What If We’re Misdiagnosing Women?

This article is for the managers. Especially the ones who genuinely care about their people.

Have you ever thought:

• "Something feels off with [fill in the name]."

• "She doesn't seem as engaged as she used to be."

• "She's not operating at the same level."

• "Maybe she's burned out."

• "Maybe she's peaked."

Now ask yourself a different question: What if your observation was accurate, but your conclusion was wrong?

One of the most important insights I've learned on this journey is that perimenopause often begins in the brain long before women connect the dots themselves.

The symptoms can look remarkably similar to the things managers are trained to watch for:

• Lower energy

• Reduced confidence

• Difficulty concentrating

• Forgetfulness

• Emotional reactions

• Withdrawal

• Loss of engagement

From a leadership perspective, those symptoms often trigger concern. From a biological perspective, they may signal something entirely different.

The challenge is that managers can't see hormones. They can only see behavior. And when behavior changes, we naturally create explanations:

• She's losing interest.

• She's overwhelmed.

• She's no longer ambitious.

• She's not ready for the next role.

But what if she's working twice as hard just to maintain the same level of performance? What if she's lying awake every night? What if she's struggling with anxiety she can't explain? What if she's terrified someone will notice? What if she hasn't lost her spark at all?

This isn't an argument for lowering standards. It's an argument for improving understanding.

The women most likely to experience perimenopause are often the same women organizations can least afford to lose. They are directors. Vice presidents. Founders. Subject matter experts. Mentors. The people carrying decades of institutional knowledge.

The question isn't whether women should be treated differently. The question is whether we are accurately interpreting what we're seeing. Because if we're not, we may be quietly pushing talented women out of the workforce during the exact years when they have the most to contribute.

And that's a leadership issue.

It’s why I created The Spark Framework. A practical guide for organizations and managers to have a compassionate conversation about midlife at work. It’s the ultimate “how-to” communications guide for what companies should be thinking about now and how to approach conversations that may once have been off-limits, difficult or uncomfortable. And similarly, a guide for women to understand how to start these conversations with managers without fear of being dismissed.

Every working woman will go through this midlife transition while simultaneously over-achieving, trying to deliver, and trying to prove herself. Let’s support her.

Five Things I Learned from my First Interviews on Perimenopause for Working Women

When I started talking openly about perimenopause, something unexpected happened. Women started talking back. Not cautiously. Not awkwardly. Immediately. One conversation became five. Five became ten. Ten became twenty. And before long I realized I wasn't collecting stories. I was uncovering patterns.

Here are the five biggest things I've learned so far.

1.      Everyone thought it was something else.

• Burnout

• Stress

• Depression

• Aging

• Lack of motivation

• Too much work

• Not enough vacation

Nobody I spoke with immediately thought: "Maybe this is perimenopause." Instead, women were treating individual symptoms while missing the larger picture.

2.      Brain fog is terrifying.

Interestingly, there isn’t any one system associated with perimenopause, but the one that came up most often was cognitive change.

Women described forgetting words. Losing thoughts mid-sentence. Walking into meetings feeling unprepared even when they knew the material cold.

For high performers whose careers have been built on sharp thinking, that experience can be deeply unsettling.

And it’s the one most often misdiagnosed as disengaged. Because when the women I talked to described how they felt when they forgot words, felt embarrassed in meetings when they lost their train of thought, they also retreated. They lost their confidence and spoke up less.

3.      Many women are suffering silently at work.

Not because they want to. Because they're afraid.

Afraid of looking weak. Afraid of being passed over. Afraid of reinforcing stereotypes. Afraid someone will conclude they've lost their edge.

So they do what women have always done. They push through.

4.      Nobody knows where to go for help.

Many women don't know where to start. Many doctors aren't trained in menopause care, let alone perimenopause care. Many employers don't talk about it. Many managers don't recognize it.

Everyone seems to agree this is happening but few seem prepared to address it.

5.      Something powerful happens on the other side.

This one surprised me.

Many women who had found the right support didn't simply return to normal. They emerged with a completely different perspective.

Some wanted bigger careers. Some wanted entirely different careers. Some left jobs that no longer fit. Others stepped into leadership roles they had previously avoided.

What looked from the outside like a breakdown often became a reassessment. And in many cases, a breakthrough.

The more conversations I have, the more convinced I become that this isn't just a health story. It's a leadership story. It's a workplace story.

And it's a story millions of women are navigating largely on their own.

Welcome to Spark

Earlier this year, I left Amazon after 15 years.

I told myself I'd finally rest. Sleep past 7. Go on vacation. Read the books that had been sitting on my nightstand for two years. Do absolutely nothing for a while. And for a few weeks, I actually did that. I rarely saw a number before 10 a.m. on my bedside clock.

But something kept nagging at me: a curiosity that wouldn’t go away. For months before I left, I'd been in the thick of perimenopause and had no idea. I'd be mid-sentence in a meeting, completely sure of my point, and just lose it. Not distracted — gone. My patience was shorter than I recognized as mine. Some days my brain and my body seemed to be on two different calls entirely.

If you've spent your whole career being the person who's sharp and fast and unbothered, that kind of change doesn't stay contained to how you feel physically. It starts to mess with how you see yourself, period.

So I went looking for answers, mostly by talking to other women. Almost everyone had some version of the same story — they thought they were burned out, chalked it up to aging, and despite their self-doubt, just powered through.

Which got me stuck on one question: how many women are quietly questioning themselves — or getting quietly questioned by everyone around them — at exactly the moment they have the most to offer?

I didn't love the answer. So I built something instead.

Fifteen years at Amazon taught me more than I can fit into a post (maybe that’ll be a book someday), but the short version is: how to build something from nothing, how to push a project forward when no one's telling you how, and how to make something actually scale. I'm using every bit of that now, just pointed somewhere a lot more personal.

Spark is what I'm calling this next thing — it sits at the overlap of perimenopause, career and leadership. The goal is simple to say and harder to do: help women stay confident and visible through this transition instead of quietly shrinking, and help the people managing them recognize what's actually going on instead of mistaking it for something else.

Right now that looks like workshops, 1:1 coaching, and consulting for companies who want to get ahead of this instead of getting caught off guard by it.

If any of this sounds familiar — you're in it, you're managing someone who might be, or you've just been wondering why we don't talk about this at work — I'd love for you to follow along.

We're not losing our spark. We're living through something nobody explained to us, at exactly the moment we needed it explained. I'm trying to fix that.