Perimenopause is becoming an elephant in the room for many high-performing female leaders and executives in businesses across the UK. The paradox is this – at the age when women often reach the peak of their career, when they should be feeling most capable and confident, perimenopause symptoms are causing a crisis in confidence.

All too often, women are suffering in silence and then quitting or taking a step back. Both the individual and the organisation suffer.

Take the lady I spoke to just last week who resigned from her senior position because she’d lost confidence in her ability to perform at the level she was accustomed. Over the previous two years her memory and clarity of thinking, something she had prided herself on as a HR professional, had diminished and anxiety, something she’d never previously experienced increased. Her company was ‘supportive’ of women in perimenopause but it didn’t address the underlying issue that she didn’t feel like she could fulfil her professional duties. She resigned in the belief that, “the company would be better off with someone younger”! She isn’t the only one, this is happening to women every single day, it needs to stop.

But the good news is, this suffering is largely unnecessary. By rethinking our approach to women’s health and perimenopause in the workplace, we can support both perimenopausal women and the organisations they work for to thrive.

In this article, I’m going to speak to individual women who to provide actionable strategies to empower us to support our hormone health and physiology during perimenopause, transforming our performance and career confidence as a result.

Facing the issue head-on

The problem isn’t perimenopause itself- it’s the way we approach it and the narrative around it. However, before we discuss solutions, it’s important to understand the scale of the problem:

In the UK there are an estimated 4.3 million working women aged 45-60 who are experiencing perimenopause. The menopausal transition lasts on average of seven years but can last up to 14 years, making up a significant period during a woman’s working life (1).

During perimenopause, levels of reproductive hormones oestrogen and progesterone vary greatly, which often leads to physical and psychological symptoms including hot flashes, headaches, fatigue, low mood, anxiety and brain fog (2,3). When inadequately addressed, these symptoms can erode performance and chip away at our confidence, stress capacity and ability to cope. The effects of this are wide-reaching, with research indicating that –

– 1 in 5 women pass up a promotion due to perimenopausal symptoms  (4)
– More than 1 in 10 women resign due to perimenopausal symptoms (4)
– The consequences of neglecting women’s health in the workplace are estimated to cost the UK economy in excess of £20 billion every year (5)

Current initiatives aren’t cutting it

After working in the corporate pharma world for many years I’ve seen the effects of women’s health struggles first-hand. Myself and my team have been optimising female performance for over 10 years, helping high-performing women to optimise not only their physical health, but also to achieve a greater sense of balance, emotional well-being and fulfilment in all areas of their life. Perimenopause is one of the areas where we seem women benefit the most from this support.

As awareness around menopause has grown, some progress has been made, but much of this progress is still fundamentally flawed. Leaving women abandoned in their careers with a narrative that is disempowering women at best, whilst fear-mongering and perpetuating stigma at worst.

There are two major approaches I see-

1. Brushing the issue under the rug and reluctance to acknowledge the impact of perimenopause and women’s health issues. High-achieving women often feel they must push through and don’t feel they can seek help. This comes at the cost of the woman’s mental and physical health, whilst performance issues, presenteeism and ultimately increased turnover in this group cost the company.

2. Policies and provision of adjustments such as flexible working arrangements, education & wellness training and wellness support, which are aimed at easing discomfort. Whilst seeming like a step forward, this approach is based on the assumption that it’s normal for women to experience debilitating symptoms. This narrative is disempowering and may risk creating greater inequalities.

The increase in awareness about menopause is great, I now have the flexibility to hibernate at home! But I’m not coping and I feel the only way out is to put something down- my career. I just can’t cope anymore.” – Compliance Director, Financial Services

So what’s the solution?

We need a root cause approach that empowers women to recognise and understand the physiological changes happening during perimenopause, and to support them to optimise their physiology to lessen the likelihood and severity of symptoms.

One of the biggest factors affecting perimenopausal women is reduced stress capacity, which has a knock-on effect on performance and confidence to lead. Here are some of the things we can implement as perimenopausal women to work with our perimenopausal physiology, expand stress capacity and rediscover peak performance-

Support our circadian rhythm

It’s no secret these days that sleep plays a crucial role in how we feel and perform on a day-to-day basis. Due to hormonal changes during perimenopause, we can become more vulnerable to disrupted sleep. However, lots of us are missing out on an opportunity to tap into our body’s innate sleep-enhancing mechanism- our circadian rhythm, aka our built-in body clock. This is what dictates when feel alert and energised, vs. When during the day we feel sleepy. Therefore, when we support our circadian rhythm, we give our chances of a good night’s sleep a major leg up. Evidence suggests that the synchronisation of our circadian rhythm can play a significant role in not only sleep quality, but also our mood and cognitive performance- all factors which influence our ability to lead and handle stress (6).

Luckily, looking after our circadian rhythm is straightforward- we need to increase our exposure to bright light, ideally natural daylight, in the morning, and decrease exposure in the evening. I recommend trying to get outside for 10-15 minutes before 12pm to get some daylight exposure, and minimising screen exposure in the hour before bed. Blue light-blocking glasses are also great for evenings when you aren’t quite able to forgo screens!

Discover the power of breathwork

The way we breathe can act as a powerful regulator of our stress response. Often, during perimenopause our stress resilience can wear down, meaning that our threshold for what we perceive as stressful can become lower. Due to this, tools such as short breathwork exercises that tap into our physiology can be great to have at our disposal for times when we need to tone down our ‘fight or flight’ stress response.

