The Explanation That Arrives First

I lost a word in the middle of teaching in Singapore. Ordinary clinical vocabulary, something I have said several thousand times. It was there and it would not come. I paused, went around it, finished the day.

What I noticed afterwards was how fast the explanation arrived. The first one available was that I am slipping. Oestrogen did not come into it until much later, when I was calm enough to think.

The distance between those two sentences is doing more work than most women are ever told.

There is decent evidence that what a woman believes about this transition shapes how she experiences it. Ayers, Forshaw and Hunter reviewed the literature in Maturitas and found that women with more negative attitudes towards menopause report more symptoms while going through it. Most of the studies they gathered were snapshots rather than long follow-ups, so the direction is not settled, and the authors say so plainly. Avis and McKinlay looked at 2,565 women aged 45 to 55 in the Massachusetts Women’s Health Study, back in 1991, and found that negative attitudes were related to symptom reporting and to depression. The finding of theirs I keep returning to is the one that runs forward in time: negative attitudes held before menopause were related to symptom reporting later, during it. What a woman expected shaped what she went on to report.

I want to be careful with that, because it can be misread as blame. Nobody thinks her way out of a 3am wake-up or a body that has stopped cooperating. The claim is smaller and more useful. When something changes in you and no accurate account of it is available, you will supply one, and the one you supply becomes part of the experience.

What I supplied that afternoon was that I am slipping. I have spent fifteen years working with this material, and that was still the first explanation to hand.

There is now research on what that costs women at work, and it is bleaker than I expected. Tatiana Rowson and Sahar Omary-Barghouthi interviewed thirty professional and executive women about their careers through the menopause transition, published this June in Gender, Work and Organization. One woman resigned from a senior role at a company she loved. She had period pain, fatigue and anxiety, no explanation for any of it, and an organisation where she did not feel able to say she was struggling. Years afterwards she described it like this: I felt its effect before I understood what I was experiencing. She said that with a diagnosis and treatment at the time she might be somewhere completely different now.

What separated the women in that study who kept some control from the women who lost years was whether they had the information to name what was happening to them. Symptom severity did not predict it.

Read that twice, because it inverts where the attention usually goes. The conversation about menopause and work is almost entirely about symptoms: how bad they are, what relieves them, what adjustments help. The variable that moved these women’s careers was whether anyone had given them an accurate account of what they were living through.

Without that account, the women in the study did not conclude they were unwell. They concluded they were failing. A confidence that had gone strange, concentration that slipped, a capacity that used to be reliable - all of it got filed under personal inadequacy, or burnout, or the beginning of the end of their competence. Then they acted on that filing. They resigned, stepped back, took long sick leave, turned down the promotion. The researchers describe women making permanent career decisions before they understood what was driving them, then assembling the explanation years later and applying it backwards to a career that had already been reshaped.

That sequence is the damage. Not the hot flushes.

The clinical version of this is familiar to me, and it explains why the most capable women are the most exposed. A woman who has spent two decades running on competence, self-control and the ability to absorb more than she should has built an identity on capacity. When capacity changes, she does not reach for a physiological explanation. She reaches for a character explanation, because that is the one she has been rehearsing her whole working life. Perimenopause does not create that pattern. It removes the conditions that were holding it together.

Given a physiological frame, a woman treats a hard season as a season, and goes and gets support. Given no frame at all, she treats it as proof, and the proof gets handed straight to the harshest voice she has.

The women in the study who fared best had one thing in common, and it was not mild symptoms. They could name what was happening early. Some had good health information. Some had been through a previous hormonal transition and recognised the shape of it. Some had a colleague or a doctor who said the word first.

Which is why I have stopped thinking of information as the soft part of this. Information has a deadline. Knowing at fifty-two what would have been useful at forty-six does not undo the decisions made in between, and the decisions made in between are jobs, incomes, and the shape of a professional life.

It also cannot be solved one woman at a time. The women in that study who did worst were in workplaces where the subject was unspeakable, where naming a difficulty felt like naming a weakness. One described her silence like this: maybe it is a fear of being judged, but probably more, I did not know what they would do with that information. A woman calculating what will be done with a disclosure is telling you something accurate about her workplace. Personal knowledge does not survive a culture that punishes it.

The word came back to me in the taxi afterwards, the way they do. What was slower to come back was the sentence I had told myself about it. I notice I am still more interested in that sentence than in the word - where it came from, how long it has been waiting, and what it would take for a different one to arrive first.