why. ACOG also lists risks, including small increased risks of stroke, blood clots and, with combined therapy, breast cancer. Hormone therapy isn’t right for everyone, and there are non-hormonal prescription options and other approaches to discuss as well.
4. Ask about bone health. It starts mattering before menopause. In the Study of Women’s Health Across the Nation, bone density loss began about a year before the final menstrual period.

None of this is a promise. No treatment can promise to make anyone feel or work a certain way, and the right answer depends on your own age, timing and health history. That’s a decision to make with a licensed clinician who knows your whole picture.

“Just stress” is sometimes the right answer

Sometimes it really is stress. Now you’ll know, instead of guessing.

Optimization starts with the right baseline. If a hormonal transition has quietly changed your sleep, focus and recovery, a plan built on last year’s inputs is built on the wrong numbers. That’s the same discipline I’d want any leader to apply to her team, and to herself. It’s also why I wrote You Underwrite Your Executives. Who’s Underwriting Their Health?

Talk it through

If any of this sounds familiar, or you want to better support the women on your team, a conversation is a better next step than another month of guessing.

Request a Private Call →

Available nationwide. Some visit requirements vary by state. Medical care through The Vitality Collective is provided by independent licensed clinicians.

— Charles

Sources

1. National Institute on Aging. What Is Menopause? https://www.nia.nih.gov/health/menopause/what-menopause
2. NIH News in Health. Managing Menopause. October 2024. https://newsinhealth.nih.gov/2024/10/managing-menopause
3. American College of Obstetricians and Gynecologists. The Menopause Years (FAQ047). https://www.acog.org/womens-health/faqs/the-menopause-years
4. American College of Obstetricians and Gynecologists. Do I need to have testing of my hormone levels during perimenopause? (Ask ACOG, September 2025). https://www.acog.org/womens-health/experts-and-stories/ask-acog/do-i-need-to-have-testing-of-my-hormone-levels-during-perimenopause
5. Davis SR, et al. The 2023 Practitioner’s Toolkit for Managing Menopause. Climacteric (journal of the International Menopause Society). 2023;26(6):517-536. https://doi.org/10.1080/13697137.2023.2258783
6. Faubion SS, et al. Impact of Menopause Symptoms on Women in the Workplace. Mayo Clin Proc. 2023;98(6):833-845. https://doi.org/10.1016/j.mayocp.2023.02.025
7. The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. https://doi.org/10.1097/GME.0000000000002028
8. Greendale GA, et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women’s Health Across the Nation (SWAN). J Bone Miner Res. 2012;27(1):111-118. https://doi.org/10.1002/jbmr.534
9. 988 Suicide & Crisis Lifeline. https://988lifeline.org/

Educational only, not medical advice. I’m the founder of The Vitality Collective, not a clinician. Talk with a licensed clinician before starting any treatment. Some medications a clinician may prescribe are not FDA-approved. Medical care through The Vitality Collective is provided by independent licensed clinicians. Individual results vary. Available nationwide. Some visit requirements vary by state.