Pamela Hutchinson OBE, Bloombergs Global Head of Diversity and Inclusion, began to lose her train of thought in the middle of conversations with senior leaders, struggling with names and facts in a way she never had before. 

I wasnt firing on all cylinders at all, she says, recalling the first moment she felt an array of uncomfortable symptoms at age 48. There were times I just didnt feel like I was showing up well. 

Hutchinsons job required her to meet with top leaders daily as she manages over 40 people globally. But the sweating, itching, and forgetfulness began to rock her confidence in the workplace. 

I was frustrated with my own body, frustrated that I wasnt who I was before, she says. I was frustrated that I couldnt remember things, and the more frustrated I got, the more I forgot things. 

While Hutchinson has allowed herself to be vulnerable in other facets of her life, divulging to colleaguesand the wider publicthat she was managing menopause symptoms at work was a whole different beast.

After much thought and being hyped up by a few colleagues and her husband, she decided to open up. She penned her own experience with menopause at work in a LinkedIn post beginning with the question, Is it hot in here or is it just me? 

I was a bit worried because now I was really out there saying, my body, my physiology is failing me, she says.

It didnt land on deaf ears. Hutchinson, who tells Fortune she cried before pressing the post button, was amazed at the number of people who shared their own stories of menopause or supporting someone going through it. People commended her for beginning a conversation about the psychological process women endure as they age in the workplace. 

The post went viral, underscoring how people worldwide were waiting for someone to break the stigma and speak openly about menopause at work. 

As a woman, I didnt want to add another stereotype to the list or show vulnerability or weakness. Not on this and not now, after having worked so hard to progress my career, she wrote in her LinkedIn post from August, 2021. 

Menopause at work 

About 1.3 million women in the U.S. reach menopause each year, yet many remain undereducated on its course of action in their lives. 

Despite menopause being a normal part of aging, women feel incredibly taken aback by the symptoms, both physically and mentally, Laura Stratte, a registered nurse at Elektra Health, a health care company focused on providing menopause education and care through community support and expert coaching, tells Fortune. 

Women come to us, and theyre like, I dont feel like myself. Im not as sharp at work, Stratte says, noting that brain fog sits on the list of common menopause symptoms along with changes in mood, hot flashes, vaginal dryness, bone loss, fatigue, insomnia, depression, and anxiety. 

Menopause affects womens mental and physical health, leading many to fear for their jobs if they cant perform to the same caliber expected of them. Its far-reaching and complex impact on womens lives stems from not only the stigma around it, but the ageism affecting older women more directly. 

Experts say leaders in the workplace need to foster more conversations on menopause, and champion comprehensive education around the physiological process a host of the population endures. 

A crisis of confidence 

On average, women enter menopause at the age of 51, although many have the symptoms of perimenopause, like hot flashes, changes in mood, irregular periods, and sleeping problems, in their 40s and sometimes 30s. People may also experience menopause symptoms in their 20s due to cancer treatment or other surgeries.

When experiencing menopause, women may have secured leadership positions that entail more demanding work when symptoms present. Coupled with the lack of awareness and support around the process, many women blame themselves for struggling to keep up at work, which in turn chips away at your confidence, Stratte says. 

Theres a collective fear of how this natural process will affect their lives, including their work life and how colleagues will see them. In Elektras annual Menopause in the Workplace 2022 Report, which surveyed 2,000 working menopausal women between ages 40 and 55, over two-thirds (67%) reported being afraid of menopauses impact on their mental health.

Its a perfect storm, says Gwendolyn Floyd, founder and CEO of Wile, a wellness company whose products are for women in their 40s and 50s. It literally comes out of left field. They have brain fog. They cant think clearly. Theyre like, am I useless now? Im not good at my job anymore.

In a whitepaper published by The International Menopause Society, many women said they feared that the brain fog associated with the normal progression of menopause reflected a more severe cognitive impairment. This finding sheds light on how education about menopause symptoms and speaking openly about it, can lessen the negative emotional impact of this stage of life, experts say. 

Healthcare practitioners play an important role in counseling women on cognitive changes at midlife and normalizing womens experience, says Dr. Nicole Jaff, co-author of the whitepaper and certified menopause practitioner based in Johannesburg, South Africa, in a statement. This knowledge can also help people grapple with which menopause treatments, if any, can treat their symptoms. Hormone therapy, clonidine pills or patches, low-dose antidepressants, and vaginal estrogen are among some of the treatments, per the Mayo Clinic, yet experts say many people dont know about the benefits or drawbacks of treatment.  

While groups and advocates alike have begun to shout about menopause from the rooftops and pray that it catches the attention of employers, health care providers, and, well, everyone, the lagging public awareness around what it means to age and age well monopolizes the conversation. 

Ageism: Theres a much higher bar for women to appear younger  

Women cant escape the anti-aging ads swarming consumers. The name itself sends a message that the most desirable way to age is to not look like youre aging at all.

Theres a much higher bar for women to appear younger, Heather Tinsley-Fix, a senior advisor of employee engagement at the AARP, tells Fortune. Women face a much higher bar with regard to ageism; they experience it earlier and more frequently than men. 

Therefore, women may feel they need to take action to look younger, leading many to accrue a hefty cost. Data from the Federal Reserve Bank of San Francisco shows callback rates for older women looking for jobs, in particular, lagged behind other age groups. In retail sales, the research found a larger discrepancy between callbacks for older women. 

