I thought I had cancer. It was perimenopause.
Why misdiagnosis, stigma and workplace silence are pushing women out of leadership at mid-career
By Priscila Pereira, Director of Research & Innovation, Shape Talent
Worldwide, 657 million women are aged 45–59, and around half contribute to the labour force during their menopausal years 1. As awareness of menopause grows, perimenopause is finally getting attention too. It’s now being added to policies, but we’re still missing the mark in how we actually support women. Too many are still misdiagnosed. Told their hormones are “normal.” Sent home with sleeping pills, antidepressants, or advice to “cut back on caffeine.” The result? Women in their 30s and 40s at the peak of their careers are being quietly pushed out of the workforce. Not because they lack competence, but because the system doesn’t recognise what they’re going through.
This is my story. But it could just as easily be yours, your colleague’s, or someone you manage.
“We need to rule out lymphoma.”
In 2018, I found myself in a lymphoma clinic at the West Berkshire Hospital, terrified.
I was 40, the sole breadwinner in my household, and going through a health crisis that no one could explain. My symptoms had built up over months intense night sweats combined with chills, forcing me to change my bedding twice a night, every night. I was constantly exhausted. My lymph nodes were swollen. I developed a strange intolerance to red wine. I’d stopped sleeping. It felt like my body couldn’t decide whether I was freezing or overheating: I was cold and drenched in sweat at the same time.
Despite all this, my blood tests were “normal.” My menstrual cycle was regular. So, the medical staff, confused, started testing for the worst-case scenario.
The relief of hearing “you don’t have cancer” was amazing, but then came the silence. No diagnosis. No support. No path forward.
For me, this was a health crisis. For employers, it’s a talent crisis. Too many women in their 40s, often at the height of their careers, are quietly leaving workplaces that don’t understand what’s happening to them.
The turning point: One conversation changed everything
I was casually talking on the phone to my cousin in Brazil when I finally broke down. We were chatting as I got ready for bed – laying out two sets of bedding and two sets of pyjamas for the night ahead. Then, suddenly, I burst into tears. I was anxious and exhausted, scared of going to sleep because I knew exactly what was coming.
Surprised by my sudden outburst, she gently asked how long I had been like this. “Months,” I admitted. She then asked if I had seen a doctor, and I explained that I had, but they hadn’t been able to help me. That’s when she said something that has stayed with me ever since: “You can’t give up. This isn’t sustainable.”
She connected me with a haematologist friend who reviewed all my test results. Her view? “I think it is perimenopause.”
I pushed back. “But my hormones are normal and what about the swollen lymph nodes?”
She explained what no doctor in the UK had: perimenopause can’t be diagnosed with a single blood test. Hormone levels, especially oestrogen, fluctuate dramatically, and the effects are often felt long before those levels fall below the so-called “menopause” threshold.
She told me that during perimenopause, these fluctuations can be particularly disruptive at night. Hormonal fluctuations indirectly disrupt the immune system by disturbing sleep, increasing stress (via cortisol), and impairing temperature regulation – all of which are vital for immune health.
I pushed back again. “But my night sweats are different – I’m cold, not hot. I don’t have hot flashes during the day.”
She explained that the issue was with my body’s temperature control. Even small hormone fluctuations can throw the thermoregulation system off balance, making me swing between hot and cold. It isn’t always about being “hot”. At night, when the body’s nervous system is less able to adjust quickly, these fluctuations are harder to manage which is why you might have night sweats without hot flashes during the day.
She then concluded: the body struggles to adapt until hormone levels eventually stabilise, a process that can take years. That’s one reason why perimenopause can be even harder than menopause itself: not only do symptoms feel chaotic, but women are often misdiagnosed because blood tests may appear normal unless they happen to capture a dip.
At that point, I realised it wasn’t just me who didn’t know enough – neither did many of the doctors I had spoken to before.
Trying to function at work while your body falls apart
At the time, I had just taken on a new role. I was exhausted and constantly dehydrated, yet I still showed up. I led meetings. I delivered work. I said nothing. But I was reaching a point where I felt I might have to choose between my health and my career.
Why? Because I didn’t feel safe to share with my boss what I was going through.
My new CPO set out his expectations on day one in a group meeting. It was clear he wanted results, not context. When we did eventually have 1:1s, I didn’t share. The risk felt too high.
