More than 90 percent of women were never taught about menopause before it happened to them. This post is the education most of us never got.
Most women arrive at perimenopause the same way. Something shifts. Sleep gets worse. Moods feel harder to manage. A period arrives two weeks early, or not at all. Energy disappears by mid-afternoon. The most common thing I hear from women is some version of the same sentence: I do not feel like myself. That sense of losing who you are, your sharpness, your steadiness, your confidence, can be one of the most unsettling parts of the entire experience. And instead of connecting these changes to a hormonal transition that was always going to happen, most women spend months, sometimes years, wondering what is wrong with them.
That is not a personal failing. It is a predictable outcome of a system that has never properly educated women about their own bodies. Research from UCL found that more than 90 percent of postmenopausal women were never taught about menopause at school, and more than 60 percent only started looking for information once their symptoms had already started. A separate analysis of 1.5 million commercially insured women found that while more than half had experienced symptoms related to perimenopause or menopause, only 8 percent had received a confirmed diagnosis.
Start Here: What Menopause Actually Is
Menopause is not a phase. It is a single moment in time, defined clinically as 12 consecutive months without a menstrual period. That is, it. One day, one year after your last period, you are in menopause. The average age in Canada is 51, though it can occur naturally anywhere between 45 and 55.
What most people call menopause, the years of symptoms, the hot flashes, the sleep disruption, the mood changes, the brain fog, is what happens in the years before and after that moment. This is also when many women notice that the habits that served them well for decades, the diet, the exercise routine, the sleep schedule, are no longer producing the same results. That is not a willpower problem. It is a hormonal one. Understanding those stages is what makes the whole experience navigable.
The Three Stages
| Stage | Typical Timing | What is Happening |
| Perimenopause | Mid to late 30s through mid 40s onward | Estrogen and progesterone begin to fluctuate and gradually decline. Periods become irregular. Symptoms begin. This stage can last anywhere from 2 to 10 years, with the average around 4 to 7 years. |
Menopause | Average age 51 in Canada | The moment defined as 12 consecutive months without a period. Ovaries have stopped releasing eggs. Estrogen production has dropped significantly. |
| Postmenopause | The rest of a woman’s life | Hormones stabilize at a new, lower level. Symptoms often continue for years. Hot flashes affect 56 percent of women in post menopause. This stage lasts decades. |
Every woman who lives long enough will go through this. It is not a risk factor or a possibility. It is a biological certainty. What varies is when it starts, how long it lasts, and how intensely it is felt.
What Is Perimenopause, and Why Does It Start So Much Earlier Than People Expect?
Perimenopause is the transition toward menopause, and it is the stage that surprises most women because it often begins far earlier than they expect. While the average age to begin noticing changes is the mid to late 40s, some women begin experiencing symptoms in their late 30s. The ovaries do not switch off suddenly. They wind down gradually, producing estrogen and progesterone in increasingly unpredictable amounts before eventually producing very little at all.
The reason perimenopause is so disorienting is that it does not follow a straight line. Hormones do not simply decline from high to low in an orderly progression. They fluctuate, sometimes dramatically, which is why symptoms can feel random and inconsistent. A woman might have a perfectly normal month followed by three weeks of broken sleep and sudden mood swings, followed by a week where everything feels fine again. That inconsistency is not imagined. It is the hormonal reality of perimenopause.
A quarter of women do not know when perimenopause typically starts. Nearly a third are unfamiliar with their treatment options when they get there. And 92 percent of women surveyed say that more education on the menopause journey is needed. Those numbers are not surprising given that most of us were never taught any of this.
What Does Perimenopause Feel Like at Work?
This is the question that matters most for a workplace audience, and it is the one that gets asked least often. Perimenopause does not stay at home when a woman comes to work. It comes with her.
