How Long Island women cope with career demands during menopause

Looking back at the end of her publishing career, Maria Caracci Ciccolella said there is no doubt that the extreme burnout she was feeling was really the lead-up to menopause. .

The company where she worked in middle management had gone through multiple mergers and acquisitions over four years. But at the time, she dismissed her lack of sleep, inability to concentrate, fatigue and other symptoms as stress from navigating company changes. 

“You're not sleeping at night," she said. "You're anxious, and I kind of wrote all of that off as like, well, we're going through this big upheaval, and there's a lot of work to do.”

Women over 50 make up one of the growing shares of the American workforce, many of whom are in leadership positions in the height of their careers, starting new businesses and mentoring others. Yet, it is at this exact moment that many in this age group are suffering in silence from hot flashes, brain fog and other symptoms of perimenopause and menopause. Menopause, which is said to have occurred when a woman has gone 12 months without a period, happens at an average age of 52 in America. 

The convergence of this natural life transition and increased career demands can leave women vulnerable to ageism and sexism, experts say. Many women weigh the questions of whether to take time off to deal with symptoms or risk reputational damage by disclosing them. Should they take fewer high-pressure roles or, worse, leave the workplace and miss out on potential earnings?

A 2023 Mayo Clinic study showed that about 13% of 4,440 women tracked between the ages of 45 and 60 had a detrimental work outcome because of menopause. About 11% said they missed work over the course of a year; 5.6% reduced their hours in the previous six months and 1% said they had quit or switched jobs within the last six months. 

“Women are extremely capable,” said Dr. Jewel Kling, an author of the Mayo Clinic study and chair of the division of women's health internal medicine at the health system. “It's just that they would be capable of maybe more, or they would just feel so much better doing the things that they were doing if these symptoms were treated.”

Despite gains women have made in the workforce, some believe that menopause could play a factor in the “leaky pipeline,” or women leaving the workforce before they are able to attain executive roles.  

The Mayo Clinic study found that reduced workplace productivity — measuring absences from work due to menopause — is estimated at about $1.8 billion in the United States annually. The figure balloons to $5.4 billion once part-time work and other elements such as layoffs and time off due to menopause and perimenopause symptoms were added, according to a 2025 analysis from the RAND Corporation — an American nonpartisan nonprofit. Researchers in both studies said their estimates are likely an undercount. 

“There still seems to be a discrepancy when we look at top leadership roles. Could it be that it's because women hit midlife when they're at the kind of peak of their career, they have the experience and then menopause symptoms kind of take them off course a bit?" Kling said. "It certainly could be that that's one of the factors."  

Juggling career with symptoms

During the day, Jenn Fasano hosts events, workshops and retreats for women as the founder of Babes in Business Long Island — a networking community for women entrepreneurs.

But for four years she was in the throes of perimenopause, and it was making it harder to keep up, she said.

Fasano, 49, who went into menopause this year, said the symptoms made it difficult to navigate a career while juggling family demands.

“I would spend from 3 to 6:30 a.m. wide awake in a hot flash and then have to get up and manage my business and my family all day long," she said. "By 5-6 p.m. I was dragging feet, exhausted, falling asleep on the couch, unable to ... support business phone calls or family obligations."

Throughout perimenopause, the years leading up to menopause, she said she never felt that she wanted to scale back her ambitions, but she did feel overwhelmed. The remedy came in the form of hormone therapy, which alleviated her symptoms.

“I’d get a hot flash in the middle of an event, and I’d have to step to the side and breathe for a moment, and those things don’t happen anymore,” she said.

Taking prescribed hormones to replenish the ones diminished or lost during menopause can be effective at reducing or eliminating symptoms, experts said, but each case must be considered individually and with medical supervision.

Women who take menopause hormone therapy may have a higher risk of developing a stroke, blood clots or breast cancer, according to The Menopause Society, an Ohio-based nonprofit that provides health information about women during the menopause transition. Hormone therapy may also result in side effects of nausea, breast tenderness and irregular bleeding.

“Up until age 60, used within 10 years of menopause, it can be protective for the heart and the bone,” said Dr. Patricia Snyder, an ob/gyn with Stony Brook Medicine. “From 60 to age 70, it's kind of iffy. You have to weigh the risks and the benefits.”

Unsure about treatments

Every day, Dr. Katie Rowan, an internal medicine clinician whose practice in West Islip focuses on women in midlife, said she would typically have a handful of patients “who just weren't feeling like themselves.”

“I've seen a lot of women who go around from specialist to specialist," she said."Sometimes they end up on a lot of different medications, not really sure what they're treating,” she said.

Perimenopause or menopause is often the source, she said, but the lack of education on the subject from physicians often leaves women confused. 

On top of that, Rowan said, many women are caught off guard by the transition because it often comes when they are at the pinnacle of their careers. At that age, they’re also part of the "sandwich" generation, and can be caring for aging parents while also raising children.

The interventions she often encourages women to take can involve hormone therapy, but also lifestyle changes such as drinking more water, exercising and meditating. She has even written doctor’s notes for women in the workplace, asking employers to allow her patients to have a fan at their desk or allow them to work from home.

"Once you recognize it, then it's time to take a step back and say, ‘All right, what can we do about it,' " she said.

Workplace accommodations

Experts say that it is also up to workplaces to provide accommodation for women going through menopause and perimenopause.

In New York, the share of menopausal women in the workforce in 2023 was between 30% and 32%. 

A research paper from The Menopause Society found that women who are experiencing symptoms of menopause sometimes are hesitant to speak out because they don’t want to feel ostracized. 

Kim Callahan, a therapist who focuses on women’s issues and owns Dandelion Wellness Counseling in West Islip, said many menopausal clients who are working “suffer in silence.” On the other hand, she said that clients complain that workplaces generally approach all matters with expectations instead of empathy.

“If you feel like you're not living up to the expectations that you once always met, then you feel like you're not good enough, like you're not worthy,” she said. “So you tend to keep that inside and try to just power through. But the powering through at that stage or at this stage of perimenopause and menopause doesn't look the same as powering through when you're 35.”

If you feel like you're not living up to the expectations that you once always met, then you feel like you're not good enough, like you're not worthy.

— Kim Callahan, a therapist who focuses on women’s issues and owns Dandelion Wellness Counseling in West Islip

The Menopause Society paper and several Long Island therapists say workplaces could train managers to respond to menopausal women with more empathy and provide accommodations, such as temperature control or access to fans for hot flashes. The Menopause Society paper also suggests that management consider allowing women to take sick leave or paid time off due to their menopause symptoms.

Understanding the transition

After deciding not to return to a career in publishing, Ciccolella began marketing her husband’s personal training business, which led her to research menopause symptoms as the company shifted its focus to older clients.

Ciccolella soon realized the changes she experienced — including the flaring up of her rheumatoid arthritis — were part of this life transition. Armed with additional knowledge, she went to her gynecologist who recommended she go on hormone therapy.  She eventually did, which helped alleviate debilitating hot flashes.

Today, she helps others understand the transition after starting Wellspring Coaching NY. She said her menopausal age clients often feel stressed or scattered and brush over the fact that they are going through this change.

“I just give them the sense that they're heard, that I recognize what they're going through, and help them feel like they again can take steps to help them in this journey,” she said.