This is why line managers matter so much. They can make or break a perimenopausal woman’s career. A supportive manager who listens, withholds judgment, and allows flexibility can mean the difference between a woman staying, thriving and progressing, or quietly stepping back, burning out, or leaving altogether. That’s exactly what happened to me: I left the corporate world just 18 months after the symptoms started. Even though I had started to feel better, I’d simply had enough by then. When women feel unable to speak up, the result isn’t just personal burnout, it’s disengagement, attrition, and lost leadership potential for organisations.
Perimenopause is not a waiting room. It’s an event itself.
Our own research , surveying over 2,352 women, confirmed what I’d lived through. Women experiencing perimenopause reported more barriers at work than those experiencing menopause. Why? Because perimenopause is so often misunderstood, dismissed, or diagnosed retrospectively.
In fact, many people (including myself) thought that menopause is the most challenging phase – perimenopause is just the beginning. But the reality is perimenopause can be more disruptive to confidence and workplace engagement than menopause itself. In our study 52% of perimenopausal women avoid raising concerns at work (vs 44% of menopausal women), and 57% worry about how they come across in meetings (vs 47% during menopause).2
I remember feeling anxious about meetings, even though I’d never felt that way before, not even at the start of my career. I had this constant fear that I’d be “found out,” that people would realise I wasn’t coping. I didn’t recognise myself.
The support needs to start earlier indeed!
I’m now 48, eight years later, and still have a normal menstrual cycle. My blood tests show that I’m still ovulating. Technically, I’m not menopausal. But if I stop my HRT or skip yoga for a week? The night sweats and weakened immune system come roaring back.
This isn’t theoretical. It’s my lived reality.
What helped and what still needs to change
Eventually, I got the right support. I was referred to a gynaecologist by the haematologist. I started HRT. I prioritised yoga and nervous system regulation. Today, I still get the odd bad night a few times a month, but I can cope.
But I had access to specialist knowledge and support networks. Most women don’t have those advantages. They’re told their symptoms are unrelated. That they’re too young. That it’s “just stress. They are depressed. They are hypochondriacs.”
What needs to change now
- Start support earlier. Perimenopause is not a footnote to menopause – it’s where the real disruption happens.
- Educate line managers. Trust and empathy start with them. And trust starts on day one.
- Normalise variation. No two women have the same journey. There’s no single checklist.
- Stop waiting for blood tests to validate what women are going through. Blood tests are a data point – not the full story.
Perimenopause is not only a women’s health issue. It’s a workplace equity issue. Organisations that ignore it risk losing their brightest talent just as they’re stepping into senior leadership.
FAQs: Perimenopause, Symptoms and Work
Q. Is perimenopause the same as menopause?
A. No. Perimenopause is the phase before menopause it can last for years. It’s when hormones begin to fluctuate, even if periods are still regular. Perimenopause can last anywhere from 4 to 10 years. For some women, this phase feels even harder than menopause itself, because hormone levels swing unpredictably before they finally stabilise.
Q. Why is menopause/perimenopause a workplace issue?
A. Because perimenopause often hits during peak career years. Without support, women drop out of leadership pipelines and companies lose critical talent.
Q. If even doctors don’t always understand perimenopause, what can managers realistically do?
A. Managers aren’t expected to be medical experts, but they can choose to be open, supportive and non-judgmental. Creating psychological safety matters more than having all the answers. When women feel safe to share what they’re experiencing without fear of stigma, managers can work with them to find practical adjustments. It’s less about diagnosing symptoms and more about listening, believing, and responding with flexibility.
Q. Isn’t perimenopause a late-career issue?
A. Not at all. Perimenopause can begin as early as the mid -30s. Many women in their 40s and 50s still in the thick of career progression, raising families, or holding senior roles experience symptoms. This isn’t a late-career issue. It’s a mid-career one, and that’s why it matters for leadership pipelines.
References
[1] R. Margaret et al. (2021), ‘Global consensus recommendations on menopause in the workplace: A European Menopause and Andropause Society (EMAS) position statement.’ Maturitas vol. 151: 55-62. doi:10.1016/j.maturitas.2021.06.006
[2] Shape Talent – The three barriers preventing women from progressing in corporate UK today