I am writing this having had approximately four hours of sleep, which is about par for the course at the moment. Not because I am stressed, not because I have a lot on my mind, not because of anything a good bedtime routine could fix. Because my body has decided that 3am is an excellent time to generate its own central heating system and I have not yet found a way to argue with it.
Welcome to perimenopause. Population: more senior women leaders than anyone is currently admitting to.
I am a leadership coach. I spend my working life helping people understand themselves more clearly so they can lead with more skill and less suffering. And for a while I was doing that while quietly wondering why I could not find words I had used a thousand times, why I felt a low-level anxiety in rooms I used to own, and why my husband asking "are you okay?" one more time was going to result in a frying pan situation that would be very hard to explain to anyone.
This article is not medical advice. It is me, in this experience, with some neuroscience to explain why it is not in your head. And a few honest thoughts on what helps when the standard playbook stops working the way it used to.
What is actually happening
Oestrogen does considerably more than most people realise, and considerably more than most medical education has historically bothered to tell women.
It has a direct neuroprotective role in the brain, influencing memory, verbal recall, attention, emotional regulation, and the speed at which information is processed. It modulates the neurotransmitters involved in mood and cognition. It affects how efficiently the brain uses energy. When levels become unstable during perimenopause, all of those systems become less predictable.
"The confidence you built over twenty years is not gone. It is operating in more demanding conditions than it has ever faced before."
Research from Monash University confirms what many of us are living: perimenopausal women show measurable difficulties with verbal memory, verbal fluency, and sustained attention. Around 60 percent of women report cognitive symptoms during the menopausal transition. This is not vagueness or sensitivity or a bad week. It is a neurological event, happening to a brain that is simultaneously being asked to lead teams, make decisions, and appear completely fine.
The word that disappears mid-sentence is not evidence of decline. The anxiety in a room you used to own is a documented symptom, not a revelation about your real capabilities. The irritability that arrives fast and hot is emotional dysregulation driven by the same hormonal fluctuation. Knowing that does not make it disappear. But it changes what you do with it.
The timing is particularly unkind
For many women in leadership, perimenopause arrives at exactly the wrong professional moment.
The children, if there are any, are finally less consuming. The experience and credibility are there. The work is at the level where it is genuinely interesting. You have, in short, done the decades of work required to get to the place where you can lead the way you always knew you could.
And then your brain starts behaving like a laptop running seventeen tabs with one bar of battery left.
The Fawcett Society's survey of 4,000 UK women aged 45 to 55 found that one in ten had left their job because of symptoms. Eight percent had not applied for a promotion. Fifty-two percent reported losing confidence at work.
That last figure stops me every time. Not because it is surprising. Because I understand exactly how it happens. If you do not understand what is driving it, the only available conclusion is that something is wrong with you. And once you start believing that, the confidence that took twenty years to build starts to quietly erode.
The silence is not helping anyone
When researchers approached female founders to speak about perimenopause on the record, almost none would. One explained it directly: publicly acknowledging any weakness, mental or physical, jeopardises a woman's chance of being taken seriously.
That is not paranoia. It is a rational assessment of a professional environment that still conflates personal disclosure with diminished credibility. In the Fawcett Society survey, two in five women who took time off for menopause symptoms cited anxiety or depression on their sick note rather than name the actual cause.
I understand that calculation. I have made versions of it myself.
What I have also found is that the silence makes everything harder. Not just for me, but for the women I work with who are in the same experience and have no language for it, no framework for it, and no reliable way of distinguishing between what is happening to them and what is wrong with them.
What my body is doing that I did not sign up for
The sleep disruption is real and it is relentless. Night sweats that arrive without warning or apparent reason. Waking at 3am with a brain that has decided this is the ideal time to process everything that happened in 2019.
The cognitive effects are real. The word that will not come. The name you know you know. The sense that your brain is slightly buffering, processing a beat slower than it used to. I am a person who talks for a living. When the words stop cooperating, it is not a minor inconvenience.
The emotional intensity is real. Things that would previously have registered as mildly irritating now arrive with considerably more heat. The speed and intensity of that flash of irritation is not who I am. It is what hormonal fluctuation does to emotional regulation, and understanding that has been genuinely useful.
The body changes are real and I did not ask for them and I am making my peace with them at varying speeds on varying days.
What helps, honestly
Naming it changes things. Not necessarily publicly, not necessarily with your team or your board, but with yourself. Understanding that the anxiety, the cognitive blips, and the emotional spikes are neurological events rather than character revelations is the difference between managing a situation and being consumed by it.
Protecting cognitive performance matters. Verbal recall and processing speed are most vulnerable under pressure and fatigue. I have become much more deliberate about when I do what. Important communications, complex decisions, high-stakes conversations: these happen when my brain is at its best.
Sleep is a leadership performance issue, not a personal inconvenience. The brain's ability to regulate emotion, consolidate memory, and make good decisions is directly tied to sleep quality.
Stopping the hidden compensation matters too. Some women compensate by working unpaid hours outside contracted time to maintain output that looks normal from the outside. I recognise that pattern in myself. It is not a solution. It is a way of hiding a problem while quietly making it worse.
And talk to someone who actually knows about this. I am not in a position to give medical advice and I would not try to. What I will say is that I wasted more time than I needed to being confused and managing symptoms alone before I had a proper conversation with someone qualified to help.
What I want for the women I work with
I want them to have the language for this before they need it. I want them to understand what is happening in their brain so that when it starts, they are working with information rather than quietly concluding that they are falling apart.
I want them to know that losing a word in a meeting is not the beginning of the end. That the anxiety is not evidence that they were never as capable as they thought. That the irritability is not who they are. That the confidence they built over twenty years is not gone. It is operating in more demanding conditions than it has ever faced before.
And I want them to know that the women sitting across from them in leadership teams, the ones who seem completely fine, are quite possibly lying awake at 3am as well and holding it together through the same combination of competence, stubbornness, and well-managed exhaustion.
We are not alone in this. We are just not talking about it enough.
This journal is not medical advice. If symptoms are affecting your health, work or quality of life, speak with an appropriately qualified clinician.