This content was created by Girlboss in partnership with Progyny.
POV: You're in the middle of a board meeting and suddenly it feels like the room hit 100 degrees, so you're subtly peeling off your blazer and whipping out your portable fan to try and cool down. Or you're three cups of coffee deep, running on four hours of (very interrupted) sleep, and struggling to multitask like you once could. Or you're running to the bathroom because your period showed up out of nowhere—and it’s never been this heavy before.
Sound familiar? Perimenopause, the transitional years leading up to menopause, can bring on brain fog, fatigue, hot flashes, mood changes, and unpredictable cycles—all of which can make it genuinely hard to feel like yourself at work (let alone tackle your to-do list).
And yet, according to Progyny—a women's and family health benefits company that partners with employers to provide personalized, expert-led care through every stage, from fertility to pregnancy to menopause—over 80% of women consider menopause support one of the most important workplace benefits, while only about 12% say their employer actually offers it.
That gap is exactly what we're digging into today.
We sat down with Cassandra Pratt, Progyny's chief human resources officer, and Dr. Janet Choi, Progyny's chief medical officer and a double board-certified reproductive endocrinologist and OB/GYN, to talk through how perimenopause can affect your productivity at work, how to advocate for yourself, and what employers should be doing better to support midlife women.
Understanding the Workplace Gap
What are the symptoms that tend to hit hardest at work, and what's actually causing them?
Dr. Janet Choi: "Brain fog, problems focusing, and concentrating. [Women] often say, 'I used to be able to multitask and juggle 10 different things and ace them, and now it’s challenging to address even one task at a time.' Another one is fatigue, sleep disruption, and trouble sleeping, which then further feed into the brain fog issue. And then hot flashes, whether it's just daytime and/or also at night, which then compounds the sleep problem and the fatigue issue. Mood changes, whether it's recurrent anxiety or depression, or new diagnoses of depression or anxiety, can also occur during this time. I've also heard of people reporting newer diagnoses of ADHD. The other thing that can be very disruptive at work is very unpredictable menstrual cycles, with unpredictable flow, especially if they're really heavy out of the blue."
From an HR perspective, how common is it for this to go unaddressed or unspoken at work?
Cassandra Pratt: "Unfortunately, I think it is very common, and it's important to change that. Many times women aren't aware of when perimenopause is starting, so they're not necessarily aware that the symptoms they're experiencing are related to perimenopause. A woman may think they're related to another condition.
There's an interview with Halle Berry where she says she was diagnosed with an STD, and after finally going to the right type of menopause doctor, she found out it was a perimenopause symptom. That's an extreme example, but imagine the other things a woman may be experiencing that go misdiagnosed because they’re not seeing the right kind of provider."
Why do so many women hesitate to bring this up with their manager or HR?
Pratt: "We still haven't normalized the conversations around perimenopause to make it acceptable to talk about. Progyny did a survey recently that found women wait an average of 7.2 months from the start of a symptom to when they seek medical care. And when people finally do find care, they oftentimes go to a GP or an OBGYN who hasn't had much training around menopause. Then they feel dismissed by their provider—37% report this experience. So the data is telling us that many women don't ask for help when they need it, and they don't always feel listened to when they do ask.”
Dr. Choi: "This is why sometimes women are afraid to speak up or even ask for help, whether it's at work or elsewhere—despite these midlife challenges, women still are able to objectively excel and do well. Some research suggests that, when symptoms are especially disruptive, or support feels limited, women may choose to defer a promotion, stretch assignment, or new project because they worry they will not be able to give it the attention they expect of themselves. That is not a reflection of their ability or potential—it underscores the importance of creating workplaces where people feel comfortable seeking support and can continue to thrive.”
What to Do if You Think You’re Going Through Perimenopause
If someone suspects it's perimenopause, what should they do next?
Dr. Choi: "To be very clear, there is no test to diagnose menopause or perimenopause. So if someone's trying to convince you to spend a couple hundred dollars on a test, ask why (and consider finding another provider). One of the hallmarks of perimenopause, for those who are not on hormone contraception and used to having fairly normal, regular cycles, is that people will often remark, 'I'm suddenly in my late 30s, early-mid 40s, and my cycles are becoming less predictable.'
I think it's important to have some easy-to-use way to track some of these symptoms. For instance, ACOG (the American College of OBGYNs) has a very simple downloadable PDF. Or you can just try to do it on your phone or in your calendar. You don't want to add more to the burden of tasks you're trying to juggle, but it's helpful to keep a health journal that you can then share with your physician or nurse practitioner."
How do you find a good provider for this, and what should you ask them?
Dr. Choi: "If you have a circle of friends going through similar experiences—knowledge-sharing is a good start [about which specialists they see for perimenopause support].
If you want something more objective, in the U.S. they have the Menopause Society provider search tool. In Canada, there's the Canada Menopause Society, a professional medical organization for menopause practitioners. The reason it's helpful to go to these reputable professional organizations is that at least you know that if this [medical provider] is on the list, there's a good likelihood they're following best-practice guidelines for what's appropriate care for midlife women.
If you're fortunate to have Progyny through your employer, just reach out to your Progyny Care Advocate. These are a team of our own employed nurses and other clinical educators who are there to help you connect to the right provider. And once you meet somebody, if you don't feel right with them, that's fine—they shouldn't take it personally, and you should not waste your time. Find another menopause provider who does connect with you and meets your needs.
