Breaking the Menopause Silence: A Leader’s Guide to Peak Performance with Kacy Fleming

Welcome to The Flourishing Edge, the podcast where we share weekly tips on making flourishing your competitive edge. I'm Ashish Kothari, your host, and each week we'll dive deep with flourishing experts, changemakers, and executives to share best practices that can help you unlock higher performance through science-based interventions. Let's step together into the edge of what's possible and live, work, and lead with more joy, health, love, and meaning. Casey, welcome to the Flourishing Edge Podcast. I am so delighted to have you here with us, my friend.

I am very excited to be here with you and to meet you and spend time with you in this space.

Well, my friend, you know, I really wanted— this is our first recording of this new year, and I really wanted to start on this topic because it's, it's a topic that affects half the world, right? Like it will affect or is affecting half the world. And it's something that, you know, I spent close to 45 years of my life completely ignorant, 25 years of my working life completely blind to something that actually affects all the people around us. And we walk through that completely unaware. So, and that's the topic of menopause. It's a topic of what happens as we get older and how our bodies change and how they actually affect not just our physical body, but how we experience, how we think about the world, how we interact. And I have to tell you, I was one of those men till 25 years. I was completely unaware. You know, there's a lot more on this topic over the last couple of years that people have been talking about. Leaders like you have been researching and sharing. But I think it is still not a core part of kind of the vocabulary or knowledge base. And so I'm really excited about learning from you, learning from your research, learning from your personal experience. And hopefully this episode has so many tips that individuals, teams, and organizations can take to support the women who work there and actually do it not just because they wanna support them, they should do that just for that, but recognize that this investment is not a split the pie investment. It's truly something that can grow the pie because you're missing out from a big segment of your workforce.

Yeah. And you're not alone. I mean, as a card-carrying woman who has been one now for 49 years, almost 50, uh, I always say I didn't hear the word perimenopause until 8 years ago. And I've worked in healthcare for 22 years. My dad was a doctor and a very good one. You know, I grew up in a medical family and we talked about the body. We were a comfortable family and, and and I still didn't know, and nobody talked about it. And the word still isn't in many people's vocabularies, or they don't know the difference in the different phases of the transition. And so I think it's really important that we're having this conversation and, and shedding light on something that, as you said, happens to 51% of the population. And for anyone born with uterus and ovaries, is as certain as death and taxes if you live over a certain age, right? Like, it's You're not getting away from it. You may or may not have symptoms. 80% will, 20% won't. But we need to know about it.

Yeah, I love what you just said. For anyone who's born with ovaries and a uterus is as certain as death and taxes, right? So it affects us in different ways. So talk to us. Let's jump right in, Casey, and talk to me about why, you know, many leaders will say, well, you know, menopause is either private or it's not that common or it's not really something that we got to do with workplace? Like, what has that got to do with work? It's your personal life. It's your personal body. Yeah, you're going through changes. Go deal with that. Why is this such a dangerous myth that organizations are holding? So talk a little bit about that. Why should organizations care?

Yeah, so I mean, I'm going to give you the health reason and I'm going to give you the financial reason because I think it's two parts for an organization, right? So we are under this false belief that menopause symptoms are just uncomfortable. They're bothersome because for generations, our mothers and our grandmothers went through this transition when there wasn't a lot of supportive agents or there was data to kind of debunk those supportive agents. So people were afraid to take them. And it's kind of like, where did this come from? Why is it suddenly a problem? Why are these women surfacing these symptoms? And what I wanna say about the actual symptoms and we'll talk about this more in the conversation— is that they're fragmented. And people only think about menopause as hot flashes, night sweats, and irritability, right? And here's the really interesting thing about hot flashes and night sweats, which we call vasomotor symptoms when we, when we lump them together. They are proven, and this is data you can get online. It's not made up. I'm not creating it. It's science that's been out there for years that these vasomotor symptoms are biomarkers for cardiometabolic dysfunction, neurodegenerative dysfunction, cognitive problems down the road. And these are impacting women in real time, and we're sitting there saying, oh, it's bothersome, or, you know, we shouldn't add them to the formulary plan, or we don't need to talk about them in benefits because they're just bothersome. But that's actually pharmaceutical study language and not all that there is to the symptoms of menopause. That second piece, and I can keep this real tight because the facts are out there, is if you look at Mayo Clinic data from 2023, and a lot of people have seen these numbers, that menopause is costing businesses $1.8 billion in reduced absenteeism— sorry, reduced presenteeism, absenteeism, turnover, all of these things. And when you add in healthcare costs, you're at $26.6 billion. And that's just in the US annually, right? So there is a component that is very much focused on the fact that employers provide healthcare, women make up large swaths of their population, and we need help. We need the actual care so that our later lives don't look like we are decompensating when we don't need to. So The business rationale, it's cut and dry. The numbers are clear. And so there's a disconnect and there's a reason that we're still not connecting these pieces. And that's what we'll get into further.

