There’s nothing like walking into an important presentation feeling prepared and confident—while secretly wondering, Is this the moment I’m going to have a hot flash in front of everyone? I’ve been there. Instead of focusing entirely on what I wanted to say, part of my brain was busy worrying about whether my face would turn red, I’d start sweating or I’d completely lose my train of thought.
That’s the lousy timing of perimenopause: it often hits just as we’re taking on bigger roles and reaching our professional stride. So how do we keep hot flashes, brain fog and other symptoms from hijacking our work—or our confidence? We asked Nicole Johnston, an expert on breaking the stigma around “taboo topics” women face, especially at work, from menopause and periods to emotional labor and boundaries, for practical advice on navigating perimenopause at work, from handling symptoms during high-stakes moments to deciding when to speak up and what employers need to understand.
Perimenopause can arrive during the exact years many women are taking on their biggest leadership roles. How can women keep symptoms from making them question their abilities or pull back professionally at a time when their experience is most valuable?
Perimenopause usually starts in your mid-40s, though it can begin as early as your mid-30s, and it runs four to eight years according to the Cleveland Clinic. That is the same decade most women step into the leadership roles that took two decades of experience to earn.
I hit my own wall of confusion at 51, waking up drenched in sweat with zero idea what had just happened to my body. My first thought was not “this is perimenopause.” My first thought was “something is wrong with me.” That gap, between what is actually happening in your body, the story you tell yourself about it, and the actions you take, is where the career damage happens. A hot flash is simply a hormone event. Deciding it means you can no longer lead the meeting is a story, and it is the wrong one.
Mayo Clinic Proceedings surveyed employed women ages 45 to 60 and found 13.4% had experienced an adverse work outcome tied to menopause symptoms, from cutting hours to turning down opportunities outright. The symptom did not cause most of that. The self-doubt did.
Learn the actual symptom list, there are more than a dozen, so brain fog does not feel like early dementia and irritability does not feel like a personality flaw. Then, keep doing the job you were already doing well before your hormones had an opinion about it.
You wake up on the morning of a huge presentation, interview, or meeting and your perimenopause symptoms are in full force. What can you do to feel more prepared and in control before you walk into the room?
My mom has a trick that sounds insane until you have lived through your first hot flash mid-sentence. Before a big moment, she goes to a private room, bends over, and tries to trigger a hot flash on purpose. If she can make it happen on her own terms first, it is less likely to ambush her in front of a room full of people.
You do not need my mom’s exact method, but you need her logic. Control the timing wherever you can.
If brain fog is the bigger worry that day, write your opening two or three lines on a card. Skip the extra coffee you are tempted to grab for nerves. Caffeine on top of a symptom flare is gasoline on a small fire.
I knew a speaker who prepared for potential bad situations by planning on a quip to redirect the energy into something positive. She once tripped going up the stairs. Instead of making a big deal of it, while she was getting up, she said, “I will now take questions from the floor.” The audience howled with laughter. Of course, people remember her falling, but they remember the recovery more. Decide beforehand that if something happens, a hot flash, a blank word, a shaky hand, you will name it once and move on. “Give me one second, having an internal power surge” beats a silent scramble every time.
What workplace habits can actually make perimenopause symptoms worse? Are there common things—skipping meals, over-caffeinating, back-to-back meetings, lack of breaks—that women may not realize are working against them?
Yes, and the worst part is these habits look like discipline. Skipping lunch to power through back-to-back meetings may feel responsible. But, it will crash your blood sugar on top of wildly swinging hormones, and that combination is a hot flash and mood swing generator on steroids.
Over-caffeinating is the quieter saboteur. Caffeine raises your core body temperature and spikes cortisol, both of which intensify hot flashes and anxiety instead of easing them. Back-to-back meetings with zero white space mean you never get a minute to reset, so small symptoms stack instead of settling before the next call starts.
Skipping strength training costs more than most women realize, too. Muscle and bone mass drop fast once perimenopause starts, and weight-bearing exercise, not just cardio, is one of the few levers you fully control.
None of this is about being high maintenance. It is about running your body the way you would run a budget, watching what goes in, instead of only judging what comes out at the end of the day. Being kind to yourself, and allowing yourself the grace you so freely give to others, is absolutely critical.
Hot flashes have terrible timing. What are your best strategies for handling one discreetly in the middle of a meeting, presentation, or interview without losing your train of thought—or your confidence?
A woman I know, Sandy, keeps a small personal fan on the table and uses it mid-meeting without a second of apology. That is one valid strategy: own it visibly enough that it stops being a secret you have to manage.