To make the most of your visit [with your medical provider]: if you've been tracking your symptoms, list the three or four main concerns associated with perimenopause, along with some of your medical history and key questions. I also think it's really helpful to have another pair of ears listening in—if you have a close friend or relative whom you trust, bring them along to the appointment, and they can help support you during the conversation."
Advocating for Yourself at Work
If someone is dealing with symptoms that are affecting their work, how should they approach that conversation with their manager? Is there language you'd recommend?
Pratt: "You should start with a trusted person—whether that's your manager, another leader or someone within HR. You don't have to go into a lot of detail; however, the more detail you give, the more someone will be able to help. You don't have to make the focus on how the symptoms are affecting your work or disrupting your work. The focus could be around flexible work arrangements—does your employer allow one or two work-from-home days? Can you move those days around? A good place to start with your manager could simply be, 'I'm going through a difficult time right now. I need some flexibility.'”
What kinds of accommodations are realistic to ask for, and how should someone frame that ask?
Pratt: "Flexible work arrangements—‘flexible’ can mean different things depending on your symptoms, it may be flexibility in hours, schedules or remote work. Private spaces in your office are also helpful if you are having a hot flash, you are able to grab a fan and take a few moments. A longer lunch can go a long way, don’t just work through a meal at your desk because oftentimes when you add activity—whether that's a short workout or a walk—it helps reset. You can also ask for a workplace accomodation. Frame the accommodation requests around making yourself more productive, because ideally that is the best outcome for everyone."
If someone doesn't feel comfortable going to their direct manager, what other resources or paths should they know about?
Pratt: "Employee resource groups or employee affiliation groups are a good place to start. These groups are safe places for people to come together about similar experiences. If your company does not have a group that is aligned with your needs, feel empowered to create those peer networks.
Another route is your EAP (employee assistance program)—your EAP is aware of all of the benefits that your employer provides. There are often benefits employees are not aware of including within a medical carrier that will help you navigate the world of menopause or fertility or telehealth. Employers often offer employee advocate tools to aid in benefit navigation. Start with, 'Here's what I'm trying to navigate through. Where should I go for this?' And if you don't have navigation support, talk to your HR department to make them aware of the gap. Employees have a lot of power when it comes to helping benefit leaders design the benefit programs at their employer."
What are some things people can actually do in the moment when brain fog or fatigue hits mid-workday?
Dr. Choi: "If you're feeling a little bit cloudy or fatigued—I know for many people it tends to hit an hour or two after lunch—try to take a quick break. Run outside, go for a walk for a few minutes around the block. Just being outdoors as opposed to being in your office sometimes helps clear the mind and can help re-energize. If you can't leave your office, close the door and try doing something active like 10 jumping jacks or 10 chair squats. That kind of total body movement oftentimes helps people wake up in the moment.
For people dealing with brain fog, it can be reassuring to know that it is a common symptom during the menopause transition. It is not, on its own, a sign of dementia—a concern women understandably raise—and it often improves over time.
To support focus, try reducing multitasking when possible and giving yourself space to concentrate on one task at a time. If your schedule allows, consider planning more demanding work for the times of day when you tend to feel most alert and energized. For some people, that may be after morning coffee or tea; for others, it may be midday.”
What Employers Should Be Doing
If someone wants to advocate for their employer to offer better perimenopause or menopause support, how should they approach that?
Pratt: "I would encourage all employees to talk to their HR folks, because sometimes you only hear small anecdotal stories if they bubble up, and the more that people can share, the more real it makes it. I would also say, tie it to productivity and how it could increase productivity. The other piece HR leaders are always looking at is reduced healthcare costs, because you're not getting treated for an unrelated symptom that could be much more extreme—it, in fact, could be related to perimenopause. Proper care also helps prevent other issues further in the future. And last but not least, you're increasing employee engagement, because you're engaging with a different segment of the population."
What's one thing you wish more managers and workplaces understood about supporting someone going through this?
Dr. Choi: "Perimenopause/menopause is going to affect every single woman in your workforce. Symptoms can start to kick in in one's mid-to-late 30s, although I've taken care of women who've gone through early menopause, so it can sometimes affect individuals in their late 20s even. Sometimes people will say, 'Most of our employees are male, so we don't have to worry about this.' And my retort is, 'Well, a lot of them have partners—if their partners are female, they're going through this.'
Progyny recently did a survey where we surveyed over 1,000 working women across different age ranges, and over 80% responded that menopause support at work is incredibly important, and yet only about 12% said they actually felt appropriately supported in the workplace. So I think there's still a big gap, and it's really important for those making decisions in organizations—especially if you want to retain seasoned talent—to consider really smart women's health, and particularly midlife, benefits."
Pratt: "I wish everybody realized that all women are going to go through perimenopause and menopause. Establishing a program that supports women through this life phase means that your employees will be supported, more productive and more engaged because of the programs you're putting in place. The more you normalize the conversations, talk about women’s experiences, the less women will suffer in silence, and the less absenteeism an employer will have. It creates a wonderful cycle where it supports a transparent and engaged population that can do their best work."
Learn more about menopause and midlife care, explore resources to help you navigate this stage, and find out how to talk to HR about bringing comprehensive women’s health support to your workplace by visiting Progyny.com or scheduling a demo today.
*This interview has been edited and condensed for clarity.
