Midlife Minds in Crisis: What Women Leaders Aren’t Being Told

Amanda Lee
May 11
3 min read

Updated: May 15

Perimenopause is not just about hot flushes and irregular cycles — for many midlife women, especially those in leadership roles, it's a mental health crisis hiding in plain sight.

The Mental Health Landscape

Hormonal fluctuations, particularly declining oestrogen, affect mood-regulating neurotransmitters like serotonin and dopamine, contributing to:

Depression
Anxiety
Insomnia
Brain fog
Suicidal ideation

In the United Kingdom, women aged 45–54 have the highest suicide rates of any female age group¹. Research published in the Journal of Affective Disorders found that 1 in 10 women in this age range report suicidal thoughts during perimenopause, with many having no prior mental health history².

In Australia, it's no different. ABS data shows that women aged 50–54 had one of the highest female suicide rates in 2022³. Suicide Prevention Australia reports rising distress in this demographic, urging further investigation into hormonal drivers⁴.

The Cost of Silence in the Workplace

Too often, symptoms like emotional volatility, poor sleep, and low confidence are misdiagnosed or ignored — both medically and professionally. Senior women are expected to perform under pressure while silently coping with invisible shifts that affect everything from decision-making to emotional regulation.

Workplaces remain largely unequipped to respond. Misunderstanding perimenopause as a purely physical or private issue leads to burnout, absenteeism, and talent loss among experienced women leaders.

Hormone Therapy: Clearing Up the Confusion

Despite decades of clinical use, Hormone Replacement Therapy (HRT) is still stigmatised — largely due to misinterpretation of the Women’s Health Initiative (WHI) study published in 2002. The WHI raised fears about a potential link between HRT and breast cancer, leading to a steep decline in prescriptions.

However, the original lead researcher, Dr Robert Langer, has since criticised how the findings were communicated:

“The fear created by the WHI analysis was disproportionate to the actual findings.”⁵

Subsequent reviews from the Australasian Menopause Society and British Menopause Society confirm that:

HRT is safe and effective for most women under 60 or within 10 years of menopause⁶.
Breast cancer risk with HRT is small and context-dependent — lower than risks posed by alcohol or obesity.
The benefits of symptom relief, mood stabilisation, and protection against osteoporosis and cardiovascular disease often outweigh the risks.

UK menopause specialist Dr Louise Newson is a leading voice in challenging misinformation:

“If HRT came out now as a new treatment, it would be seen as a wonder drug.”⁷

Her advocacy highlights the urgent need for better education among doctors and policymakers — and the importance of women having access to informed, individualised care.

Why It Matters for Leaders

Women aged 45–54 are at their career peak — leading teams, managing families, and navigating ageism. Ignoring perimenopause puts their mental health, performance, and longevity at risk.

When left untreated:

Confidence can plummet
Work engagement may decline with senior leaders leaving their positions and work places
Relationships and self-esteem suffer, including a higher inclination towards divorce

With appropriate support — including access to HRT, workplace accommodations, and mental health care — these challenges are manageable.

From Silence to Strategy

Perimenopause is a biological transition with psychological consequences — not a personal failing. It’s time to stop sidelining the conversation and start treating mental health in midlife women as a priority, not an afterthought.

Education, policy, and leadership must evolve — for the wellbeing of women, and the future of workplaces that depend on their talent.