The other strategy is quieter. Dress in layers you can adjust without anyone noticing, a breathable top under a blazer works well. Keep water within reach and take a sip when it hits, which buys you a few seconds and looks like nothing more than a sip of water. If you lose your train of thought mid-flash, do not apologize for it. Say “let me finish that thought” and take the pause you would take anyway while choosing your next sentence carefully.
When Drew Barrymore had a hot flash live on her talk show and talked through it instead of hiding it, she did more for open conversations about menopause than most HR memos ever will. You do not have to announce yours in a client meeting. But you also do not have to spend your energy hiding a normal biological event instead of running the room.
Confidence is not the absence of a hot flash. It is finishing your sentence anyway.
Brain fog can be especially unnerving when your job depends on thinking quickly and communicating clearly. How can women prepare for high-stakes moments when they’re worried the words just won’t come?
Dr. Pauline Maki’s research at the University of Illinois Chicago found something specific: verbal memory measurably dips during the menopause transition itself, independent of aging, sleep, or mood. It is not your imagination, and it is not early dementia. It is estrogen doing less of the job it used to do for word retrieval, and the finding buried in that research, is that memory tends to recover once you are through to the other side.
I lost the word “purse” mid-conversation once. Not a fancy word, obviously, and one I had used thousands of times, just gone. I ended up saying “the thing women carry that holds their stuff,” and my friend said, “Purse?” and laughed with me instead of at me. Now she and I call this walking around the word. When we can’t recall a word, we just describe it until someone else can get it from our context. My winner so far? Feet fingers. Yes, I forgot the word toes.
For a high-stakes moment, do not memorize a script. Memorize the handful of nouns you cannot afford to lose, names, figures, the one term that matters, and write them on a small card you can glance at. Rehearse your opening two sentences out loud, since fog tends to hit hardest at the start and clear once you are moving. Build in five extra minutes before you walk in, not to calm your nerves, but because rushing is what turns a normal word-search pause into a visible stumble.
How do you decide whether to tell a boss, colleague, or interviewer what you’re experiencing? Is there ever a professional advantage to being open about menopause, or is it better to keep it private?
There is no universal right answer, and anyone who claims otherwise has not sat across from enough different bosses. Early in my career at Procter & Gamble, I told my manager I had sudden breakthrough bleeding and needed to leave immediately. She looked at her own boss, who hated not being able to look over his employees’ shoulders, and said loudly, “Great, let me know how your store checks go.” She gave me cover without me explaining a single detail. That only worked because she had already earned my trust, and I had earned hers.
Before disclosing anything about your menopausal journey, look at how your company has handled other medical situations like pregnancy, injury, a mental health leave. That history tells you more than any written policy will. A recent Benenden Health survey found 63% of women still find it awkward to raise menopause at work, while only 45% would feel comfortable telling their manager directly, numbers that show most workplaces have not caught up yet.
The professional advantage tends to show up less in disclosing the biology and more in reframing the ask. “I need to shift my start time” or “I need the office cooler” lands differently than a full symptom list, and it gets you the accommodation without making your hormones the topic of conversation. Save the fuller disclosure for the people who have already shown you they can handle it well.
What should managers and employers understand about perimenopause and menopause? Are there simple workplace changes that can make a meaningful difference without singling women out?
The Menopause Society’s 2024 workplace consensus recommendations are blunt about the cost of doing nothing: untreated symptoms are linked to a 57% jump in productivity loss, and U.S. employers lose an estimated $1.8 billion a year in missed work tied to menopause. This is a business case before it is ever a fairness case, which happens to be the argument that gets budget approved.
The fixes are not expensive. Temperature control, a fan at a desk, access to cold water, flexible start times, and leave policies that name menopause explicitly as a covered reason instead of leaving women to invent a story. None of that requires singling anyone out or announcing who is using it.
What actually moves the needle is manager training, and not the kind that turns into an awkward seminar. Managers need to know the symptom list exists so a woman asking for a schedule change does not get read as suddenly unreliable. Most people in a given office, men and younger women both, have no real idea what perimenopause looks like day to day. That gap in understanding is what turns a hormone shift into a career penalty, and it is entirely fixable with information most companies have simply never bothered to provide.
Nicole Johnston is the founder and CEO of innatePOWER LLC, an executive and leadership coach, and the bestselling author of Taboo Topics: Things Women Should Talk About, But Don’t.
As if navigating perimenopause at work weren’t enough, Gen X women have another workplace challenge to contend with: ageism. Read Aging Out Loud: Navigating Workplace Discrimination as a Gen X Woman for a closer look at what women are up against.
