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A highly experienced woman walks into a meeting she has chaired dozens of times. She knows the figures. She understands the politics. She has spent years building the authourity to command the room. Yet halfway through her presentation, the words disappear. Her sleep has been fractured for months. Her concentration is unreliable. Her confidence is beginning to erode. She suspects stress, overwork or burnout. Her employer sees a performance problem.

For years, the conversation around menopause has centred on symptoms. We have debated hot flushes, hormone replacement therapy (HRT), sleep disruption and brain fog, all of which deserve attention. Yet by focusing almost exclusively on biology, we may have overlooked a much bigger question. What if we have spent decades treating menopause as a women's health issue when it is also one of the greatest leadership, productivity and economic challenges hiding in plain sight?