Yeah, no, I think it is blindingly obvious and yet common sense is not common practice, right? So before we get into that, Kasey, talk to me a little bit about how you actually What was this like for you? How did you become awake to this? And through your journey, share a little bit about what that experience of somebody who's going through this actually is.

Yeah, I mean, I'll say I was dragged in kicking and screaming and totally unaware. And I think this is very common. I refer to it as perimenopause blindness, where I have these brilliant friends that'll be slightly younger than me now, and they've watched me go through it and run my business and talk about this. And they'll be like, well, I'm feeling like this and like this and like this, and my life is blowing up. And I'll be like, have you talked to your doctor about your symptoms? Well, no, I don't think it's that. I've got this complexity of my, you know, career being at its peak and my family being at its peak and all these things, and I, I don't think it's perimenopause. And I'm like, okay, yep. So this is this blindness that happens for everybody. And so when my journey started, it started with Crazy increases in anxiety, panic out of nowhere, startling awake from kind of a dead sleep, which then came with panic attacks and brought me to my knees. And I talk about this, I am not ashamed, but I became suicidal in my thoughts. Not all the time, not even a quarter of the time, but there were days when I would sit on my couch and I would look at my life I didn't feel like myself emotionally. I didn't feel like myself or look like myself physically. I didn't have the relationship with my partner that I had had previously. I was irritable and uncomfortable in my work body, and things that would never have bothered me would bother me. And I thought I was losing my mind. And I think this is what we hear from women all the time is until somebody shared their story, I really thought I was losing my mind. And so that is kind of how my journey started. And of course, I'm very blessed that I have a great doctor and I have a loving partner. And he said, we need to get you help. Like, and I said, I need help. I, I don't wanna feel like this. And I had one of the few healthcare practitioners that put the fragmented symptoms that I was experiencing together with my age. And said, you know, Casey, I think you're in perimenopause. And I was like, who? Like, I'm in my early— is like, what? No, come on. Like, look at me. I don't look perimenopausal. And he was like, yeah, you are. So we have options. Let's talk about them. And I was actually the first patient he ever put on hormone replacement therapy because he's my generation. He was trained that it could be dangerous. He's got a lot of men in his practice. He's a primary care doctor. But he ran through everything and every contraindication and was like, I think you're a great candidate. And if you want it, let's try it.

So I want to unpack that a little bit, but like, wow, what a journey. And I can so relate because we do have— I'm 51 and we do have several friends, right, who are in 40s and 50s and, you know, are experiencing— have experienced many of these. These things, right? So I want to highlight 3 things that are coming up for me, Casey. The first one is, you know, I started by saying, you know, I feel a lot of the men are blind to this, but what I'm taking away is a lot of women are blind to it as well, especially in the premenopausal phase. You know, a core part of work we do, I often say we see the world as we are, not as the world is. And a big part of how we see the world is based on our beliefs. It's based on what we experience as emotions, but also our body and what we are feeling in our body. And so with all of these hormones, changes in our body, if they're creating a mood of, as you said, you know, I was anxious, I was having panic attacks, I had dissatisfaction with my relationships, I was questioning my own self-worth, I was suicidal. So we don't think about the body. The body is invisible. We are experiencing this. And then we hold— we then go from there to say, hence something must be wrong. I need to change my career. I need to change my spouse. I need to eject. And many people go down that path versus saying, hold on, maybe the lens through which we are seeing is actually not clear anymore. And the reason it's not clear is what's happening in my body. And if I could get the help to clear the lens, maybe I'll see differently. And if I still don't like what I see, then go do all the changes you want to go do. But don't do it when you are not seeing clearly because of where you are.

