The Promotion I Nearly Walked Away From

How perimenopause almost derailed a high-flying career, and the hormone care that changed everything

Dr Lucy Mather doesn’t believe women should have to choose between their career and their hormones. And yet, for many, that’s exactly how midlife can feel.

At 45, Heather was thriving in a senior leadership role in health tech. She was sharp, decisive, energised by pressure - the woman who could “cope with anything.” Until, slowly and imperceptibly, she couldn’t.

“I had absolutely nothing left in the tank,” she says now. “For the first time in my life, I felt anxious. I was snapping at my children. I’d burst into tears without warning. I even thought about quitting my job.”

She was still having periods. Menopause, she thought, was something that happened after they stopped. She had no idea that the years leading up to menopause, the perimenopause, can bring fluctuating and declining levels of oestrogen and progesterone, with profound effects on mood, sleep, cognition and physical health.

And like many women, she had grown up believing that “the change” was something to endure quietly.

The symptoms no one joins up

Between 45 and 49, Heather’s resilience unravelled.

• Mounting anxiety and the beginnings of panic attacks

• Broken sleep and crushing fatigue

• Joint pains

• Brain fog and loss of confidence

• Emotional volatility she didn’t recognise in herself

Perimenopause can cause psychological symptoms including low mood, anxiety, poor concentration and reduced confidence, alongside physical symptoms such as sleep disturbance and joint aches. But Heather didn’t initially join the dots.

“I work in health tech and femtech. I kept seeing the word ‘perimenopause’ everywhere. Eventually I thought - what if this is me?”

The GP appointment that almost ended the story

Heather has Factor V Leiden, a clotting condition. She had long believed HRT would never be an option.

“I went to my NHS GP and was told I couldn’t have HRT because of my clotting history. It was over in five minutes. I felt dismissed.”

Historically, concerns about clot risk were associated with oral oestrogen. Current guidance, however, differentiates between oral and transdermal oestrogen (patches or gel), which does not increase clot risk in the same way and is often preferred for women with clotting risk factors.

This nuance matters. And it requires time and specialist knowledge.

“You’re not broken, you’re perimenopausal.”

When Heather booked a private consultation with Dr Lucy Mather, the difference was immediate.

“It was an hour. I sobbed my heart out. For the first time, I felt listened to. I was told I wasn’t failing, I was perimenopausal.”

Heather’s treatment plan was personalised:

• Transdermal oestrogen

• Micronised progesterone

• Blood testing where clinically indicated

She began to improve. Sleep stabilised. Anxiety softened. Energy began to return.

But something still wasn’t fully restored.

Despite clear progress, Heather continued to experience low drive, residual fatigue and a sense that her spark, the decisive edge that had defined her leadership, hadn’t completely come back.

Further assessment confirmed low testosterone levels.

The missing piece of the jigsaw

Testosterone is often overlooked in women’s hormonal care. Yet it plays a clinically recognised role in energy, motivation, cognitive clarity and sexual wellbeing. In women with persistent symptoms despite adequate oestrogen replacement, and where blood levels are low, carefully monitored testosterone therapy can be considered under specialist supervision.

For Heather, it was transformative.

“Adding testosterone was the missing piece of the jigsaw,” she says. “Within weeks, I felt completely restored. Not just improved - myself again.”

The fog lifted fully.
Her confidence returned.
Her resilience came back online.

“It wasn’t just that I wasn’t anxious anymore. I felt sharp. Decisive. Energised. Like the version of me I thought I’d lost.”

Dr Mather’s approach also included lifestyle guidance aligned with national recommendations: resistance training to protect bone density, cardiovascular exercise, and weight management, all particularly important as declining oestrogen is associated with increased risk of osteoporosis and cardiovascular disease.

“Every woman deserves the space to discuss her hormonal health,” says Dr Mather. “Menopause is not an acute illness, it’s a life stage. But when symptoms are severe, evidence-based treatment, including testosterone where appropriate, can be transformative.”

Eight weeks that changed everything

The change wasn’t overnight. But within four to five weeks of starting HRT, Heather noticed her energy returning. By eight weeks, her anxiety had significantly reduced.

The full restoration came after testosterone was introduced and stabilised.

“The real shift,” she says, “was when my daughter told me I wasn’t snapping anymore. And my husband said he felt like he had his wife back.”

Three years on, she is still on HRT, now prescribed via her NHS GP following specialist initiation, and thriving professionally.

“I’m successful in my career. But I genuinely don’t believe I’d be where I am now if I hadn’t started treatment. It had become a choice between my job and my family. Now I can do both.”

The bigger picture: menopause and women’s careers

Research consistently shows that unmanaged menopause symptoms can affect workplace performance, confidence and retention. The British Menopause Society advocates for improved education and access to treatment to prevent unnecessary suffering, and prevent women from leaving the workforce prematurely.

For Heather, the most powerful shift was not just symptom control, but validation.

“I thought I was losing my edge. I wasn’t. I was hormonally depleted.”

Dr Lucy Mather believes this distinction is critical:

“We would never deny someone treatment for thyroid deficiency or diabetes. When hormones decline and symptoms are significant, replacing them appropriately isn’t indulgent, it’s medicine.”

Menopause is inevitable. Suffering through it is not.

With specialist, evidence-based care, women do not have to watch their confidence, clarity and careers erode in silence. For Heather, the difference was simple: someone took her hormones, and her ambition, seriously.

.