Carrying the Elephant
Author’s Note
This essay is for women who are already leading. Already carrying responsibility, judgment calls, and the expectation that they will steady the room regardless of what their own bodies are doing.
It is also for the leaders beside them who sense something is happening, but have never been given the language, the data, or the permission to say it out loud.
Menopause is not a niche concern.
It is a leadership reality hiding in plain sight.
Holding the Room
I was talking a male peer out of quitting.
He was frustrated. Burned out. Convinced the organization no longer valued him. He wasn’t wrong, but I listened, reflected, steadied the conversation, and helped him see a path forward.
All while my body began misfiring.
Heat surged suddenly, sharp, nauseating, and dizzying. Sweat gathered at my hairline and down my back. My heart sped up, not with fear exactly, but with that unmistakable edge where fight and flight start negotiating for control. I planted my feet more firmly on the floor, held onto the corner of my desk, and slowed my breathing without breaking eye contact.
I kept my voice even. I asked the right questions. I stayed present.
Later that day, leading a different meeting, the fog crept in.
I lost the thread of my own sentence halfway through making a point I know well. Not a word this time, but the entire shape of what I was saying. It was just… gone. I paused, redirected, circled back, hoping muscle memory would carry me through.
It did.
I finished the meeting. Answered questions. Made decisions.
When it ended, I realized I could not recall most of what I had just said. The conversation had happened. I had led it. And it was already gone.
This is the quiet work many women leaders do daily: holding together organizations while deciding how much longer they can carry themselves.
Leadership Through the Narrowest Path
Women already lead on a narrow path. I picture it as a rope bridge, stretched high over everything that could go wrong. The planks shift. The ropes sway. Everyone is watching the crossing, even when they pretend they are not. Every step requires calculation: how firm to be, how warm to be, how much to say, how little to reveal. Drift too far in either direction and the story changes fast. You stop being seen as credible. You become a “problem.” The work becomes secondary to the narrative about you.
Too quiet, overlooked. Too direct, difficult. Too emotional, weak. Too composed, cold.
Menopause compounds this dynamic. It adds weight to the crossing and reduces the margin for error at the exact moment the stakes are highest.
At the exact career stage when women reach senior leadership, typically between 45 and 55, the same window when most experience perimenopause and menopause, the margin for visible vulnerability narrows even further. Research confirms this is also when women hold their most complex roles, manage the largest teams, and carry the greatest institutional risk³.
So, women do what they have always done.
They carry the hot flashing, sweaty, brain-fogged elephant that is menopause across the rope bridge.
Careful. Without room to stumble.
What the Quiet Work Actually Looks Like
This work rarely announces itself, but we women know it well.
It shows up navigating meetings through a brain fog that research links directly to hormonal fluctuation, not lack of preparation³.
It looks like managing under a spotlight with hot flashes that affect up to 80 percent of menopausal women, many of whom report sleep disruption severe enough to impair concentration and decision-making¹².
It feels like the onset of a panic attack, arriving suddenly in moments that require calm.
It sounds like code. “The change of life.” “This phase.” “My hormones are being dramatic.” Carefully softened language designed to preserve authority and avoid embarrassment.
Women share fans discreetly. They trade doctor names quietly. They normalize symptoms for each other behind closed doors because formal systems do not.
Meanwhile, entire advertising ecosystems openly address men’s erectile dysfunction with humor, urgency, and federal approval. Menopause, which affects more than one billion women globally by 2030, remains largely invisible in corporate life¹⁵.
Again, women learn to adapt.
What Organizations Are Actually Losing
The cost of this silence is measurable.
More than 40% of women in perimenopause and menopause report calling in sick because of symptoms, and studies suggest 10–20% consider leaving work when symptoms go unmanaged²⁶. At the same time, women are rated more effective than men across most leadership competencies7.
McKinsey estimates that menopause-related symptoms contribute to thousands of dollars per employee per year in healthcare costs and lost productivity, while remaining largely absent from how organizational risk and workforce health are assessed¹⁵.
Taken together, this creates a contradiction. Organizations absorb the cost of attrition and disruption while losing leaders who consistently score higher on leadership effectiveness.
When senior women step back, decline visibility-heavy roles, or exit leadership entirely, organizations frame it as choice. The data points elsewhere.
Politics and Power Reality Check: Why This Remains Hidden
Menopause exposes a truth: Leadership has always had a body. We simply normalized one kind.
Medical research historically excluded women from clinical trials, particularly in midlife and beyond. As a result, what counted as “normal” health, stamina, and cognitive performance was defined through male bodies and linear aging patterns¹⁴.
Corporate norms grew up alongside that medical knowledge. Workplaces came to prize steady, uninterrupted performance: always available, always composed, always consistent. The “ideal worker” became someone whose body stays predictable, bounces back quickly, and does not introduce surprises into the workday.
These expectations shape who is seen as strong and who is seen as struggling. They reward people whose bodies fit the template and turn everyone else’s variability into a private problem to manage.
Women learned this early. Adaptation became part of professional competence. Symptoms were masked. Explanations were kept vague. The work continued, even as the template left less room for a human body.