Yeah. Yeah. It's— you see the numbers, right? So women, the highest rate of divorce for women initiating divorce is during the menopausal transition. Which can start traditionally anywhere from like late 30s all the way through your 50s. Now, there are other people that will go through menopause sooner, either because they had a surgical procedure, or they may be one of the smaller populations that has, you know, premature ovarian insufficiency, or some of these other things that can happen due to genetic factors. But I don't think anybody 5 years ago, except for maybe a couple really wise physicians and some women who had gone through journey early themselves looked at perimenopause and thought, oh, I need to be thinking about this when I feel these symptoms arise in my late 30s and early 40s. I need to question what is making me want to make all of these changes. And I think what layers on to the challenge here for so many women is what I call the midlife collision. You've got your work life booming. I, I see it as like two barges, like packed full of like shipping containers. One is your work barge where you're excelling and you're leading. Even if you're working in the home, it doesn't matter. Yeah. You are doing more than you did before. The other is that home life component where if you have kids, they tend to be getting a little bit older and having more demanding lives and more demanding schedules. If you don't have kids, you probably have aging parents. You may have both.

Yep.

And then underneath is this like hormone fluctuating current that looks like the worst roller coaster you've ever been on in your entire life. And you can't figure out why the containers are coming off the boats. Is it the current? Is it something wrong in work life? Is it something wrong in personal life? And you know what? As you said, It could be all of the above. It could absolutely be that you need to blow up your life because you've lived in some way that is out of alignment and it's just come to pass and you know. But for many people, if given the time and the awareness and the education to understand what is happening to your body and communicating with your partner, you can find a new, not normal amazing together. And it's a process and it requires patience and learning and iteration. It's not like you take one thing and you suddenly feel amazing. You might for a little bit.

So, so that's where I want to go next because I'm curious, Casey, you— so if you are, let's start with what are the telltale signs? So if you're a woman, right, how do you know that you might be premenopausal or going through? Is there like, you know, here are the— now that you've gone through and you write about it, you teach about it, what are the 6 or 7 things? And linked to that, is there a medical test that can help give you some level of idea, or is it just symptoms? So talk to us a little bit about that.

Yeah. So this is the hard— this is the hardest part, right? So if you know one woman's menopause, you know one woman's menopause. I can give you some of the symptoms that usually come on earlier as opposed to later in the transition. Obviously, the telltales are not having a period for 365 days. Yeah, that one day after that is menopause, and you're in menopause for the rest of your life. Some people call it postmenopause, but you hit menopause after 365 days with no period. So that is a really clear sign. There is no definitive test for whether or not you are in perimenopause as long as you are still having a cycle, even if it's irregular. And so that's what's so challenging, right? There's so many people selling different tests to tell you, and it's a clinical diagnosis. If you ask any clinician who practices in this space, they may test your baseline hormone levels because they just want to know where you are as they progress, but that's not going to tell them that you're in or you're not. I see.

So it's not like certain hormone levels are going lower or higher and you're like, if it's below this level, hey, this is what's going on.

Because that's on a daily basis, right? So until you're in menopause, they're fluctuating. So you could have a day when they're bottom basement, 100%. You'd say, yep, this person's in menopause. And then tomorrow they're spiking off the roof, right? So you would have to test daily for a period of time, and, and people aren't really doing that. So it's a clinical diagnosis, just like a lot of other things out there, um, and it's a diagnosis of exclusion a lot of times. So people will look for thyroid, other issues that could potentially mimic menopause symptoms to kind of rule that out. That's always a smart, safe thing to do because you never want— I never want someone listening to hear these symptoms and just go, oh, I'm in perimenopause, I don't need to go to the doctor. It's like, no, you got to go to the doctor.

