The Midlife Vanishing: Why Women Are Quietly Leaving and No One’s Asking Why
From menopause to market forces, this is the real reason high-performing women are vanishing and no one is fixing it.
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When Jane got her annual review, her manager looked uncomfortable. “You’ve been off,” he said. “Less sharp. Less strategic. Not the performance we expected.”
Jane was 48. A senior strategist. Top-tier talent. She hadn’t missed deadlines, but something had shifted. She couldn’t find words mid-presentation. Her sleep was wrecked. Her body ran hot, her brain ran slow. But she didn’t have the language for it. And no one in the workplace did either.
It wasn’t burnout. It wasn’t depression. It was perimenopause. And within six months, Jane was gone.
She didn’t get fired. She resigned quietly. With shame and self-doubt. Like millions of women every year. And the system barely noticed.
In the past year or two, I have come to know a few Janes…and I want to talk about her today.
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When High Performers Disappear
Right now, in corporations across the world, women in their 40s and 50s are vanishing from leadership pipelines. Not because they lack ambition. Not because they can’t deliver. But because the system is built around a body that doesn’t bleed.
Brain fog. Insomnia. Anxiety. Irregular heartbeats. Joint pain. Memory lapses. For some women, perimenopause feels like being possessed while trying to keep a straight face in the boardroom.
Yet most employers still don’t screen for it. Doctors miss it. Leaders don’t talk about it. And capital doesn’t price it in.
The Number Must Go Up: A System That Can’t Afford to Care
Matt Stoller’s viral piece, The Number Go Up Rule, nailed something that most economic commentary dodges: In the Booming Twenties (which we happen to be in the middle of), we don't fix things. We protect asset prices.
Monopoly power. Market capitalization. Merger deals.
These are the gods of American policy and anything that threatens them gets dismissed as “whining.” So…
Health care costs skyrocket? Shrug.
People die younger? Shrug.
Women leave the workforce because their biology is on fire? Shrug.
Because fixing care especially women’s care does not make the number go up.
And that is precisely the point. When capital markets drive the system, human wellbeing - especially women’s, becomes a rounding error.
This is why I keep saying: follow the money. It’s the only way to understand what gets funded and why women’s health keeps getting left behind.
I have spent 20 years inside the system, advising investors and seeing how capital decisions get made. If you care about changing the future of care, join me in the Women’s Health Investing Masterclass. Because awareness drives intention and intention changes everything.
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The Cost Of Doing Nothing
Let’s put a price on silence.
In the UK, menopausal symptoms cause nearly 900,000 women to leave their jobs according to BUPA, the private health insurance company1. In the U.S., women aged 45–54 experience the largest earnings gap compared to men despite being in their peak experience years.
One study found that lost productivity from untreated menopausal symptoms costs American businesses $26.6 billion annually (Mayo Clinic, 2023). And yet most U.S. employers offer no menopause support, no education, no clinical benefit parity.
We have the data. We just don’t care enough to act.
This Is Not Just a Health Gap. It's a Capital Market Failure.
Midlife women are not a niche. They are the backbone of the care economy, paid and unpaid. They are the drivers of consumer spending. And they are increasingly the inheritors of wealth. When their biology derails, and the system has no answers, the whole stack suffers.
We lose talent.
We lose innovation.
We lose compounding capital because when women leave, they don’t just leave jobs. They leave wealth-building. Equity. Influence.
Aging, in this context, is not a linear decline. For women, it’s a cliff. And we have built no bridge across it.
From Shame to Signal: What Real Change Looks Like
We don’t need more pink brochures. We need capital frameworks that actually see women. That build for their bodies. That measure the economic loss of inaction.
Imagine if we treated menopause the way we treat cardiac risk in men.
Imagine if performance reviews came with hormonal literacy.
Imagine if health technology actually served the people holding up half the sky.
It’s not utopia. It’s overdue.
Jane Was Not a Fluke. She Was the Canary.
The story of Jane is not rare. It is systemic. It happens in law firms, trading floors, nonprofits, and startups. And the silence around it is costing us not just women’s careers but our collective resilience.
If we can’t make space for women to age with dignity, strength, and full support, we are not a society that deserves their leadership.
The Next Decade Must Be Different
The last decade was about making women visible. This one must be about making them valuable on their terms. Because if “number go up” is our only North Star, we will optimize portfolios and abandon people.
We will fund AI that writes emails faster, but not clinics that treat menopause.
We will praise innovation until it asks for care. And we will lose the women who were always holding the system together.
Let’s not let Jane be another footnote. Let her be the signal.
Reflection inspired by Matt Stoller’s “Number Go Up” essay, and by Sara who sent it to me with the note: “I think your brain would be good at disentangling this for women.”
You were right, Sara. And this one’s for Jane.
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Disclaimer & Disclosure
This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.
House of Commons Women and Equalities Committee Menopause and the workplace. 19 July 2022; London (UK). Available from: https://committees.parliament.uk/publications/23281/ documents/169819/default.
"For some women, perimenopause feels like being possessed while trying to keep a straight face in the boardroom."
...and bedrooms and dining rooms! I embarrassingly can't tell you how many times i've lashed out and felt indeed possessed sometimes mistaking my hormonal episode with mental illness. —for some it is, and that's another conversation. thank you for starting this conversation and making space for us.
xx,
42-year-old who started an herbal line for hormonal bodies and left it.
Yes to every word. I hear this story from clients in perimenopause all the time - and it's not even something I specialize in as a business coach. Maybe I should, lol! In all seriousness, this is an aspect of social justice thst gets so little attention. Along with all healthcare (or we might say health concerns, shrug and yawn) that women experience across our lives.