Why some of Australia’s most experienced women are leaving work at their peak — and what private, integrated care offers instead.
There is a reassuring version of the perimenopause story, and it is largely true: for most women, the transition through their forties and fifties is part of healthy ageing, navigated without derailing their health or their work. Clinical thinking is rightly moving away from treating menopause as a disease to be feared or corrected.
But there is another version — the one Australian boardrooms are only beginning to tell honestly. It concerns the women for whom perimenopause arrives just as they reach the peak of their careers, who are misread or dismissed before anyone names what is happening, and who are often the least likely of anyone to ask for help.
This might seem an unusual subject for us. Raindrum is a private residential program in Byron Bay, known for treating addiction, burnout and complex mental health in high-performing people. But perimenopause sits closer to that work than it looks: in women at midlife, the anxiety, broken sleep and rising alcohol use we treat are often the surface of a hormonal transition no one has named.
Where we are: perimenopause in Australia in 2026
Perimenopause — the years of fluctuating hormones before a woman’s final period — usually begins in the forties and can last years. Most women reach menopause between 45 and 55, and up to 80% have symptoms along the way. They reach well beyond hot flushes: disrupted sleep, anxiety, low mood, joint pain, and the symptom women find most destabilising — brain fog, reported by around two-thirds. For more than a quarter, symptoms are moderate to severe enough to interfere with daily life.
What makes this a workforce issue is who these women are. More than 80% of Australian women aged 45 to 54 are in paid work — the precise age perimenopause arrives — and they sit at the centre of their careers, not the edge. Yet MetLife Australia found in 2024 that 14% of Australian women and non-binary employees had left work entirely because of menopausal symptoms — not reduced their hours, left. The Australian Institute of Superannuation Trustees puts the cost, in lost earnings and superannuation, at more than $17 billion a year.
The issue has belatedly reached the national agenda. The Senate’s September 2024 report made 25 recommendations and conceded how little Australian data exists — Professor Susan Davis AO summarised the gap as “walking blind.” The Government’s 2025 response added an awareness campaign, a Medicare menopause health assessment and subsidised hormone therapies. The conversation is finally being had at a policy level — but not yet, with any consistency, in the rooms where these women work.
The executive blind spot
High-functioning people are, by definition, good at compensating. So when perimenopause arrives — gradually, often without the textbook hot flush — the instinct is the one that has always served them: push through, do not let it show. Which is exactly why it goes unrecognised. The brain fog gets blamed on overwork; the anxiety and broken sleep filed under stress or age.
When the transition goes unnamed, the care built on top of it is shaped around the wrong question. Antidepressants have a place — but treating a hormonally driven presentation as a primary mental health condition is the wrong frame, and care built on it tends to miss. This is less a failure of clinicians than of a fragmented system and consultations too short for the complexity — the AMA told the Senate inquiry that menopause care needs longer appointments than the system allows.
For high-profile women, a second pressure sits over the first: visibility. In industries as small and connected as Australia’s, a senior woman has a rational fear that any sign of struggling will travel — to her board, her competitors, her clients. So she manages it alone, and what becomes known, and to whom, becomes its own barrier to care. None of this is a failure of resilience. It is neurobiology: the brain is dense with oestrogen receptors, and as those hormones fluctuate and fall, mood, sleep and cognition are directly affected. The woman who feels suddenly, inexplicably out of her depth is not imagining it.
“I regularly see women in their late forties and fifties who have been told their exhaustion or brain fog is simply stress — when what they are describing is a perimenopausal transition no one thought to ask about. The answer is rarely a single prescription. It is taking the time to understand the whole picture — hormonal, psychological and personal — before deciding what, if anything, needs treating.” – Dr Tonya Coren, Raindrum Clinical Director.
A composite picture
Consider a composite, details changed. A managing partner in her early fifties, twenty years building a firm and a team that depends on her judgement. Over eighteen months something shifts — she sleeps badly, is short with people, loses words mid-sentence in meetings she would once have chaired without a note. She assumes it is the workload, or age; her GP, in fifteen minutes, hears “low mood and poor concentration” and reaches for antidepressants. No one asks about her cycle, and she tells no one at work — the last thing she wants is for it to be known she is struggling. What changes her path is the first proper assessment, with time to take a full history and see how the pieces connect, made with her, not for her. Someone finally looked at the whole picture, somewhere she needn’t worry who might find out.