The symptoms most likely to affect workplace performance include disrupted sleep, which compounds every other challenge a woman faces during the day. Brain fog and difficulty concentrating, affecting 60 to 65 percent of women, can make tasks that once felt effortless feel laboured. Mood changes, including increased anxiety and lower tolerance for stress, can shift how a woman shows up in meetings, under pressure, and in her relationships with colleagues. Fatigue, experienced by close to 70 percent of perimenopausal women, affects energy, decision-making, and the capacity to sustain the kind of output that high-performing roles demand.
Beyond the physical and cognitive symptoms, there is a quieter cost that rarely gets named: the erosion of confidence. Women who were ambitious, vocal, and forward-moving begin to pull back. They stop putting their hand up for stretch assignments. They take themselves out of the running for promotions they would previously have pursued without hesitation. Some downgrade their roles, moving to less demanding positions to manage what they are experiencing. Others leave the workforce entirely. The Menopause Foundation of Canada has documented that 10 percent of women quit their jobs because of unmanaged symptoms. But the number who quietly step back, who make themselves smaller, is harder to count and almost certainly higher.
Many women in this stage describe a version of the same experience: performing well on the outside while quietly wondering whether they are losing their edge. They are not. They are navigating a significant hormonal transition with almost no education, no workplace support, and often no language to even name what they are going through.
The Diagnosis Problem
One of the most significant barriers to support is how rarely perimenopause is correctly identified. An analysis of 1.5 million commercially insured women found that only 8 percent of those experiencing perimenopause or menopause symptoms had received a confirmed diagnosis. Only 6.8 percent of medical residents feel prepared to manage menopausal symptoms, and more than 20 percent received no training on menopause at all during their residency.
The practical consequence is that women presenting with fatigue, low mood, sleep disruption, and cognitive changes are frequently diagnosed with depression or anxiety, and prescribed antidepressants rather than hormone therapy. It is estimated that it takes an average of three years from symptom onset for a woman to receive a correct diagnosis. For many, the number is higher.
I spent years in a demanding corporate role not knowing that what I was experiencing had a name. The exhaustion, the brain fog, the joint pain, the sleepless nights. Nobody talked about it. There was no framework, no language, and no support. That experience is why Menovate exists. Women deserve to walk into this transition informed, not ambushed by it.
The good news is that once perimenopause is correctly identified, there is a great deal that can be done. Hormone therapy, non-hormonal medications, lifestyle changes, and targeted support strategies can all make a significant difference. But none of that is accessible without the first step: knowing what you are dealing with.
What You Can Do Right Now
If you are in your late 30s or 40s and something feels different, start paying attention. Track your cycle, your sleep, your mood, and your energy. Note when symptoms appear and how they shift. That information is valuable when you speak with a doctor, and it helps you advocate for the right diagnosis rather than accepting the first one offered.
If you are a manager or HR leader, understand that the women on your team who are in this stage of life are navigating something real, often invisible, and rarely supported. The cost of doing nothing is measurable: the Menopause Foundation of Canada estimates 3.5 billion dollars in lost productivity annually from unmanaged symptoms. The cost of doing something is an education session, a policy, a conversation.
Post 3 in this series covers the hormones behind everything described here: what estrogen and progesterone do, what happens when they decline, and why the symptoms of perimenopause feel the way they do.
Aimee Debow is the Founder of Menovate and a certified Menopause Coach. She appeared as a witness before the House of Commons Standing Committee on the Status of Women in June 2026. Menovate helps Canadian organizations build menopause-supportive workplaces through corporate talks, e-learning, and HR advisory services. Learn more at menovate.ca.
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Sources: UCL News, Nine in Ten Women Were Never Educated About the Menopause, April 2023. Evernorth, Research Finds That Few Women Receive Diagnoses of Perimenopause or Menopause, June 2025. Fortune, Women Are Unprepared for Menopause and Want More Education, June 2022. Cleveland Clinic, Perimenopause, updated 2024. Stony Brook Medicine, What Age Does Perimenopause Start, March 2026. PMC, An Online Survey of Perimenopausal Women to Determine Their Attitudes and Knowledge of the Menopause, 2022. The World Data, Women in Menopause Statistics, March 2026. Menopause Foundation of Canada.