Perimenopause is affecting women at work. So why aren’t we talking about it more?

For about six months, Elaine Tan couldn’t explain what was happening to her body. “I was moody, anxious, and my body felt like it was on fire every day,” says the 40something Singaporean banker. Her once-regular periods became erratic. Foods she’d eaten for decades suddenly triggered allergic reactions. “Work was fine, technically,” she adds. “But I was just grumpy all the time.”

It wasn’t burnout. It wasn’t stress. It was perimenopause. 

And like many women in Singapore, Elaine didn’t feel the workplace was where she could discuss it.

A silent disruption

Perimenopause, often described as the hormonal roller coaster before menopause, typically begins when a woman is in her 40s. In Singapore, the average age for menopause is 49, with symptoms starting three to five years earlier.

But unlike the definitive end of menstruation, perimenopause is murky. Hormones fluctuate unpredictably, and symptoms creep in quietly. Hot flushes and irregular periods are the most recognisable signs, but lesser-known effects – joint pain, insomnia, brain fog, anxiety and low mood – often go unrecognised or misdiagnosed as stress, ageing or personality changes.

Uma Thana Balasingam, 47, founder of The Elevate Group and former vice-president at VMware Asia Pacific, remembers when her body no longer felt like her own. 

“I was doing everything right – training, eating well – but the weight came anyway. Shirts stopped fitting. Then one afternoon, my shoulder just locked. I couldn’t tie my bra or carry a bag without wincing. I was leading a forecast call with a frozen arm, camera on, trying to look composed while freaking out.”

She didn’t say a word to colleagues. “We had mental health check-ins and parental leave policies. But hormones? Silence. I didn’t feel unsafe, but I also didn’t feel invited.”

High stakes, low visibility

For many women, silence feels safer than uncertainty. “There’s pride in being the one who can juggle everything,” says Uma. 

“But one day, the words don’t come as easily, and your brain works like a fogged-up windscreen. And you think – ‘Is this stress? Age? Am I losing it?’ No one tells you that it might be hormonal.”

Despite this, the topic remains largely absent from workplace conversations. Elaine didn’t tell her managers. “Why would I?” she shrugs. “If I’m really not fit for work, I’ll just take medical leave. I don’t think bringing it up will make any difference.”

Like Elaine, many women keep their symptoms to themselves. A 2024 survey by Femtech Association Asia and Milieu Insight found that nearly half of Singaporean women felt there was inadequate workplace support for menopause-related issues. Just 4 per cent used menopause tracking apps, and 22 per cent still viewed it as an undesirable topic to discuss.

This disconnect between lived experience and institutional readiness has real-world consequences – for individuals, and for the economy at large. According to a 2025 report by Hey Venus and NUS Bia-Echo ACRLE, menopause is still considered taboo at work by over 60 per cent of women across Asia Pacific – especially in Japan, Indonesia and Vietnam.

Globally, productivity losses tied to women’s health issues are estimated at US$105 billion ($134 billion) each year – a figure that reflects systemic neglect across multiple health concerns, including menopause. In Japan alone, nearly US$2.8 billion is lost annually due to menopause-related resignations.

“Flexibility means little if there’s no awareness,” Uma adds. “What would’ve helped? If just one person – one doctor, one friend – had said, ‘Could this be perimenopause?’ It would’ve saved me a year of self-blame.”

The medical maze

The search for answers can be long and frustrating. Elaine consulted psychiatrists, gynaecologists, endocrinologists, even TCM specialists. “One doctor told me it was all in my head. Another said to wait and see.” Blood tests offered no clarity. Meanwhile, her symptoms intensified.

“There is no single test to diagnose perimenopause,” says Dr Felicia Chin, a gynaecologist at Mount Elizabeth Hospital. “And many symptoms – from brain fog to joint pain – are written off as stress or general ageing. These changes are often hormonal, but the knowledge gap delays proper care.”

Hormone Replacement Therapy (HRT), one of the most effective treatments, remains underutilised. “It’s not always covered by insurance or Medisave,” Dr Chin notes. “And misconceptions about its safety persist.” This lack of clarity – combined with affordability issues – often leaves women navigating treatment on their own.

Cultural conditioning and the “tahan” mentality

In Singapore, stoicism is a virtue many women are taught to wear early. “There’s this ‘tahan’ mindset,” says psychologist Haanusia Prithivi Raj of Annabelle Psychology. “You keep going. You don’t complain. But when symptoms pile up – fatigue, rage, forgetfulness – it becomes a quiet crisis.”

She sees professional women grappling with shame, confusion, and a fear of fading relevance. “They tell me they’re scared of breaking down in meetings, being seen as unstable or past their prime.”

“The first step is acceptance,” she adds. “Menopause is a natural part of ageing, not a problem to be fixed. When women begin to honour their bodies through this transition, it opens the door to more mindful ways of living – and helps them stay grounded in their strengths, even at work.”

A new generation advocating for change

To shift the conversation, younger advocates are stepping up. Valery Tan, 28, co-founder of Surety – Singapore’s first menopause-focused wellness platform – launched the initiative after candid conversations with her mother.

“Menopause isn’t a niche women’s issue. It’s a workforce equity issue,” she says. 

Surety partners with companies to offer awareness workshops, manager training and policy development. In 2024, it hosted Singapore’s first Menopause Festival. Its upcoming app, Pauseplay, aims to make evidence-based support more accessible to Asian women.

Valery points to companies like Standard Chartered, HSBC and IPG Mediabrands as regional leaders. “They offer coverage for treatment, counselling, flexible work, and even leave for menopause-related symptoms. Retention, performance and respect – all hinge on how we show up for women at this stage.”

Change doesn’t have to start big. “Begin small,” Valery suggests. “Form an interest group. Share resources. With traction, partner with organisations like Surety to run tailored awareness sessions or HR workshops.”

Support also begins with education – across HR teams, healthcare providers, and among women themselves. “Most of the time, I’ll do a Google search or look on social media to find a solution,” Elaine says. And that shouldn’t be the norm.

Public hospitals offer more affordable care, but long wait times and limited access remain major hurdles. Expanding public health initiatives and relooking insurance coverage could help ease the burden for women navigating this transition.

Ultimately, it’s not about special treatment – it’s about building the right infrastructure for care, clarity and continuity.

As Uma puts it: “You’re not crazy. You’re not alone. We’ve  got you.”