What Perimenopause Is Costing Women and Their Work
- 3 days ago
- 8 min read
Written by Amanda Michelle Crisel, PharmD, Certified Wellness Practitioner, and Perimenopause Educator
Amanda M. Crisel is a PharmD, Certified Wellness Practitioner, and perimenopause educator who helps women navigate perimenopause with evidence-based information, strategies, and clinical insight. She is the founder of Amanda Michelle Wellness and creator of PeriNavigatHer™.
She is almost certainly near the peak of her career. She has spent years building a solid reputation, she is a high achiever, dependable, a trusted thought leader, and a content expert. For better or worse, her work is a significant part of her identity. For the entrepreneur, that’s literal, she is the business. Her focus, energy, and executive function are the product. So, what happens when she starts losing words in meetings, forgetting to follow up, or presenting herself as unfocused or unprepared?
The change begins to erode her confidence, her sense of self, and even her productivity. She quietly fears something serious is wrong.
The truth is, there’s nothing wrong with her. The confident, dependable woman is still in there, but she’s trying to function through a life stage that presents enormous physical, emotional, and mental change. And while the phase is inevitable, she’s probably unprepared. Most women are.
Research now confirms what women have suspected for years, perimenopause, or the menopausal transition, can begin far younger than we once thought, and it’s been wreaking havoc on women and their work for decades.
She's not too young
Perimenopause is the period of hormonal transition leading up to the final menstrual period. Symptoms typically begin in a woman's early-to-mid 40s, however, a study of over four thousand women, released in early 2025 by UVA and the Flo app, reported that 55.4% of women aged 30-35 and 64.3% of women aged 36-40 experienced perimenopausal symptoms that would be considered moderate-to-severe. We know symptoms can last for up to 10 years.
That places the transition squarely in what should be the most professionally productive decade of a woman's life, leadership roles, entrepreneurship, highest earnings, solo ventures, and maximum influence.
It is estimated that nearly 8 in 10 women navigate this transition while still working. Most of them are doing it without adequate support, often from their own healthcare providers.
Physically and mentally 'showing up' is more than half the battle
While hot flashes are one of the most widely known, uncomfortable, and obvious symptoms, the hormonal changes during perimenopause impact almost every system in the body.
Some of the first symptoms to emerge are those related to neurotransmitter function, which directly impacts cognition (brain fog, memory loss), emotional and mental stability (anxiety, irritability, depression), and sleep quality. These symptoms quietly erode professional confidence and performance, and they are far more common than most women and employers recognize.
In a peer-reviewed cross-sectional study published in Occupational Medicine, the most frequently reported symptoms affecting work performance for more than half the time were fatigue (54%), sleep disturbance (47%), poor concentration (44%), and poor memory and brain fog (40%). Sixty-five percent of women in that study reported that symptoms directly impacted their work performance, and 35% reported making career decisions, including declining promotions or reducing hours, as a direct result of their symptoms.
Research presented at The Menopause Society 2025 Annual Meeting found that perimenopausal women experience an average work impairment of 22.5%, significantly higher than those who are premenopausal (12.7%) and postmenopausal (16.9%). The same analysis estimated annual U.S. productivity losses attributable to perimenopausal symptoms at an eye-watering $49 billion, which reflects the combination of absenteeism (lost productivity from missed work days) and presenteeism (reduced productivity while at work).
A high-performing woman struggling to retrieve words in a meeting or taking more sick days than usual is not ‘disengaged’ or ‘losing her edge.’ She is navigating an enormous physiological shift that we are only now beginning to understand.
Careers and livelihoods are directly impacted by perimenopause
Available data around the impact of perimenopause on the workforce is sobering. For entrepreneurs and solopreneurs, the stakes are compounded in ways that salaried employment data alone cannot capture.
In a 2022 UK survey of 47 self-employed women working as freelancers and independent consultants, 49% reported that perimenopause had a significant impact on their business, 62% cited fatigue and sleep disruption as directly reducing billable hours and income, and 51% reported that brain fog and memory issues threatened their client relationships and professional reputation. One consultant said her business of 15 years had "nearly crumbled" in a single year from eroded confidence, unreliable cognitive function, and reduced organizational capacity.
No peer-reviewed study has yet quantified perimenopause's toll on women entrepreneurs specifically, and that research gap is itself telling. If we take the liberty of extrapolating from the 22.5% average work impairment finding in perimenopausal women, the impact on the estimated 2.3 million U.S. women business owners in perimenopause is likely steeper, as their income is directly tied to their daily output. Their reputation is built on every client interaction, they tend to bear the cognitive load alone, and women are already at a disadvantage when it comes to venture capital. Conservative estimates place the annual productivity cost to women entrepreneurs at $55-78 billion.
Drawing on national registry data from Sweden and Norway, a 2025 longitudinal study found that women experience an average earnings reduction of 4.3% in the years following a perimenopause diagnosis, which increases up to 10% when viewed at four years. For women in their peak earning years, that is a meaningful and lasting setback that compounds over time.
The talent retention implications are also significant. Some research suggests that 1 in 5 women will quit or seriously consider leaving their job due to severe perimenopausal symptoms. In the United Kingdom, 23% of women aged 40-60 considered resigning because of the impact of symptoms, with 14% actively planning to hand in their notice. These are experienced, mid-to-senior-level professionals who carry a wealth of institutional knowledge and organizational relationships. Estimates suggest replacement costs can exceed $38,000 per employee.
