Article · 5 min read

Same Hormones, Different Grace: Pregnancy, Menopause, and the Workplace

By Dr. Jessica D. Johnson, PharmD, BCACP · Reset With Dr. Jess™

Two women, two tears, two verdicts

Picture two women in the same Monday meeting. One is 28 weeks pregnant. The other is 51 and hasn't slept a full night in months. Both get choked up when a project gets yanked out from under them.

For the first woman, the room softens: "Aww, it's the hormones. She's pregnant." Someone brings her water.

For the second, the room goes quiet in a different way: "She's emotional. Maybe she can't handle this account anymore." Someone makes a note.

Same biology. Same shifting estrogen and progesterone. Two completely different verdicts. One woman is excused. The other is evaluated.

I've spent my career in women's health, from building a hormone management clinic to sitting with women who were terrified their brain fog meant they were "losing it." Here's what I want every employer to hear: it's not her, it's her hormones, and hormones don't stop mattering just because there's no baby bump to point at.

The double standard has a name

Let's be honest: pregnant women don't get a free pass at work either. In a field study published in the Journal of Applied Psychology, Hebl and colleagues (2007) found that store employees were ruder to pregnant job applicants, yet more touchy and overly friendly with pregnant customers. Researchers call that benevolent sexism: warmth that comes packaged with lowered expectations.

So the "she's just hormonal" grace pregnant women receive is real, but it's conditional. It's sympathy tied to a visible, temporary, socially celebrated reason.

Midlife women get the other side of that coin. A 2024 review in Maturitas notes that many women hide their menopause status at work for fear of gendered ageism, being seen as less competent, less capable, and less competitive. Organizational researchers describe menopause as a taboo, where symptoms like irritability, fatigue, and poor concentration are treated as embarrassing or shameful rather than physiological. In one UK employer survey, 62.6% of staff agreed menopause is a taboo.

The difference comes down to three things:

• Visibility. A belly explains itself. A hot flash, a 3 a.m. wake-up, or a surge of rage does not.
• Story. Pregnancy is framed as a beginning. Menopause is framed as a decline.
• Timeline. Pregnancy has a due date. Perimenopause can run for years, so the "temporary" grace never gets extended.

Same hormones, same brain

Pregnancy, postpartum, and perimenopause are all periods of big swings in estrogen and progesterone, and the brain feels every one of them. Estrogen helps regulate serotonin, sleep, temperature control, and verbal memory. When it rises, crashes, or zigzags, mood follows.

The evidence is strong on both ends of the reproductive lifespan:

• Pregnancy and postpartum. Perinatal depression affects roughly 12% of women and perinatal anxiety about 20%, and most cases go undiagnosed. ACOG now recommends routine mental health screening across the perinatal period.
• Perimenopause. In the Harvard Study of Moods and Cycles, women with no history of depression who entered perimenopause were twice as likely to develop significant depressive symptoms as women who stayed premenopausal, and the risk was higher with hot flashes. The Penn Ovarian Aging Study, an 8-year cohort, tracked the same pattern of new-onset depressed mood tied to the menopause transition.

In other words, the tears in that Monday meeting come from the same neurobiology. What's different is how visible the cause is, not how real it is.

And not every midlife symptom looks like sadness. Irritability, anger, anxiety, poor sleep, and brain fog are all part of the picture. When those show up at work, they get misread as attitude or incompetence.

What it's costing you

Misreading menopause isn't just unkind. It's expensive.

The largest U.S. study on the topic, published in Mayo Clinic Proceedings in 2023, surveyed 4,440 employed women aged 45 to 60. The findings:

"Adverse outcomes" included cutting hours, being laid off or fired, quitting, retiring early, or changing jobs. The more severe the symptoms, the worse the outcomes.

Think about who these women are. They're often at the peak of their expertise, in line for senior leadership, holding institutional knowledge you can't replace. Losing them to a treatable, predictable transition is a leadership failure, not a personal one.

The law already knows how to do this

We've already written the playbook for one hormonal transition. The Pregnant Workers Fairness Act took effect on June 27, 2023. It requires employers with 15 or more employees to provide reasonable accommodations for known limitations tied to pregnancy, childbirth, or related conditions, unless doing so causes undue hardship.

There is no federal equivalent for menopause yet. Women have had to squeeze claims through age, sex, or disability law, none of which was built for this.

That may be changing. On July 14, 2026, Reps. Debbie Dingell and Yvette Clarke introduced the Menopausal Workers' Fairness Act (H.R. 9671). It would guarantee the right to request reasonable accommodations for menopause-related limitations, bar employers from forcing leave or a specific accommodation, and require medical confidentiality. It is still in committee. States are moving too; Virginia and Rhode Island are among those with menopause workplace bills in 2026.

You don't need to wait for a law to do the right thing. The pregnancy framework already shows what good support looks like.

How to support women across the whole hormonal journey

The goal isn't to treat menopause like pregnancy. It's to give every woman the same benefit of the doubt, whether her hormones are visible or not.

1. Train managers on the full lifespan. Periods, PMDD, fertility treatment, pregnancy, postpartum, perimenopause, and menopause. Mayo Clinic's lead author urged employers to teach managers how to handle these conversations with sensitivity.
2. Change the script. Swap "she's emotional" for "what does she need?" Judge performance on outcomes over time, not on one hard afternoon.
3. Offer simple accommodations. Flexible start times after poor sleep, temperature control or a desk fan, access to cold water, breathable uniforms, camera-off options, and quick breaks. Most cost little or nothing.
4. Protect privacy. Research shows many women choose not to disclose, and that choice deserves respect. Make support available without requiring a confession.
5. Cover the care. Make sure your health plan covers menopause-literate clinicians and evidence-based treatment. Even low-cost tools help: in the MENOS@Work randomized trial, a 4-week self-help CBT booklet delivered through employers was tested with working women struggling with hot flashes and night sweats.
6. Write it down. A written policy that names menopause alongside pregnancy tells women this is a normal part of working life, not a secret.

It's not her. It's her hormones.

The pregnant woman and the menopausal woman are running on the same biology. One gets a glass of water. The other gets a note in her file.

We can do better, and it's not complicated. Extend the grace you already give to pregnancy to every stage of a woman's hormonal life. Believe her before you can see the reason. Support her before she has to ask twice.

Because when you support women through every season, you don't just keep good people. You keep your best ones.