You need to go to the doctor. It's a clinical diagnosis.

But if you are in the age range, you know, that's traditional, so late 30s, early 40s, and you're starting to feel insomnia more often coming on, increases in anxiety and depression, some cognitive fatigue or overall fatigue that often is attached to sleeplessness, right? Certainly, if you're having vasomotor symptoms, hot flashes and night sweats, that, that's kind of— I think the reason that gets so much attention isn't because people understand how dangerous they are. That would— that's what should get them attention. They get attention because once people start having that, it's like, Okay, I know what this is. The challenge is for most of us, those don't start until after we have some of the other things. And it's not until we know we're in menopause, we look back and we go, I got it. Okay. All that, like irritability, the irregular periods, the insomnia, it was all perimenopause. And I didn't— it didn't connect until the hot flashes or night sweats.

I see.

So irregular periods, all of those sorts of things, but it can be joint pain. It can be genitourinary syndrome symptoms, it can be other musculoskeletal symptoms, it can be other behavioral symptoms.

Talk to me a little bit about, you know, what we think and feel like, how is that changing? Because oftentimes that can also be like, as you said, for you, like something's changed.

Yeah.

For a period of time.

Yeah. I think, you know, the biggest change that I noticed um, in myself, and probably what caused me the most suffering or to ideate about suicide. Um, it's not even a word, but suicidal ideation is a word, so we'll go there. Uh, and I think they made it one. But when we look at this behavioral component or this cognitive component, two things are very pronounced. One, many women don't feel as sharp as they felt before, so you forgetting things. You walk into a room and you can't remember why you're there. You are sitting in a meeting, and this was really debilitating for me being someone who speaks for a living, right? And who does a lot of this work in front of people, was losing my train of thought in a meeting. And the first time that would happen, I would be like, oh, you know, if it's important, I'll remember. We all say that, right? But when it starts happening 2, 3, 4, 5 times in a meeting and you find yourself like writing down what you just said or what someone said said so you don't forget. And sometimes you forget to do that and you keep losing your thought. It's, it's mind-wrecking, right? From a, a brain fog, cognitive fatigue perspective, you start to think, am I losing it? Am I going to be able to do my career anymore? My job is about my ability to connect, to communicate with people, and I can't remember what I'm saying. And I know I'm not— am I, am I in dementia? And a lot of us think that. I think the other piece mentally is many times the activities, the things in our life that were pleasurable to us. And I'm not just talking about intimacy with our partner, but you enjoyed family time or you really loved, you know, going out and having a cocktail or dinner or, you know, being in big groups of people. It suddenly doesn't appeal to you anymore, and you feel really apathetic towards these things that you once loved. It's called anhedonia, and that is such a common precursor that we don't think of as depression. We're like, well, I just don't feel like doing this, I don't feel like doing that, I don't feel like myself. When really we're in anhedonia, which is a phase of depression. And because we're not bedridden or crying constantly or all the things that we've thought of as depression, we don't recognize it. So we just feel broken.

I see. So if you are, if you are experiencing these, obviously you said step number one, go see a doctor, talk about it.

Yes.

Right. What are other things? What are the some things that are available? And let's just start with an individual. If you are a woman who's going through this, what are 3 or 4 things that in addition to talking to the doctor, what advice would you give them? What did she do?

