A few weeks ago I was standing in front of a trainee, walking through a straightforward differential for a patient, and mid-sentence, the words just disappeared. Not a complicated word. A word I’ve used a thousand times. It was there, and then it wasn’t, like it got locked inside a safe inside my head.
It’s kind of ironic that at the same point in life when both men and women start taking on more serious leadership roles, women find themselves in the midst of a massive hormone shift and are suddenly interrupted by sudden sweating, visible redness, or a struggle to find the right word in the middle of an important meeting.
If you’re a woman physician somewhere in your forties or fifties, you already know this feeling. And you may have already decided it means something is wrong with you.
I want to tell you what the research says is actually happening. And then I want to share some insights you can start using today.
The Menopause Penalty and What Perimenopause Really Costs Women Physicians
In a 2025 Canadian study, nearly half of the women studied reported severe menopausal symptom burden and felt they had lower work performance. That part isn’t surprising. What stopped me was the other statistically significant outcomes:
- Perceived loss of promotional opportunities
- Lower job satisfaction, and
- Almost none of them ever took time off to deal with it.
We are the profession that tells patients to rest when they’re sick, and then we walk straight past our own advice like it doesn’t apply to us.
I don’t think the symptom itself is the real problem. I think the real problem is what we’ve been trained to do the second the symptom shows up, which is to hide it, push through it, and quietly decide it means we’re failing. I know this because I’ve done all three in the same week.
There’s research from the business world that backs this up in a way I didn’t expect. When a woman visibly shows a symptom, like a hot flash in a meeting, people rate her as less competent in that moment. But when she names it out loud, actually discloses what’s happening, her ratings go right back up to where they were before.
The fix for the professional cost isn’t that we should be better at hiding it. It’s simply saying out loud what is actually happening.
A Real Story: Brain Fog, Word-Finding, and the Voice That Asks What’s Wrong With You
This recently happened to me. I was mid-conversation with a resident, walking through a patient’s treatment pathway, nothing dramatic about the conversation itself.
And then my next word was just gone.
Not a vague sense of forgetting. I knew the piece of knowledge was there, but I simply could not find it.
So I laughed. I told the trainee, straight out, that I was having brain fog and some word-finding trouble, and I used other words to get to the same place.
The trainee came right along with me. No judgment on their face, nothing. We finished the conversation, got through the teaching, and finalized the plan.
But here’s what happened inside me in that half second before I laughed it off. A little voice showed up, and it didn’t hesitate.
Wow, how could you have forgotten that? What’s going on? What’s wrong with you?
Not the kindest self-talk!
That same week, I was in the middle of my normal morning routine, the gym, getting the kids ready, the most streamlined part of my day, and exhaustion just flattened me.
Now, I don’t nap. I have never been a person who naps and then miraculously continues to function. I usually wake up angry and don’t adjust well.
I texted my husband: something is different with me right now. And then I set an alarm and slept for 30 minutes before my next meeting. No negotiation, no internal argument. My body made the decision for me.
After that cat nap, I was grateful for giving in, because I know that not all of my days are that flexible. And on most days, I would just push through and ignore the signal.
The Path Through Perimenopause: What Women Physician Leaders Need to Know.
After a little research, I found that the solutions to overcoming menopausal symptoms at work and in life are some of the same tools we use to prevent and overcome burnout.
- Investing in and advocating for yourself,
- Finding connection and support with other women, and
- Managing your own people-pleasing tendencies.
The research describes a five-stage arc, and the first stage is symptom advocacy and self-care.
You have to fight for yourself, because plenty of the medical system still doesn’t understand menopause.
I recently switched PCPs because mine didn’t understand what I was going through. He honestly thought if I wasn’t having hot flashes I wasn’t in perimenopause. That I was too young at 43 years old.
If your own doctor can’t hold that conversation with you, that’s not a reason to push through quietly. That’s a reason to find someone who can.
The next stage is disclosure, and this is the one that surprised me most.
There’s research showing that when a woman visibly shows a symptom, she gets rated as less competent in that moment. BUT when she names it out loud, just says what’s happening, her perceived competency goes right back up to baseline.
If disclosure feels awkward, and for a lot of us it does, the evidence says it’s working in your favor, not against it. Just say, “I have brain fog, give me a second.” That’s the whole sentence. You don’t need to explain more than that.
Then there’s building support, and this is so close to my heart.
Connection, especially connection with other women, gets you through almost anything, and this transition is no exception.
The women in this research built support inside their workplaces and outside of it, sometimes something as simple as a group of women trading advice on how to handle a hot flash mid-meeting.
You are not supposed to be doing this alone, and you were never supposed to be doing it alone.
And somewhere in the middle of all that fighting and disclosing and connecting, something else starts to happen.
You stop managing everyone else’s perception of you.
Honestly, I think you just get to a point where you have no more energy left to spend on what other people think. And on the other side of that, you build more confidence, and more assertiveness.
This shouldn’t be the part of our careers where we get smaller or step back. It should be the part where we stop shrinking.
Next Steps for Women Physician Leaders Ready to Stop Pushing Through
If any part of this sounds like a regular day for you, I want you to hear this clearly.
You are not failing. Your body is going through something, and the training you got in medicine, the part that tells you to push through even when you’re sick or tired, was never built for this particular season of your life.
Start small this week. Say the disclosure line out loud the next time brain fog or the hot flash shows up in front of someone. Or reach out to another friend or colleague to chat. Build that community.
If this kind of conversation means something to you, please join my community. You can join directly at womenmdleaders.com/join.
As always, thanks for listening, and thanks for leading with heart.https://www.physicianleaders.org/articles/new-research-on-how-women-in-leadership-navigated-menopause