Instead of embracing aging, there seems to be a collective fear and distance from it in society. The public outcry over Canadian broadcaster Lisa LaFlammes reportedly being fired due to her gray hair underscored the harmful pressure on women to meet unrealistic physical standards to stay relevantimplying that gray hair isnt. Many resonated with the pressures, especially those in forward-facing or service industry jobs. 

Theres this sort of growing unease, this fear of how [ageism] could actually impact me in a material way. Could I lose my job? Or if I lose my job for a reason that has to do with, say, a merger or something, will I be able to get back into the workforce? Tinsley-Fix says. 

Forty percent of adults report sometimes or often experiencing three or more forms of ageism every day, with it being more common among women, according to the University of Michigans national poll on healthy aging from 2020.

In a new AARP survey released this year, age discrimination was the top reason older workers faced a lack of confidence when finding another job within three months if they needed to. The majority (64%) of people surveyed believe older workers face age discrimination, and 94% of that group view it as commonplace. Still, the survey finds its rare for an employee to make a formal complaint against the discrimination.  

This discrimination has taken an emotional toll on women: the number of women in their 40s and 50s taking antidepressants surpasses every other age group, and experts point to the silence around the realities of aging, including menopause, as a catalyst for womens worsening mental health, self-esteem, and confidence. 

Their caregiving duties also exacerbate thismany, sandwiched between an aging relative and their children. In a survey from CarrotFertility, a fertility-based healthcare company, women rank their 50s as the most challenging decade in the workplace, lagging far behind second-place 20s. 

With the 50s being the most challenging decade, its clear that menopause plays a role here, says Tammy Sun, CEO of CarrotFertility in a statement to Fortune. We remain stagnant in the area of fostering an open dialogue around aging in the workplace. 

What often isnt talked about is that older women want to work and excel at their work, Tinsley-Fix says. Some leave in part because of feeling ignored or sidelined, she says. They may also try to keep [their] head down and do whatever [they] can to sort of stay employed, she says. Not looking young has consequences for women seeking jobs. 

So its no surprise that speaking up about menopause symptoms, and seeking out support, feels riskybut experts say recognizing this experience in the workplace matters for the bottom line. 

Supporting older workers supports the bottom line 

Elektras survey further found one-third of respondents say menopause negatively impacts their work performance; 18% havent gone for a promotion because of the symptoms, with Black women more likely to not go for one due to their symptoms; and one in five respondents say they have left or have considered leaving their job altogether due to their menopause symptoms. 

For Hutchinson, speaking openly about menopause in the workplace was not only a medical issue but an issue of diversity and inclusion. At its core, it affects every facet of life, including the workplace. White women have dominated the menopause conversation, and Hutchinsons post highlighted that as a Black woman, menopause can present differently.

In her post, she points to the lack of research on older Black women, noting they experience worse menopause symptoms than their white counterparts and leaders do not do enough to act on the discrepancy in the workplace. A study last year found that Black women are more likely to start menopause earlier than white women. 

Some would say its a medical condition and sits firmly within occupational health or wellness. Others might say it affects womens ability to contribute and thrive in the workplace and is therefore a diversity issue, she writes in her essay. Whichever side you land on, its an issue that has the potential to impact womens performance in the workplace, and consequently, the performance of the business. So perhaps we should consider that its neither a diversity nor a wellness issue, but a practical business issue. 

Its estimated that over $2.2 billion is lost in productivity from menopause every year, and women spend, on average, 24 years in the workforce in the menopausal state, according to Midday, a digital menopause app.

Elektras survey underscored that almost half of older women do not receive enough menopause support from their employers. The women point to the need for more flexible work policies and support groups. Over two-thirds say they would find an expert platform helpful if it had personal care recommendations, expert-led groups, or education. Midday suggests employers educate themselves on what many women face in the office. Distributing anonymous surveys to see what kinds of support or accommodations employees may need to work their best may be a place to start.

The group chat feeling flush that Hutchinson now participates in at work gives her and her co-workers a community and safe space to talk about what they are going through. 

Accommodations like a desk fan, flexible work policies, or temporary relocations are also a step forward, Hutchinson notes in her post. When she had bad days, colleagues stepped up to fill in for her, Hutchinson says, and some even passed her notes so she could remember her talks in meetings. All of this wouldnt be possible without an openness around menopause, she says. 

To expand their services and provide education to a broader set of workers, Elektra partnered with EmblemHealth last year, which will give the New York-based health insurers over 3 million employees access to Elektras offerings and be the first paid partnership looking to provide employees with menopause support. They also signed on to Mass General Brigham Health Plan this year to offer menopause support to eligible members. Elektras digital platform offers a menopause guide or doula virtually, access to monitored community support groups, and expert physicians in the space. 

In the last two decades, weve made strides in demonstrating the value of caring for women during pregnancy [and] post-partum, says Alessandra Henderson, CEO at Elektra Health in a statement. However, we need greater research to demonstrate to payers, health systems, and employers at large that caring for women in menopause has massive financial and societal impacts.

Age-inclusive benefits that mirror other more widely instituted health benefits can show older employees that they matter. 

The mental health challenges older women face in the workplace reflect larger societal messages around aging, rather than an inability to produce. Experts say women deserve morewe need to get to a place where menopause and aging arent inherently fraught. When employers better understand how menopause and other age-related experiences manifest in the workplace, they can address what people may need to feel supported. 

We spend a third or even a half of our lives in this post menopausal state, Stratte says. Were not going anywhere. We have things to do. Weve got places to see. Weve got goals to achieve, and we still have a lot to offer the world.