I think the most important things you can do, number 1, track your symptoms. So you want to keep some kind, I don't care if you do it in your phone, I don't care if you do it on an app, I don't care if you do it on paper, I don't care if you do it every every day. It's better if you do, but for a couple of weeks at least, track your symptoms. Take the little notebook or your phone with you, and when you feel something different than you were feeling before, notice what you ate, notice what you drank, notice when the symptom came on, what time did it happen, how often are you waking up during the night. Like, start taking notes because those notes are going to be so helpful to you getting the diagnosis that you want or need. I would say head over to sources. You can come to the Fuchsia Tent. We have free resources. I'd love to have you, but there are other sites like the Menopause Society and Let's Talk Menopause, Society for Women's Health Research, that have amazing resources that are free. The one in particular on my site I tell women to utilize is a tracking called the Greenscale. It's been around since like the '70s, but it is the most effective, widely recognized standardized scale for tracking your symptoms against a verified scale, and it's free. So go to the site, do that. The other thing I will say is talk to your doctor that you trust. But if you are told you are too young, there is nothing wrong with you, your labs look perfect, you need to be on an antidepressant when you haven't mentioned mentioned any symptoms of anxiety or depression.

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Get a second opinion. Just because someone delivered your babies and has been with you since, you know, you were 16 does not mean they are a menopause-trained expert. And they know this. Just because you've trusted the doctor in your hometown with your 7 generations of family does not mean that this person is the right person to take you through this journey. And so if you're looking for providers, it's easier said than done. There are not that many menopause-trained clinicians, which is another problem. But Menopause Society has a list. I have a list. Meno Channel has a list. All of these organizations have lists of providers, and there are also third-party telehealth solutions if that is something that you are interested in. So again, my 3 tips are track your symptoms, Go to great sites like The Fuchsia Tent, download the free resources, educate yourself so you can advocate for yourself, and then see a healthcare practitioner you trust. If you don't get an answer you like, don't take it as your final answer. Go to somebody else.

Yeah, I mean, you didn't mention this, but Casey, what comes up for me also is just, you know, talking to your partner and just being able to share, right? Or finding other women who might be slightly older or, you know, like just— I don't— I'm not sure if people talk about it. I'll give you an example. I turned 50.

Yeah.

My dad calls it like I'm going through, right? I'm going through, you know, an enlarged prostate happens to almost all men as they go through 50s. Nobody talks about it.

Right, right, right.

I went to my primary care physician because my father, he's 78, he struggled with this. So I know all the symptoms.

Exams, right?

I'm in my annual exam. I'm telling him, here's what I have. And he says, no, you're— I think you're fine. And I'm like, really? And I'm like, no. He said, well, if you want, you know, we can book you a specialist appointment. Your PSA in your blood test looks fine. PSA tests for cancer, not if you have an enlarged prostate. And I went to the urologist and he's like, you are 7 on 7 on all the scales. Let's talk about what you can do about it. Right. But I think that is also to your point in this particular case, you know, that primary care physician, like he would have said, no, no, no, deal with what you're dealing, except, you know, in this case, it's only a physical, it's a life, you know, it's a lifestyle, like all of that issue versus what you've described is it, you know, menopause fundamentally affects our way of being and how we are experiencing the world. And it's critical to find some somebody who knows it.

Yeah.

And to find others who've gone through the journey so that we can actually get the support.

It's really interesting you say that, because when I first started the Fuchsia 10, you know, everybody told me, oh, I just want to talk to other women about it, I want a community around it, I need to be supported. And what I found is that's not necessarily the case. There are women who want to talk about it, and there are women who want to be in community around it, and they're few and far between. What most women want is to feel better so they can get back or get to the new version of themselves. They don't want to be stuck in this kind of purgatory, and they also don't want special treatment at work. They want the right care so that they can take care of themselves, which becomes a healthcare workplace conversation, and then they don't want to talk about it anymore. They want to do what they always did at the top of their game, and they don't want to be looked at differently because they shouldn't be.

I'm with you, Casey, but I do, you know, but I've seen this and I'm curious to get your thought.

Yeah.

Telling your partner, right? Often if like, if you're going, right, tell your partner about it. Like, I mean, if I, if all of a sudden I can't see clearly.

Yes. Yeah.

Right. Do not tell your partner like, hey, I can't see clearly right now. And you're not seeing your relationship clearly. So even that can take some of the tension out versus saying, You know, so I think that's, I think that's an important piece, don't you think?

