Brain fog, disrupted sleep and anxiety are reaching women in their peak career years, and employers can help
Many women reach the peak of their careers in the same years their bodies start to change. Perimenopause and menopause can bring brain fog, disrupted sleep and anxiety in the very years women are earning leadership roles and boardroom visibility.
Dr. Jordan Emont, a board-certified OB/GYN and Menopause Society Certified Practitioner, sees that overlap in his practice. He’s the founder of Emont Medicine, a California-based telehealth practice focused on menopause and hormone care, and serves as Adjunct Clinical Faculty at Stanford University.
“This really is very directly affecting not just the individual and their ability to perform their job, but also affecting companies,” Emont said.
Employers are losing talented people, he said, or seeing them change their schedules because they can’t access treatment.
Symptoms can start a decade before menopause
Menopause is defined as one year without a period, Emont said, and the average age in the U.S. is 51, with a normal range of 45 to 55. Symptoms, though, can appear much earlier, during a stretch known as perimenopause.
“The hormonal changes leading up to that one year without a period can start even 10 years before your final menstrual period,” Emont said. “So that means that there might be some 35-year-olds out there that are already starting to experience those changes and are starting to notice symptoms.”
Emont said the earliest changes can be difficult to identify, and he often jokes about what patients tell him when they first come in.
“I always say that the first symptom of menopause is somebody coming in and telling me, ‘I just can’t stand my partner, or I just can’t stand my family,'” Emont said. “I think that what it goes along with is this general sense of ‘I don’t feel like myself.'”
Mood and sleep changes are among the most common early symptoms, Emont said, including increased anxiety, depression and difficulty falling or staying asleep. Others include hot flashes, night sweats, joint pain and decreased libido or sexual function.
How symptoms affect work and productivity
Charmaine Brown, founder and CEO of Balancia, a company that helps professional women manage menopause brain fog, memory lapses and anxiety, said the cognitive changes affect women at least as much as the physical ones.
Brown, an Austin, Texas-based performance coach who holds a doctorate in cell and molecular biology, said anxiety can rise suddenly to a level that can’t be controlled, and brain fog can mean forgetting a client’s name or a key word in a board meeting or on a client call.
“I think it really starts to shake your confidence when you’re like, ‘Oh, I just looked like a fool because I couldn’t remember the name of the person I was talking to,'” Brown said.
Brown said trouble focusing, or regaining focus after an interruption, affects day-to-day work.
Memory changes can compound the problem, she added. Before women adapt, they can miss deadlines, lose track of what they committed to and spend extra time recreating details they once would have remembered.
To avoid falling behind, many women attempt to compensate rather than ask for help.
“Instead of having those conversations, we hide it, we work harder, we work longer hours to compensate for the things that we used to be able to do quicker and easier,” Brown said.
The effects impact employers, too. The Menopause Society’s 2024 consensus recommendations on menopause in the workplace say that hot flashes and night sweats, mood changes, cognitive changes and insomnia can negatively affect productivity and performance.
A 2023 Mayo Clinic study of 4,440 employed women ages 45 to 60 estimated that missed workdays tied to menopause symptoms cost the U.S. about $1.8 billion a year.
Turnover can add to the cost. The society noted that employers risk losing female talent, many of them at the pinnacle of their careers, and that replacing an individual employee can cost between half and two times their annual salary
What women and employers can do
Emont said the first step for women is seeing a medical professional with menopause training. He pointed to Menopause Society Certified Practitioners and members of the International Society for the Study of Women’s Sexual Health as two places to look.
His biggest advice for women is not to doubt themselves when something feels wrong and they aren’t getting an answer that makes sense, Emont said.
Employers have a role, too, and fear of judgment is the first hurdle. A 2025 LiveCareer poll found that many women with symptoms feel pressure to hide or downplay them at work.
“I think women will always wonder if saying something, putting a label on it, calling attention to the fact that their brains and their bodies have changed will make them be seen as less than, be easier to push out,” Brown said.
That hesitation limits what formal programs can accomplish, she said.
“Saying that you have a policy around menopause or perimenopause and your ability to get accommodations at work only goes so far because it is only helpful if women are willing to use it,” Brown said.
Brown said managers should start the conversation with the work itself.
“I think it is very reasonable to have the conversation of like, ‘Hey, we’ve noticed some changes in the way you work or in your performance, and we want to support you and help you get back to the level of productivity and efficiency that we are used to seeing from you,'” Brown said.
She said managers can leave it up to the employee to decide whether to disclose what’s behind the changes, or simply work through them together.
A 2026 Wondr Health poll found that many employees back stronger menopause support at work, and Emont said he’s seeing employers respond.
Many big companies are starting to prioritize menopause, he said, including by offering education for the whole company.
Some are building access into their health plans, Emont said, with programs designed to help women reach menopause care and see knowledgeable providers. He also pointed to time and accommodations as someone begins treatment, when side effects can arise.
The society’s recommendations also challenge employers to build supportive workplaces, and a Kearney benchmark found that many organizations still treat women’s health as isolated initiatives.
“This is something that is happening to every single woman,” he said. “And if it happened to every single man, we would redesign our workplaces around it. But because it happens to women, we don’t prioritize it.”
October is Menopause Month, but women experience symptoms year-round.
“My number one message is always just for women to not accept suffering,” Emont said, “there is literally always something we can do, even if you have a complex medical history, to help you feel better, and it’s just a matter of finding the right person who can help you with that.”
“Don’t assume that it’s something you need to suffer through. There are people who can help always,” he said.