Silence is not accidental. It is structural.
What Changes When Women Name the Work
Something shifts when women name the quiet work they do. A confident sentence. A matter-of-fact acknowledgment. A leader saying, “This is part of midlife. This is part of work. We can handle menopause.”
The HBR study of 64 senior women leaders found that 87 percent continued performing at high levels through menopause. Many described a second-stage effect: clearer boundaries, stronger confidence, and a deeper empathy that made their leadership even more impactful³.
Women leaders have been privately supporting one another for years. Now the work is moving into public view. Women-led philanthropy is funding menopause research and clinician training, pushing institutions to take midlife health seriously and helping close gaps in care and education¹. It is a reminder that women are not waiting to be rescued. They are building what they needed, then leaving it behind for the next woman.
Naming it lets a woman stay with the work because it removes the split attention.
When menopause is unnamed, she is doing two jobs at once. She is leading the meeting and managing the concealment: monitoring her face, her voice, her pacing, her memory, her temperature, her sweat, the timing of a pause, the risk of being misread. That self-monitoring pulls cognitive bandwidth away from listening, synthesizing, and making decisions.
A named reality changes the conditions. It gives her permission to use simple supports without explanation, to pause and reset without narrating it, to ask for a brief break, to move seats, to use notes, to follow up later. The work stays central because her brain is no longer allocating resources to passing as unaffected.
This Is Not a Detour
Menopause is not a detour from leadership. It is part of the terrain women have always navigated, and the language is finally catching up to the reality.
Remember the woman carrying the hot flashing, sweaty, brain-fogged elephant across the rope bridge? Naming it is what lets her keep crossing the rope bridge without being consumed by what she is carrying.
When it stays unnamed, she carries two loads at once. The elephant is the symptoms. The second load is concealment, the constant effort to keep the elephant invisible while crossing in front of everyone. That effort steals balance. It narrows attention. It turns leadership into a performance of perception management.
Naming it does not remove the elephant. It changes the conditions of the crossing. The bridge stops being a solo performance. She can take a breath, use supports, set expectations, and stay oriented to the work instead of scanning for how she might be misread. She keeps her footing because her attention returns to the path in front of her.
That shift has organizational consequences. When menopause is treated as a private inconvenience, women step back quietly at the height of their power. When it is normalized with steadiness and competence, organizations keep experienced leaders in the roles they have earned.
That is organizational intelligence.
A Personal Note on Leading with Menopause
No one prepped me for menopause. Not a mentor. Not a leadership program. Not an HR poster. Not a single “women in business” panel with a microphone and a blazer.
When the brain fog started, I assumed it was stress. Then the symptoms became harder to explain away: inner earaches, depleted energy, and hot flashes that can bring instant nausea and a panic response that feels sudden and intense. I can lead through it, and I do. It takes more effort than anyone can see.
At the same time, I’m at the height of my career, looking up at the next rung toward the C-suite. That is part of why this stays quiet. When all eyes are on you, you manage it privately and keep moving.
I’m writing this so other women can recognize what they’re experiencing and stop questioning their competence. Nothing about these symptoms makes you less capable. You are navigating a transition no one trained you for, while still doing the work.
I’m also writing it for leaders. Women are carrying real weight you cannot see. Notice what they bring to the table. Respect boundaries. Support time management without requiring disclosure. Create enough psychological safety that women do not have to manage perception on top of everything else.
And be kind to each other. Most women are already stretched thin.
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Learn the basics: common symptoms, typical age range, and how they can affect sleep, concentration, and confidence.
Normalize flexibility without requiring disclosure. Offer options. Let people choose.
Improve meeting hygiene:
Use an agenda and stick to it.
Record meetings and send notes or key decisions afterward.
Build 10-minute buffers between meetings.
Notice who is carrying invisible load and name the contribution in real time.
Make peer support easy: introduce optional small-group spaces, share reputable resources, and back leaders who speak plainly about women’s health.
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Treat menopause as a retention and leadership continuity issue.
Ensure health benefits include evidence-based menopause care and access to trained providers.
Train managers to respond with steadiness and competence.
Track mid-career female attrition alongside absence, engagement, and internal mobility data.
Build psychological safety through consistent norms: flexibility, clear meeting practices, and leadership language that makes women’s health discussable.
References
Lazar, K. “Women leaders spearhead menopause care renaissance.” Boston Globe, 2025.
DeRosa, A. “10 Ways to Improve the Workplace for Women During Menopause.” Inc., 2025.
Decker, M. & Grandey, A. “New Research on How Women in Leadership Navigated Menopause.” Harvard Business Review, 2025.
Robinson, C. “Women’s Health Is Holding Leadership Accountable.” Forbes, 2026.
Kemble, E. et al. “Unlocking Opportunities in Women’s Healthcare.” McKinsey & Company, 2022.
Schuster, C. “Supporting Women Executives Through Health Challenges Like Menopause.” Forbes, 2025.
Zenger, J., & Folkman, J. “Research: Women Score Higher Than Men in Most Leadership Skills.” Harvard Business Review, June 2019.