Is huge. It takes clarity though, right? So you kind of need to know what's going on with you and you need to accept what is going on with you so that you can have that discussion. You need some language, but it's life-changing. And I hear this from men because I, I don't— I run Menopause Mondays and I talk to a lot of men about menopause because they are part of the conversation, not just as partners but as bosses and colleagues and friends and uncles and dads and granddads. And when I talk to them about this, what I hear, especially about the primary relationship, if it's a heteronormative relationship, is, I thought I haven't changed. Why doesn't she love me anymore?

Why?

What did I do? Like, I'm doing everything I always did and She's not happy and I don't know how to fix it. And so often when we go through this process, that's not true for everybody. There are people that need to change things and learn things. We are changing and we don't know what we like anymore. Things that might have been really soothing to us, great on our nerves. Like I'll talk about Mark, my husband, all day. His chewing and breathing. Would drive me crazy during this process. And that sounds really mean, and I don't mean that meanly. Yeah, you're not in control of how you perceive things auditorily, how things feel to you. Even like little touches would drive me insane, and I used to love that. And so it's confusing, and I think it is very important once you know what's going on with you and you have accepted it and you have conversations and awareness, that you speak with your— all the people that you have primary relationships with. So your kids, if you have them, your partners, your family. Hey, this is what's going on with me. You may notice that, you know, I am not the same person that you knew, and I'm trying to figure things out. What would be really helpful for me during this time is X, Yes.

Yep. So one, creating awareness, right? And then asking for what I need. And as you said, this is not like forever. This is in the period while you get, you know, what you need to do to get help. But I think because I also see often people will say, okay, I have all these things, again, thoughts, beliefs, right? Stories. I'm experiencing things differently. They cause me discomfort mentally. And so I might go talk to a therapist. The therapist is not going to talk about a fundamental way we are experiencing the world, which is what's happening in our body. Unless they're trained and they are aware and then say, hey, have you looked at X? Right. And so I think number one, I love your tips. Go find a doctor. Talk to— first become aware. Talk to a doctor. If your doctor says, hey, no problems, get a second opinion. Right. Look at all those places. We'll put them in our show notes. The resources that you mentioned. You know, Fuchsia Tan, several others that you can go to. Talk to your partner, talk to those who have relationships with that. Here's what I'm going through. And hence, you know, ask for grace, ask for at least awareness. And so space, oftentimes, you know, we don't share that. So if people understand what we're going through, they're there to support, but we don't. And so as you said, for many men, they felt, I don't understand. Well, let's start with understanding.

Yeah. Yeah. My husband's my rock and my biggest supporter because we went through this. So, yeah.

So let's talk a little bit about, uh, if you are a team leader, whether you are a leader of a team, whether you're a leader of a function, a location, a department, what are some things that you can do? What are some things that you would invite them to consider?

Yeah. So, I mean, I look at menopause support in the workplace under the lens of the 3H framework, and I have a whole research piece coming out about this for organizations. But let's talk about the part that leaders play in this discussion. Number one, awareness is important. Don't wait. Sure, you should, as a leader, advocate for your company to have resources and for your HR business partner to tell you all of the things that you have. And don't wait. Like, if you know you don't know anything about this, which is most people, women included, Number 1, go to the sites that are going to be in the show notes and do a little homework. Don't be lazy about it, right? Or go on Claude or ChatGPT and tell them to tell you everything about menopause in the workplace, and it'll pull you together some summary that's probably not great, but it's going to give you at least some kind of a framework. The second thing I would say is look at your benefits and your policies and know them. Do mini audits if you have time. Talk to your HR business partner and say, hey, what do we have? If your HR business partner says, I don't know, they should. So that should be a clue to them to start investigating. Because what I find when I work with most companies is that the symptoms are fragmented. We've already talked about mental health. We've already talked about base and motor symptoms. We've already talked about joint symptoms. We've talked about how these different things show up. Most companies have an employee program. They have some kind of mental health benefit or well-being programs around this. They have many of them now musculoskeletal benefits. They have benefits related to OB-GYN under healthcare, and they have some drug formulary coverage related to menopause. They're not connected. And when you're going through it, you do not have the time to find it.

