The Transition We've Been Ignoring: What Every Leader Needs to Know About Menopause at Work
A conversation with Kacy Fleming, CEO & Founder, The Fuchsia Tent
51% of the population will go through menopause. And yet, in most workplaces, it remains one of the least understood, least supported, and least discussed transitions a person can experience.
Why should organizations care? That is the question I brought to Kacy Fleming, CEO and Founder of The Fuchsia Tent, and one of the most clear-eyed voices working on this topic today. Kacy has spent years researching, living, and now helping organizations navigate this topic.
What We Don’t Know Is Hurting Us
The word “perimenopause” is still not in most people’s vocabularies and many who do know it don’t understand the different phases of the transition. That gap in awareness has real consequences.
For generations, symptoms were dismissed as merely “bothersome”, a framing that obscured just how serious they can be. What we now know from science is that vasomotor symptoms like hot flashes and night sweats are biomarkers for potential cardiometabolic and neurodegenerative dysfunction down the road. These are not inconveniences. They are signals from the body that deserve clinical attention and care.
And the organizational cost of ignoring them is staggering. Mayo Clinic data from 2023 shows menopause costs US businesses .8 billion annually in reduced productivity and absenteeism. When healthcare costs are added, that number reaches 6.6 billion in the US alone and 50 billion globally. These are the numbers behind the silence.
The Midlife Collision And Why We Misread It
Kacy describes what so many women experience as the “midlife collision.” Two barges, loaded to capacity, one carrying a career at its peak, the other a personal life of growing demands. And beneath both, a powerful hormonal current shifting in ways nobody warned you about. The containers start falling off the boats, and the question becomes: is it my job? My relationship? Am I losing my mind?
When the lens through which we interpret our lives is clouded by profound hormonal shifts, the decisions we make from that place can feel urgent and certain and yet be distorted. Kacy shared that the highest rate of divorce initiated by women occurs during the menopausal transition.
The Symptoms We’re Missing
Most of us think of menopause as hot flashes and night sweats. And while those are real, they’re often not what comes first and not what causes the most quiet suffering.
Kacy described her own perimenopause: surges of anxiety, panic attacks, waking from sleep in terror, and something she speaks about with remarkable courage, suicidal ideation. Not because she wanted to die, but because she no longer felt like herself. Physically. Emotionally. Relationally. Cognitively.
She describes losing her train of thought mid-sentence in a meeting. Forgetting why she walked into a room. Feeling apathetic toward things she once loved, what psychologists call anhedonia, a precursor to depression that often goes unnamed because it doesn’t look like what we think depression looks like.
“I thought I was losing my mind,” she told me. And that is what so many women are quietly thinking while sitting in a meeting, leading teams, serving clients.
What Individuals Can Do: Three Starting Points
If you are a woman navigating this transition, Kacy’s guidance is grounded and actionable.
- Track your symptoms: Use a notebook, or an app. Write down what you feel, when it happens, what you ate, how you slept. This data becomes your voice in a medical appointment. Kacy recommends the Greene Climacteric Scale, a free, validated tracking tool available through The Fuchsia Tent and other trusted resources.
- Educate yourself: Visit trusted sources: The Fuchsia Tent, the Menopause Society, Let’s Talk Menopause, Side Effects Health Research. Knowledge gives you the language to advocate for yourself.
- Find the right clinician: See a doctor. If they dismiss your symptoms or push antidepressants without exploring hormonal factors, get a second opinion. Menopause is a clinical diagnosis, and not all practitioners are trained in it. That’s not an excuse; it’s a signal to keep looking.
- Tell the people close to you: Share what you are experiencing so they can offer support and grace while you find your footing.
What Leaders Can Do: The 3-H Framework
Kacy’s 3-H Framework gives leaders a clear structure for action:
H1 — Healthcare: Audit your benefits. Most organizations already have mental health programs, OBGYN coverage, and musculoskeletal benefits relevant to menopausal symptoms — but they’re fragmented and invisible. A woman navigating brain fog and insomnia does not have the bandwidth to piece together a disconnected benefits maze. Make it easy to find and use what’s already there.
H2 — Help: Invest in training for difficult conversations, not menopause-specific training that singles people out, but universal compassionate leadership skills that help every manager show up for every human challenge. The ability to hold a supportive, quality conversation is one of the most underleveraged skills in most organizations.
H3 — HRT and Non-Hormonal Therapy Access: Do a formulary review. Hormone replacement therapy is often generic and inexpensive, but copay structures or missing coverage can make it inaccessible. New non-hormonal therapeutics (NK3 inhibitors) are also available for those who cannot or prefer not to take hormones. Ensure your plan actually covers what your employees need.
Pay Now or Pay Later
Kacy put it simply: organizations can pay now, with attention, aligned programming, and appropriate healthcare, or pay later in lost productivity, declining health, and human potential quietly walking out the door.
Here is my takeaway: if you think about the segment of your workforce that is perimenopausal or menopausal, they are not at their best. They cannot be, not without support. And our collective lack of awareness, combined with discomfort around these conversations, means they are often suffering alone. Silently. While continuing to show up and deliver.
We need to act on this simply because everybody matters. And as a leader, if the people working alongside you are not flourishing, if they are not at their best, they cannot give you their best work. That is not a performance issue. That is a leadership responsibility.
At Happiness Squad, we believe organizations flourish when the humans inside them flourish. You cannot hold that commitment while leaving 51% of your workforce to navigate one of life’s most significant biological transitions alone and unsupported.
I am grateful to Kacy Fleming for her courage, her research, and her relentless commitment to changing this for women everywhere. To learn more and access free resources, visit The Fuchsia Tent.
Learn more about Kacy Fleming on LinkedIn.
Listen to the podcast with Ashish and Kacy Fleming, on Apple Podcasts.
Access and subscribe to all of the episodes of the Flourishing Edge Podcast here.
Make Flourishing Your Competitive Edge.
