The Silent Years

Some of the most important health changes in a professional's life produce no symptoms at all. They develop slowly over years, show up in routine blood tests long before they become disease, and often coincide with the stage when careers reach their most senior point.

Rosa Caballero is a physician specialising in Clinical Immunology and Allergology, with clinical experience in the UK's NHS and in the United States. In her conversation with SALUZ, she described one of these silent processes in detail: how metabolic disease develops, and why menopause is a critical moment to pay attention to it.

A disease that announces itself years in advance

Type 2 diabetes rarely appears suddenly. As Rosa explained, it progresses in stages. First, insulin loses its effectiveness: cells stop responding to it as they should, and the body needs to produce more to achieve the same effect. Then blood glucose starts to rise. Only at the end, when the pancreas can no longer keep up, does the condition become chronic.

The key point is that the first two stages — insulin resistance and prediabetes — can be detected in a standard blood test long before disease appears. In her words, they can be reversed. Movement, reducing inflammation and caring for the microbiome are among the levers she described.

The signals are available and the window to act is open. The problem is that nobody is looking.

Why menopause matters

Rosa explained that the drop in oestrogen during menopause removes a biological brake that protected women's cardiovascular and metabolic health. As that protection falls away, cholesterol and arterial stiffness can increase, and insulin resistance becomes more likely. For women in this stage, watching these markers stops being optional.

Her answer is not a single intervention but four pillars that work together: a varied, anti-inflammatory diet; movement with a focus on strength; sleep and circadian rhythms; and stress management. These are not accessory habits. They are the foundation on which metabolism, immunity and cardiovascular health operate.

The workplace dimension

Menopause usually arrives at the peak of a career, and the data shows it is not only a private matter. A Mayo Clinic study published in 2023 surveyed women aged 45 to 60; 4,440 respondents were employed. It found an association between menopause symptoms and adverse work outcomes, including lost productivity. The more severe the symptoms, the higher the likelihood of an adverse outcome.

Around 13% of the women surveyed reported an adverse work outcome related to menopause symptoms, and around 11% had missed days of work. Scaled to the national population, the researchers estimated $1.8 billion in lost work time per year in the United States, rising to $26.6 billion when medical expenses are included. The estimate excludes reduced hours, job loss, early retirement and job changes, so the real cost may be higher.

At a global scale, the McKinsey Health Institute and World Economic Forum found that women spend an average of nine years in poor health, affecting their ability to be present and productive. They estimate that better treatment of premenstrual syndrome and menopause combined could add about $235 billion to global GDP.

Why organisations stay silent

One reason the issue stays invisible is cultural. The study's senior author, Ekta Kapoor, noted that menopause has been a taboo topic, particularly at work, and that women often fear bias, discrimination and stigma if they disclose symptoms to managers. She suggested that creating a safe environment to discuss health needs may help address this.

Many organisations invest in developing senior women leaders and then pay little attention to a biological transition that affects many of them during exactly those years. Supporting women through this stage is not a separate initiative. It is part of retaining experienced leadership.

What this means for organisations

Rosa's message is ultimately a hopeful one. The silent years are silent, but they are not invisible: the markers are measurable, the early stages respond to habits, and the knowledge to act already exists. What is often missing is attention and context.

• Do our people understand what their routine health markers are telling them?
• Can women in midlife talk about menopause at work without fear of consequences?
• Do we treat experienced talent as something to sustain, or only as something to replace?

At SALUZ, we believe understanding the biology of midlife belongs in Executive Education, because it affects some of the most experienced people organisations have.

A note on the evidence

The description of metabolic stages, oestrogen's protective role and the four pillars comes from Rosa Caballero's conversation with SALUZ. The Mayo Clinic study surveyed women receiving primary care in the United States. Most participants were white, married and college-educated, limiting how far the results can be generalised. The economic estimates from McKinsey Health Institute and the World Economic Forum are modelled projections.

Sources

• Mayo Clinic News Network, ‘Mayo Clinic study puts price tag on cost of menopause symptoms for women in the workplace’ (2023), based on Faubion, S. et al., Mayo Clinic Proceedings.
• McKinsey Health Institute & World Economic Forum, ‘Closing the women's health gap: A $1 trillion opportunity to improve lives and economies’ (2024).
• McKinsey, ‘A $1 trillion boost from better health.’