So as a lot of the mental clarity of like trying to piece all of these pieces together while you're trying to get, you know, deal with work, life, and everything else in between.

Totally. So if you're a leader, listen, if you're in finance, I'm not telling you to become like the menopause expert of the Western world and compile all this. So go to your HR business partner and ask them to compile it for you. And guess what? Then they will share it with the rest of the organization once it's been done. And that is one of the biggest services that you can do. The other thing I'm gonna say about leaders, and this is H— we've kind of touched H1, which is healthcare, and H3, which is HRT and non-hormonal therapy access. What we haven't touched is H2, and I am not an advocate of having people train on menopause specifically. That doesn't mean I'm not an advocate of education and awareness, but leaders are overtaxed with everything right now. Women don't need to be singled out. As you mentioned, there's plenty of people going through prostate changes, cancer. It's very common. Um, in my uncle, many people I know and love have been through prostate cancer or had prostate issues, right? We have many other things that are difficult, like performance management conversations that leaders are not comfortable having. We have conversations about caregiving that leaders aren't comfortable having. So invest in a training that gives people a structure and framework around difficult conversations in general. My solution is the 3 C's method of compassionate leadership. There are tons of other trainings that give people frameworks for having difficult conversations because in our generation, I don't know about you, but I have been through 4 or 5 leadership incubators in my career. And maybe one, maybe one taught me how to have difficult conversations. The research shows that compassion doesn't need to grow in order for you to get better at a difficult conversation. Your ability to have that conversation based on frameworks and practice are what make you better at those conversations. So can we, as a leader, or as, you know, C-suite or team leaders or learning and development, put in skills training around quality conversations that are going to benefit every single employee and midlife women. Now we're not singling people out, we're not forcing leaders that may or may not have any team members going through menopause through a training, but we're creating awareness and then we're giving them the opportunity to do a universal training that's going to benefit them in all aspects of their career. And that's what leaders can do.

So Casey, the 3 Hs, the first one is healthcare. Healthcare.

Yes.

Look at your benefits, look at your policies, make sure you have coverage for it. Your second H, help.

Help in the form of universal difficult conversation skill building. So whether it's compassionate leadership or emotional intelligence leadership training or any of these trainings that are going to give you a framework for how to hold difficult conversations and support employees through a variety of different needs.

So I take H as be helpful, right? Like, make sure you're actually learning regardless. I mean, people might struggle with a lot of things. This is one of them. There might be other things. Somebody struggling with too much work, somebody struggling with something else going on in their life, somebody struggling with, you know, having not having access to another resource or a difficult peer.

Yes.

This notion of how do we surface difficult conversations so we can, or how can we support people? How can we be helpful to the human on the other side regardless, right? This is just one of those. And you're talking about this as a foundational skill that can help.

And then the third H. HRT and non-hormonal therapy access. This is the low-hanging fruit. So So two things that are really easy for companies to operationalize now. Number one, do a benefits audit. I guarantee you, you have benefits for people going through the menopausal transition. And if you're not comfortable doing it, which I totally understand because a lot of benefits professionals are more on the actuary side and they're not, you know, necessarily understanding, and ICD-10 classifications and symptoms are fragmented. Hire a professional who does these sorts of reviews and understands the nuances of menopause to kind of audit your benefits for you, right? That's something that I do. That's something that other people do. Step 1, low-hanging fruit. Second one, you need to do a formulary review because HRT, so hormone replacement therapy, also referred to as menopause hormone therapy, is generic and it is pennies on the dollar. But you could be paying $30. Your employees could be paying $30 a month if you haven't looked at the copay that you have set up for hormone replacement therapy. Many companies now have birth control at $0, but they don't have the same audit on hormone replacement therapy. And there are new novel therapeutics called the NK3s. There's two of them, and they work on vasomotor symptoms. And so for people that can't or won't take hormone replacement therapy, they may be a great option. And most companies have no coverage or step edits or prior authorizations. They will have people stepping through antidepressants and things that aren't even indicated for menopause. So it's just really important to audit before you start adding programs and slapping on, you know, different trainings. Know what you have.

