The Silent Struggle: Midlife Women, Hormones & Mental Health in Leadership

As Australia sees a troubling rise in suicide rates among midlife women, an overlooked factor is beginning to emerge: the intersection of hormonal change and mental health, particularly for women aged 45–55. This period often coincides with perimenopause and menopause — life stages that bring profound changes to a woman’s body and mind. Yet, the way we respond to this issue, especially for women in leadership roles, remains alarmingly inadequate.

At Blaze Coaching, we believe it’s time to shine a light on this silent crisis — and on the women advocating for themselves and others in boardrooms, homes, and health care settings alike.

An alarming trend in women’s mental health

In recent years, suicide rates in women aged 45–54 have steadily increased in Australia. Data from the Australian Bureau of Statistics (ABS) and mental health organisations shows that in 2015, the highest rate of female suicide occurred in the 45–49 age group (10.4 per 100,000), followed closely by women aged 50–54¹. This trend aligns closely with the typical age range for perimenopause and menopause — suggesting a possible hormonal connection that deserves greater scrutiny.

More concerning is the data on suicidal ideation: perimenopausal women are at an almost 7-fold increased risk of suicidal thoughts compared to their pre- or post-menopausal counterparts². These statistics point to a dangerous gap in the current approach to women’s mental health — one where symptoms linked to hormonal change are often dismissed, misdiagnosed, or misunderstood.

Hormonal shifts: Not just mood swings

The symptoms of perimenopause and menopause extend far beyond hot flushes. Women frequently report:

• Brain fog

• Loss of motivation or drive

• Mood instability

• Heightened anxiety

• Feelings of disconnection from self

• Sleep disturbances

  
  

These changes are biological, not imagined. Hormones such as oestrogen and progesterone play a crucial role in regulating brain function, including serotonin and dopamine production. As oestrogen levels fluctuate or decline, women may experience symptoms that closely mimic clinical depression or anxiety. However, many are prescribed antidepressants — often without assessment of their hormonal health.

Neuroscientist Dr Lisa Mosconi explains:

“The menopause transition is a neurological transition. It’s not just about hot flushes — it’s about your brain rewiring itself.”³

The good news? Many women who begin Hormone Replacement Therapy (HRT) report a dramatic improvement in symptoms. A study published in the BMJ suggests that oestrogen therapy may reduce depressive symptoms and improve emotional well-being during the menopause transition⁴.

The invisible load of midlife leadership

Women in their mid-40s to mid-50s are often at the peak of their professional careers. Many are in senior leadership roles, responsible for strategic decision-making, leading teams, and influencing organisational culture.

At the same time, they are often:

• Raising teenagers

• Managing complex household responsibilities

• Caring for ageing parents

• Facing financial and career pressures

• Navigating identity shifts and physical changes

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The result? A perfect storm. And unlike burnout, which is often addressed with rest and recovery, the hormonal dimension of this experience is seldom acknowledged — especially in corporate settings.

At Blaze Coaching, we regularly hear from women who say:

• “I don’t feel like myself anymore.”

• “I’ve lost my edge.”

• “I’m overwhelmed, but I can’t explain why.”

• "I'm so angry at the smallest things."

These women are not failing. They are experiencing a physiological shift that deserves informed care, not dismissal.

Time for change: Women leading the way

Many women are now stepping forward to challenge outdated assumptions about mental health and menopause. They are asking better questions, seeking integrative medical support, and sharing their stories to help others recognise the signs.

And they are transforming the conversation around leadership and mental wellness in the workplace. Women who receive the right support — including access to HRT, nutrition advice, psychological counselling, and coaching — often report a resurgence in clarity, confidence, and creativity.

This isn’t just about surviving midlife. It’s about thriving.

What needs to happen now

1. Greater awareness of how hormonal changes affect brain chemistry and mental health

2. Better education for GPs and mental health professionals on menopause-related depression

3. Holistic approaches to care, including options beyond antidepressants

4. Workplace support for midlife women navigating perimenopause and menopause

5. Policy change that recognises this life stage as a serious mental health consideration

   
   

A call for compassion and action

We must acknowledge the real mental health toll of hormonal change — particularly for women who are carrying so much, both professionally and personally. And we must give them the tools, care, and space to advocate for themselves without stigma. To the women stepping up and speaking out: you are not alone — and your voice is essential to the systemic change that is long overdue.

If you’re a midlife woman in leadership navigating these challenges — or supporting someone who is — Blaze Coaching is here to help. Contact us for tailored coaching solutions focused on resilience, wellbeing, and sustainable leadership.

We’ve chosen the orca as a symbolic image for this article because, like human women, orca females are one of the very few mammals to experience menopause. After their reproductive years, they take on a powerful leadership role within their pods — guiding, supporting, and enhancing the survival of the entire group. This mirrors the often-overlooked value of midlife women in our society: wise, resilient, and central to both workplace and family ecosystems. Including the orca highlights that menopause isn’t an end, but an evolution into a new and vital form of influence.

#MentalHealthAwareness #WomenInLeadership #PerimenopauseSupport #SuicidePrevention #BlazeCoaching

Footnotes

1. Australian Bureau of Statistics (ABS), Causes of Death, Australia, 2015

2. Gordon, J.L., et al. Suicidal ideation in perimenopausal women, Harvard Review of Psychiatry, 2020.

3. Dr Lisa Mosconi, Director of the Women’s Brain Initiative at Weill Cornell Medicine, quoted in The XX Brain

4. Maki, P.M., et al. Menopausal hormone therapy and cognitive function: an evidence-based review, BMJ 2024;384:q220