A distinction that matters: empowerment is not the same as dismissal
There is a real tension worth naming. In 2024, a major Lancet Series led by Professor Martha Hickey of the University of Melbourne cautioned against over-medicalising menopause: treating a natural transition as a disease of hormone deficiency, solved by replacement, can disempower women and drive unnecessary treatment. Most women need no medical intervention to move through it — an assumption heavily promoted by those with something to sell.
All of which is true at once with this: the Australasian Menopause Society notes that over a quarter of women have moderate-to-severe symptoms, for whom hormone therapy remains an evidence-based, first-line option. Empowerment is not an argument for leaving suffering untreated. Medicating everything and dismissing everything are both shortcuts. What the woman in the middle needs is neither — an honest assessment, and a decision made from there.
Who is most at risk
Some women carry more risk: those with a history of depression, anxiety or significant premenstrual syndrome; those who reach menopause early, including through cancer treatment; and women in high-stakes roles, where the seniority that makes them valuable removes the slack to slow down before symptoms compound. The women most able to keep functioning are often the last assessed properly — because they are so good at appearing fine.
What good care looks like — and how Raindrum approaches it
None of this means perimenopause is a crisis, or that every midlife woman needs intervention — only that it deserves to be recognised and assessed properly, not misattributed, pushed through, or reduced to a single prescription in either direction. Good care begins with the right question being asked at all: a consultation long enough to take a full history and see how the threads connect, the woman treated as the expert in her own experience. For some that means hormone therapy; for others, psychological support, lifestyle change, or simply an accurate explanation.
This is the standard of care Raindrum is built around. Programs are led by Dr Tonya Coren, GP and Clinical Director. She is supported by Raindrum’s own team of psychologists, psychiatrists, dietitians and allied health, with medical, psychological and nutritional care brought together around one person, at Raindrum, rather than through separate doors.
Crucially, the work is done one client at a time and in genuine privacy — which, for a woman whose central concern is that no one find out, is what makes getting help possible at all. It also offers something simpler: time, and distance from the pressure compounding the problem.
If you’re looking for discreet management of your symptoms, we can also offer remote medical treatment through Raindrum.
Questions worth asking
If you are making sense of this — for yourself or someone you support — these are worth asking of any assessment, and our team is happy to discuss them.
Has anyone asked about your menstrual cycle, and how it has changed?
Has a full history been taken — hormonal, psychological and occupational — or only the symptom you walked in with?
Was the full range of options discussed — hormonal, psychological, nutritional, lifestyle — or only one?
And, if it matters to you: is this care genuinely private?
If you, or someone you support, is navigating this alongside the demands of a high-profile professional life, a confidential conversation with our team costs nothing and commits you to nothing — and is held in complete confidence.
1300 007 607 | programs@raindrum.com.au | raindrum.com.au
Raindrum — Private Rehabilitation, Byron Bay NSW
Sources
Senate Community Affairs References Committee (September 2024), Issues related to menopause and perimenopause — aph.gov.au
Australian Government response to the Senate inquiry (February 2025) — health.gov.au
Jean Hailes for Women’s Health — menopause symptoms, brain fog and workforce data — jeanhailes.org.au
healthdirect — Perimenopause (symptom prevalence and onset) — healthdirect.gov.au
Australasian Menopause Society — response to the Lancet Series; guidance on moderate-to-severe symptoms and MHT — menopause.org.au
Hickey M et al. (2024), Menopause Series, The Lancet — University of Melbourne & Royal Women’s Hospital — thelancet.com
MetLife Australia (2024); Australian Institute of Superannuation Trustees (2022) — workforce and economic data
Australian Bureau of Statistics, Labour Force Australia (2025) — workforce participation
Australian Medical Association (2024), submission to the Senate inquiry — ama.com.au
This article is for informational purposes only and does not constitute medical advice. If you are experiencing symptoms you think may relate to perimenopause or menopause, please discuss them with a qualified medical practitioner. If any of the above raises concerns for you, support is available through your GP or Beyond Blue (1300 22 4636).