Yeah. Beautiful. So Casey, keeping an eye on time, bring this home for us. I always say at Happiness Squad, I launched this company 3 years ago, right? And our tagline is make flourishing your competitive edge. And I wanted to invite leaders to bring the same level of attention and care to their human assets as they do to their physical assets. You know, we measure continuously. We take all of the actions that is needed to, you know, make sure they're operating at their best. My takeaway from this is if you think about a segment of your population that's working that is either going through premenopause or are menopausal, they are not at their best. They can't be in that period of time. Our lack of awareness on top of it and our discomfort with these conversations make them suffer alone. So we need to do this just because everybody matters. Your job as a leader, if your people who are working are not flourishing, are not at their best, they're not giving you the best work that they can. So even if that's the reason that drives you, go do that. But you should do that recognizing that there is a group, right, that is struggling and they don't need to. Because Casey, what you just highlighted is many of the programs might already have access. Many of the leaders, if they really leaned into this, this comfortable conversations we scale them, will help them on so many other domains, not just this particular domain, and provide the help that they can as leaders. Bring it home to me to just say, from your research, you've done this now extensively, right? If helping the human, people say, yeah, yeah, yeah, that's great. But what is the business case, the ROI for those who actually need the financials? You alluded to it at the beginning of the conversation. What's the financial case?

Yes. And I want to add one, one nuance to what you've said. So perimenopause, not premenopause. Premenopause is before anything happens. So perimenopause is the phase. And not every woman has debilitating symptoms. 80% have symptoms, and that's not all debilitating. It's, you know, it's a group. But I think the business case is clear, and here's how I phrase it. Businesses, you can pay now or you can pay later. Either you can pay now with your attention, with your careful, aligned programming with appropriate healthcare, with good leadership skills training like compassionate leadership and help, and ensuring the formulary access is there and that patients are aware of it so that they can get HRT and non-hormonal therapy access. And you will not be looking at a $1.8 billion— and that's just US— issue around productivity. You will not be looking at $26.6 billion in the US annually for healthcare costs, $150 billion globally. You will have women performing at the peak of their game who are grateful to work for your organization, who actually cares enough to provide the right healthcare, the right help, and the right hormone replacement therapy or non-hormone replacement therapy access, that they bring others with them and they won't have, most likely, if they start taking medications that help them early enough, as bad of a, a potential path towards comorbid factors, which is why I say you can pay now or you can pay later. You can either pay now for the drugs that are going to help people feel well and the healthcare that's gonna help them perform at the top of their game. Or you can pay later when their health decompensates and the fact that you've lost productivity because people aren't feeling their best. So as much as I would love for organizations out there to do it because it's the right thing for women and the right thing for their human capital, do it because you're either going to pay now or you're going to pay later. Why not get the most out of your people?

Why not be proactive about it? And look, um, Every woman who's working for you is somebody's daughter, somebody's mother, or somebody's— right? So they are just like you have. And if you would want that somebody who your daughter or your mother worked for or cared for to give them the help that they needed to support them, then as a leader, no matter where you are, it's your job to do the same.

Well, and we all come from a mother. We didn't get here without a mother. So it's kind of like Like we can have this discussion all day long about like men, women, gender equity, whatever. This is basic healthcare. This isn't like a special segment.

This is 51% of the population. Casey, thank you for, you know, your focus, all the work that you're doing at Twishiya Tent to really bring this issue to support people through it. I learned a lot through it. I hope our listeners did this as well. And take an action, check out Fuchsia Tent, get smart on this topic, and truly make flourishing your competitive edge for yourself, for your teams, and for your companies. Thank you for listening. Casey, have a wonderful day.

You too. Thank you so much.

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