I was leading a workplace session on menopause, screens full of faces from the same company. We’d covered the standard symptoms: hot flashes, sleep loss, the cognitive fog that shows up uninvited. Then I said something not on the agenda. I told them the emotional volatility of perimenopause can carry different professional consequences for women of color, because of the layers of bias they already navigate before they walk into any room.

A woman closed her eyes. Then another. Then another, until heads were nodding across the screen, quietly, almost in unison.

That moment crystallized something I’ve known for years in clinical practice but hadn’t found quite the right way to say out loud: we have built an entire public conversation about menopause around the symptoms that are easiest to name, and left out the one doing the most damage.

To be clear, institutional momentum is finally building around menopause, including some of its mood symptoms. In June, Melinda French Gates announced a $215 million commitment to women’s health research and advocacy. That same month, Washington Governor Bob Ferguson signed an executive order directing state agencies to build menopause accommodations into workplace policy, and Illinois lawmakers advanced the bill that would require employers to provide reasonable accommodations for menopause-related conditions. 

But almost none of that momentum has reached the one mood symptom doing the most damage. The word we’ve settled on is irritability. The word my patients use is rage.

Women in my practice describe something sharper than short-temperedness: an emotional intensity disproportionate to the moment. What scares many of them is the loss of predictability, the sense of no longer recognizing their own reactions.

The science on this has existed for........

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