The glass ceiling prevails: 43% of executive women considered leaving the workforce because of (peri)menopause symptoms.

When I dug into the impact of unsupported and untreated symptoms in the workplace I was shocked at the numbers. 1.8 billion in annual productivity losses in the US, 900,000 women in the UK left the workforce, 28% of women in the UK considered leaving their jobs. And the kicker: the trend worsens as we scale the corporate hierarchy. 31 percent of first-level supervisors, 36 percent of mid-level managers and 43 percent of senior executives.

I set out to interview women in executive leadership to see what worked and what didn't for them and together with some research these are some recommendations to better navigate this transition and keep shattering that ceiling!

(Peri)Menopause is not something that happens to you while you wait it out. It's a system change and systems can be understood, mapped, and worked with.

These five strategies are not about slowing down. They're about performing at your level with more intention and less white-knuckling.

1. Map it.

The most underused executive tool in perimenopause isn't a supplement or a specialist. It's a simple log.

Hormonal fluctuations during perimenopause affect cognition, verbal recall, emotional regulation, and processing speed in ways that are real, measurable and, crucially, patterned. Brain fog is one of the worst symptoms for executive women. It throws you sideways like nothing else. But it doesn't arrive randomly. Once you start tracking it, you'll begin to see when it's more likely to show up.

For four to six weeks, spend two minutes each morning rating your energy, focus, and mood on a simple 1 to 5 scale. Log it together with your cycle and sleep quality. After a few weeks, patterns emerge and those patterns are intelligence.

With that data, you can do something no amount of caffeine or willpower enables: you can schedule strategically. Move your highest-cognitive-load work -- the board presentation, the difficult negotiation, the strategic review -- to your known peak windows. Protect your low-clarity windows for the less demanding tasks.

2. Regulate Your Nervous System Before the Meeting Starts

This one I learnt when I went on stage to give a TED Talk another lifetime ago, I was a baby but I still use it today. Anxiety is a physiological state -- it is something that occurs physically in your body, not just in your mind. Our bodies have a natural kill switch that happens autonomously. Have you ever felt that sudden sigh, or double breath intake? That's your body re-balancing its carbon dioxide to oxygen levels. It automatically calms you down.

Hot flashes and the anxiety spikes that often accompany them are not purely hormonal events in isolation. They are amplified by cortisol. Chronic leadership stress and perimenopause interact in a feedback loop. Stress worsens symptoms. Symptoms cause stress. The loop tightens.

The way to interrupt it is not a spa weekend. It's a 90-second intervention you can use right before a high-stakes moment.

For hot flashes, before you walk into that meeting apply cold water on the wrists or the back of the neck -- it can interrupt a hot flash before it peaks.

3. Redesign Your Environment

You wouldn't expect a surgeon to operate in a room set to the wrong temperature, with flickering lights and inadequate tools. Why expect yourself to perform in an environment that's making your symptoms worse?

During perimenopause, your thermoregulatory system becomes genuinely unreliable. The hypothalamus, which controls body temperature, is directly affected by estrogen fluctuation. A room that feels fine to everyone else can tip you into a hot flash within minutes. If you run meetings, choose the room or request the temperature.

Environmental design is within your control, and it matters enormously.

This one I also know too well unfortunately: lighting matters more than most people realise. Harsh overhead fluorescents worsen fatigue and migraines. Where you can, switch to warmer, softer light for focused solo work.

These are not accommodations. They are the same environmental controls that any serious performer would demand. Treat your workspace the way a professional athlete treats their kit. Don't be ashamed, ask for what you need to perform.

4. Communicate

This one requires something harder than a tracking log or a breathing exercise: it requires a degree of vulnerability with selected people. It's worth it.

Many executive women manage menopause in complete silence, absorbing the cognitive and physical load on top of everything else, adding the additional layer of managing how they appear while doing it. That triple load is unsustainable, and it's entirely self-imposed.

You do not need to disclose to your organisation, your board, or your wider team. But consider who in your immediate circle could help you if they knew what was going on. An EA who can protect a 15-minute buffer between your most demanding meetings. A trusted peer who won't misread a slower day as a performance issue. A direct report who can take the lead on a particular deliverable during a difficult week.

This is not weakness. It is exactly what good leaders do: assess where support creates leverage, and deploy it deliberately. Knowing what to delegate, including information about your own needs, is a leadership skill.

5. Sleep is a Non-Negotiable KPI

If there is one symptom that creates the most downstream damage to executive performance, it is disrupted sleep.

Night sweats, difficulty falling asleep, waking at 3am with a racing mind, lighter and less restorative sleep cycles: these are not incidental inconveniences. Sleep is when the brain consolidates memory, clears metabolic waste, regulates emotional response, and restores the prefrontal cortex.

A poor night's sleep doesn't just make you tired. It impairs the cognitive functions that your role depends on. Treat sleep quality with the same rigour you would apply to any business metric. Same advice as before, map it. Identify the specific blockers: is it night sweats waking you? Anxiety? Early waking? Each has different interventions.

Then act on what you find. Sleep hygiene protocols -- consistent sleep and wake times, no screens in the hour before bed, cooler room temperature -- have genuine evidence behind them.

Speak to a specialist about medical support. Hormone Replacement Therapy (HRT) has evidence for improving sleep quality and significantly reducing other menopause symptoms. Other therapies are available if this is not for you. Discuss it with your GP.

Matthew Walker's book Why We Sleep is worth reading if you need a push to take this seriously.

Perimenopause typically begins in a woman's mid-to-late forties. Often at the exact moment careers are at their most demanding and most visible. The timing is difficult. The cultural silence around it makes it harder.

But this transition is also, for many women, a moment of profound recalibration -- a chance to get far more intentional about how they spend their energy, what they tolerate, and what they need to perform well.

If this resonated, share it with a woman in your network who might need to read it. The conversation changes when we're willing to have it.

This article is for informational purposes and does not constitute medical advice. If you're experiencing symptoms that concern you, please consult a qualified healthcare provider.