Menopause used to be considered just an employee wellness issue. For example, Progyny , a women’s health benefits company, offers a Menopause and Midlife Care benefit that includes access to specialized care and clinical coaching, HR support on forming flexible work policies and hybrid arrangements, mental health support, and educational resources to reduce stigma and increase awareness, among other solutions.

But in June, Washington became the first state to publicly turn it into a workplace policy issue, using an executive order to direct state agencies to address menopause-related workplace accommodations. The executive order explicitly connects menopause to retention, career progression and economic security.

Last year, LiveCareer published the Working Through Menopause Report , which found that 91% of respondents began experiencing menopause symptoms before age 50, including 38% before age 45 and 53% between 45 and 49. Menopause impacts women’s day-to-day work experience, and it also impacts a woman’s career. In July, telehealth services company Womea surveyed 831 employed women aged 45 and older who identified as perimenopausal, menopausal, or post-menopausal, to explore how menopause affects a woman’s experience in the workplace.

Dr. Shannon Arora, a U.S.-licensed provider with Arora Health & Aesthetics, the independent medical group that cares for Womea members, says women do not necessarily announce that menopause is driving a career decision. “What I do see is women turning down promotions, agreeing to less desirable assignments, or choosing to retire earlier than they had originally planned.” Indeed, the data suggest career-pipeline leakage, including declined promotions, reduced hours, an avoidance of stretch assignments, moves into less demanding roles, earlier retirement, and a disinterest in career advancement.

Menopause overlaps with the years when women are moving into, or competing for, senior leadership roles; the symptoms can emerge during years when experienced women are competing for greater responsibility and influence. Jasmine Escalera, career expert for LiveCareer, notes that women experiencing menopause may be at a career stage where they are seeking advancement. “Protecting how they are perceived professionally can feel incredibly important,’ she says. That can make discussing symptoms affecting focus, energy or productivity feel professionally risky.” Makes sense, since Womea found about 17% of women surveyed believe their symptoms have cost them a promotion, raise or high-visibility project.

Lean In and McKinsey found that women account for just 29% of C-suite positions and six in 10 senior-level women already report frequent burnout. Add hot flashes, sleep disturbances, brain fog, headaches, mood swings, and a loss of confidence on top of burnout. It’s no wonder 12% of these women have turned down a job opportunity they otherwise would have pursued, 23% have considered reducing their hours and 14% are considering leaving their jobs.

An organization could look at metrics and report strong retention among midcareer women. That’s wonderful. Company benefits tied to menopause may be expanding. Another win. But employers also need to track whether midcareer women are advancing professionally, and whether they feel safe pursuing promotions and other career opportunities while navigating menopause.

Midcareer women may also feel they do not have psychological safety (whether they believe they can speak honestly without professional punishment) to use that support. For instance, LiveCareer found that 97% of respondents had felt pressure to hide or minimize their menopause symptoms at work. Among women who had remained silent, 61% said their company culture didn’t support those conversations and the same percentage feared being judged.

As Dr. Arora puts it, “a menopause policy without culture is basically window dressing.” If companies want to fill their leadership pipeline with diverse talent, they’re going to have to accommodate the needs of perimenopausal, menopausal, and post-menopausal women, and that accommodation has to go beyond HR benefits, even if it feels like an unfair ask.

That means employers should examine promotion requests, promotion acceptances, reduced-hours requests, lateral moves and departures among midcareer women. Ask employees whether they believe they could disclose a menopause-related need without harming their reputation, assignments, performance evaluation or advancement on employee surveys. Provide managers with guidance on how to distinguish temporary performance variability from assumptions about competence or leadership potential. And lastly, organizations should examine whether leadership potential is being inferred from constant availability, stamina, travel, visibility or uninterrupted consistency rather than actual judgment, capability and results.