One of my favourite breathwork techniques is the ‘Physiological Sigh’ – a simple way to slow our breathing, which some research suggests may be more effective (or at least a faster) in helping us to improve stress and anxiety (7). To perform the physiological sigh, simply take two short, sharp breaths in through your nose, followed by a long, slow exhale through your mouth. Repeat this until you feel calmer. In the study, participants carried out this technique for 5 minutes, but neurobiologists suggest it can be effective when done just one to three times.

Kick the caffeine and sugar crutches

When we feel stressed and fatigued, it’s natural to reach for things that give us a ‘boost’. For lots of us, these come in the form of caffeinated drinks and sugary snacks. However, during perimenopause, reaching for that mid-afternoon coffee and cake comes at an increased cost to our physiology, resulting in worsening symptoms. This is due to caffeine and sugar’s effects on our blood sugar balance and stress hormones- they tend to cause an initial energy hit followed by a crash. These spikes in blood sugar and stress hormones can put more stress on our physiology. When layered onto the hormonal changes we experience in perimenopause, this tends to worsen symptoms such as anxiety, brain fog and difficulty sleeping.

Instead, try to minimise your caffeine intake and opt for more balanced snacks and see how you feel. For example, you could cut your three daily coffees to having just one cup with your breakfast, and swap your mid-morning biscuits or cereal bar for some homemade trail mix, a handful of almonds and an orange, or a boiled egg and some salted popcorn. Simple snacks like these are easy to pack and take on-the-go and can help us to feel more energised and balanced during our workday. If you would like to enjoy a sweet treat, try to save it for after a balanced meal – the protein, fats and fibre will slow down the release of the sugars, minimising the blood sugar dysregulation.

Switch up your breakfast

What we eat has a significant effect on how we feel both day-to-day and long term, so making some tweaks to our meals can have a big impact on perimenopause symptoms and performance. Many of the women I work with are blown away by how transformative this can be, as well as how delicious and satisfying it can be to nourish themselves properly.

I recommend starting with breakfast, as this is the meal that sets us up for the day. Many of us are used to eating a largely carbohydrate-based breakfast which can contribute to dysregulated blood sugar levels. To remedy this, simply reduce your portion of carbohydrate, for example toast or oats, and add some extra protein, healthy fats and fibre. This may look like adding berries, nut butter and ground flax seeds to your porridge, or adding some smoked salmon, spinach and eggs to your morning slice of toast. These small shifts can help us to feel far more energised and focused, as well as giving our body extra nutrients that support with hormone balance and metabolism.

Be conscious of alcohol

Alcohol is deceptive. Whilst we know drinking too much isn’t good for us, many of us believe that a glass or two of wine can help us to relax, unwind and drift off to sleep. Even though alcohol does have a sedative effect, it can actually decrease sleep quality and disrupt our circadian rhythm, leading us to be less well-rested (8). Additionally, alcohol can exacerbate the hormonal fluctuations that we experience in perimenopause in various ways, including changing how our liver metabolises hormones. Due to this, many women find that limiting their alcohol intake is helpful in managing their perimenopause symptoms.

Rather than simply going without, it can be helpful to try alternatives- I love kombucha and water kefir- tasty fermented drinks that feel more sophisticated than your average soft drink, but that also boast gut health benefits.

Consider bioidentical HRT

If you’ve made diet and lifestyle changes and are still struggling to manage your perimenopause symptoms, seeking Hormone Replacement Therapy can be a helpful step in many women’s perimenopause journeys. I recommend adding diet and lifestyle approaches first, not only since they can in themselves be very effective tools for managing perimenopause symptoms, but also because they give us a more balanced foundation from which to add in HRT.

My favourite type of HRT is bioidentical HRT, which ensures that the hormones are identical to the ones produced by our body, and also tailors the amounts of the different hormones to your unique biology. It typically involves functional testing to check hormone levels and other health markers, before tailoring a prescription accordingly, whilst continuing to monitor and adjust. For example, at the start of perimenopause, many women experience an initial increase and big fluctuations in oestrogen levels, whilst progesterone is often the first hormone to drop. In situations like these, adding in progesterone-only HRT to start with can be very beneficial for some women.

Harness the power of connection

Finally, connecting with others both in and outside of the workplace and sharing your experience is crucial. Perimenopause can often feel isolating, and some women may even feel guilt and shame around how their symptoms are affecting their performance. But speaking openly with other women can help to break this stigma and show us that we are not alone. It reinforces the fact that perimenopause is a natural phase of life, and it does not make us flawed.

A final note

If there’s one thing that women should take from this article, it’s that we do not need to simply push through or struggle in silence with perimenopause symptoms. There are lots of strategies available to us that allow us to support our physiology, reduce the likelihood and severity of symptoms, and improve our stress resilience in order to thrive in our career.

By empowering women with these evidence-based strategies, we can improve the health, wellbeing and leadership of our female workforce, and foster a more inclusive workplace culture.

Download my free guide for more practical action on how to take back control of your hormones:



Elizabeth Sergeant
Elizabeth Sergeant
Women's Health and Performance specialist at Well Nourished Club | + posts
Elizabeth Sergeant (BSc, MSc, ANutr, AFMCP), is a respected expert in women's health and performance optimisation. As the founder of Well Nourished Club, she empowers women worldwide to achieve excellence. Elizabeth shares insights on women's health and hormones with women worldwide including female leaders and corporations. She believe in understanding your hormones and harnessing their power to enable sustained high performance and success. Her work with this sector including peri-menopause, menopause and hormones is extensive.