The care gap that compounds
Women who recognize what is happening and seek medical support frequently encounter a second obstacle, a healthcare system that is not equipped to help them. Studies suggest that fewer than 7% of medical residents in the US feel adequately prepared to manage perimenopause, and the majority of women who present symptoms to their primary care provider leave without a treatment plan.
Access to information is no longer the primary barrier, as awareness of perimenopause has grown meaningfully in recent years. What remains is a demand for care that far exceeds the supply of knowledgeable clinicians. Women know something is wrong, but the first provider they see is rarely equipped to help. This leaves them managing a complex physiological transition largely on their own, during the workday, in the middle of their careers.
Perimenopause is not a personal inconvenience. It is a workforce issue, a public health issue, and an increasingly material business strategy concern. When women are supported and empowered through this transition with accurate information, accessible care, and workplaces that recognize what they are navigating, the outcomes extend well beyond symptom management.
There is good news
According to The Menopause Society's 2022 Hormone Therapy Position Statement, early intervention during the menopausal transition, including hormone therapy, lifestyle modification, and psychological support, is associated with meaningful improvements in long-term cardiovascular health, bone density, quality of life, and overall well-being.
So, awareness and proactive care are not just health decisions, they are business continuity decisions. Understanding what is happening physiologically, getting ahead of symptoms before they compound, and building a care team that takes this transition seriously are among the highest-leverage investments a woman in business can make in her 40s.
Interventions at the employer level do not require significant investment. Only 29% of managers are currently aware of the menopause support options available to employees. Practical starting points include educating leadership, flexible scheduling to accommodate symptoms such as sleep disruption and fatigue, temperature-flexible work environments, access to menopause-informed benefits or Employee Assistance Programs, and normalized internal conversation around women's midlife health. More progressive organizations are beginning to incorporate perimenopause explicitly into their workforce health strategies as meaningful retention and productivity initiatives.
The challenges with access to high-quality, affordable clinical care make it even more important to be prepared to advocate for yourself at medical appointments. Peer-reviewed research confirms that women who arrive at menopause appointments prepared, by tracking symptoms, setting an agenda, and preparing questions, achieve measurably better outcomes. A 2021 systematic review found that symptom diary use alone produced reduced hot flush (flash) frequency and improved patient-doctor communication and treatment goal-setting. Broader research shows that prepared patients have better clinical outcomes, higher treatment adherence, and fewer hospital visits.
Clinicians only elicit patient agendas in 36% of visits, so women who proactively advocate for themselves gain a decisive advantage in receiving appropriate care. The difference between leaving your appointment with or without a treatment plan can have a meaningful impact on you and your career over time.
For women, self-employed or otherwise, the most impactful steps are to be informed, understand your options, understand what the evidence supports, know the right questions to ask based on your personal experience, and show up at that first appointment prepared to advocate for yourself.
The research is clear, whether part of a team or self-employed, ensuring optimal support through perimenopause is not simply a wellness to-do, it is a strategic imperative.
Take the next step
If you are navigating perimenopause and would like to explore resources that can help you be informed and prepared to optimize outcomes at your next healthcare appointment, explore the resources at Amanda Michelle Wellness and check out PeriNavigatHer™, an evidence-based perimenopause platform designed to help women prepare for and make the most of their healthcare conversations.
Amanda M. Crisel, PharmD, is a Certified Wellness Practitioner and perimenopause educator dedicated to bridging the gap between perimenopause research and the care women are actually able to access. She is the founder of Amanda Michelle Wellness and the creator of PeriNavigatHer, an evidence-based perimenopause resource platform designed to help women prepare for and make the most of their healthcare conversations. Learn more at amandamichellewellness.com.
AI tools were used in the drafting process. All research and clinical content were sourced and verified by the author.
Read more from Amanda Michelle Crisel
Amanda Michelle Crisel, PharmD, Certified Wellness Practitioner, and Perimenopause Educator
Amanda M. Crisel is a PharmD, Certified Wellness Practitioner, and perimenopause educator dedicated to addressing the gap between women and the evidence-based care they need to optimize health during and beyond perimenopause. With a doctorate in pharmacy from Purdue University, a clinical practice residency at Johns Hopkins, and nearly two decades in biopharmaceuticals, she's focused on the imbalance between what the research says and the care women can actually access. Her work is informed by clinical training, a focus on holistic health, and her own experience navigating Premature Ovarian Insufficiency at age 39, a combination that allows her to meet women where they are and provide the science-backed support they need.
Sources:
Faculty of Occupational Medicine. Guidance on Menopause and the Workplace. London: FOM; 2016.
Ainsley. Survey of self-employed women and perimenopause. UK; 2022. (Practitioner Survey)
Persson M, et al. The Economic Consequences of Menopause. Stanford SIEPR/IFS Working Paper; 2025.
The Menopause Society. Hormone Therapy Position Statement. 2022.
Andrews R, Hale G, John B, Lancastle D. Front Glob Womens Health. 2021;2:757706.
Singh Ospina N, Phillips KA, et al. J Gen Intern Med. 2019;34(1):36-40.
