Stacy London (00:12.174) Okay, so we know that women, usually 40 to 60, are often at peak career experience and peak physiological disruption when it comes to menopause. And I've long suspected that when we talk about this decrease in earning potential with women, we know that that has to do obviously with this bias against aging, certainly in women. But nobody talks about the fact that there could also be this decrease in earning potential because we are coping with the actual physiological symptoms of menopause in a way that makes it hard for us to be as productive as we were before, right? I mean, brain fog and hot flashes and all sorts of things. What do you see as sort of the biggest challenges that we're facing in the workplace to kind of fix some of these issues so that they don't become real markers for discrimination?

Kacy Fleming (01:14.144) Yeah, so I like to think of menopause — and this just kind of came to me. I'm a dorky puzzler. I love to puzzle. I just started puzzling in the last couple of years. But for anybody who's ever done a puzzle, you know that when you're halfway to three-quarters of the way done, you are sure there are pieces missing, right? Like you're just totally sure. You're like, it's not there. I know it's not there. Call the manufacturer. Who can I talk to about the fact that I'm going to get to the end of this puzzle and it's not there, right?

Stacy London (01:35.682) This is never gonna work, right?

Kacy Fleming (01:43.508) And then you get to the end and it all makes sense. And that describes my perimenopause journey in the workplace to a T, right? And I think so many women — that's where it starts, right? It starts with anxiety or it starts with panic or it starts with heart palpitations or brain fog. Wherever it starts for women, it rarely starts with hot flashes and night sweats, which is the one place we would know to kind of look under the hood and be like, okay, could it be this, right? And so often in the workplace, we have that same kind of puzzle. Now, you take with that the fact that most of us get our benefits from an employer, and employers look at claims data to understand which benefits, which things to bring in for their patient populations.

Kacy Fleming (02:37.632) Well, the coding for menopause is bunk, right? So the ICD-10 codes — this is really in the weeds — but those codes don't look for menopausal brain fog. They don't look for menopausal anxiety. They don't look for menopausal hot flashes. These things are coded as totally different conditions, not a life stage, right?

And so when employers go to look for who's suffering from hormonal fluctuations of menopause — if they even know that much — they're not seeing it in the data. And then we tack on top of that the benefits, which are disparately lined up. So most employers will have a mental health benefit in any EAP. Most of them will have telehealth or OB-GYN care and some reproductive endos.

Stacy London (03:12.387) Mm.

Kacy Fleming (03:31.782) Many will even have musculoskeletal and some of the other things that happen in menopause. But this puzzle continues to persist all the way through. And so to employers, midlife women and our challenges are largely invisible. And so then this noise kind of comes into the setting and it's like, well, where is all this coming from? And where are these women coming from? I'm not seeing it in my data. And we've been there all along.

Stacy London (03:50.167) Hmm.

Kacy Fleming (04:01.448) And so that is where the complexity on the really weedy side starts. And then you layer in societal norms, bias, ageism, all these gender stereotypes, and telling people we don't talk about this at work. Like we don't talk about sex. We don't talk about politics. And we don't understand that menopause has to do with our entire bodies and not just our reproductive organs. And so we don't talk about it at work. And that is where we end up with people in this kind of completely invisible, silenced state.

Stacy London (04:37.836) And it's amazing to me that we're talking about this. It's so funny when I hear that — like, we don't talk about menopause the way we don't talk about sex or politics at the office. I mean, it's kind of hilarious, right? We've been saying this for how long, that menopause is not a bad word, that it is a life stage. And regardless of the fact that it has these physiological symptoms and mood issues and all of these things, we could do so much more if we were just to acknowledge that it is a phase of life that requires more care, more time, more attention, and that the workplace should be prepared for it.

It seems to me like speaking up is always a danger, especially if you are one of the first people to do it in your company or in your office — talking about specialized care. If it's for women, it's a problem. We know that for men, it's not the same issue at all. So how do we go about this conversation? When we are talking with HR departments, when you consult with companies, how do you go about making these changes? Because it feels like it's so endemic to the way that workplaces are run — this gender gap in pay and in care and in the way that we're thoughtful about gender.

Kacy Fleming (05:57.462) Totally.

Stacy London (05:58.306) How do we start to bridge that gap? How do we start to talk to companies about productivity, about what they're losing if they're not helping?

Kacy Fleming (06:06.220) Yeah. I mean, originally my thesis when I started doing this work with companies — I was stoked — because never have I had such a clear-cut business case for what employers should invest in, right? Like, 51% of the country. We've got 75.8% of the workforce between 44 and 65 working. We've got $1.8 billion in lost productivity annually just in the U.S. because of menopause. We've got $26.6 billion when you layer in healthcare.

These numbers — you would think they would have alarm bells going off in HR and in the C-suite everywhere. What we're challenged with is exactly what you said, which is how do we talk about this, right? How do we take this from something that is kind of labeled in areas of stigma to making it something less taboo?

When I work with companies, I talk a lot about structured frameworks. That doesn't mean we're just talking about menopause, but look — we have an engagement problem in United States companies. I think it was 23% engagement in 2025, which means the rest of people are disengaged. The rest of the population is not engaged, which is a huge productivity problem. We need to have dialogue frameworks where people can be checking in on a whole host of topics that they either know nothing about, don't necessarily feel comfortable with, or don't have personal experience with, right?

And so when I work with companies, I talk about compassionate leadership. That's the framework I use. It's a three-step process. It doesn't have to be menopause — it doesn't matter. It goes across boundaries. It's just asking people how they're really doing. It's confirming what is happening with them. It's clarifying that you understand what's going on with them. And then it's taking action on behalf of people, right?

And having structure around these conversations starts to break down some of the barriers that make it less scary. Because we know from research that if people are not given a framework for difficult conversations — this number is going to blow your mind, at least it blows my mind every time I think of it — 69% of people will not have the conversation.

Stacy London (08:32.493) I mean, I thought it would be higher, to be honest. Because we don't want to have difficult conversations to begin with. We don't want conversations we don't know how to have. And then it's such a touchy subject because we haven't made it acceptable in any kind of way.

Kacy Fleming (08:38.518) Right! And that's the beauty of the framework — it gives people a backbone to kind of know how to enter into the discussion.

Stacy London (08:57.398) And equal footing, right? It gives employee and employer a little bit of a script. You know, you need a map. I feel like we need roadmaps for lots of things in life, and we're lucky to get them when we can. So it would make sense that this would be such a helpful thing to do.

Kacy Fleming (09:16.118) You do. This is an important way to really enhance the discussion. I think the other important thing is getting men into the rooms of decision-making and discussions around menopause and midlife at work. And what's really interesting is when we ask men and women in surveys if they would be comfortable if a colleague or a direct report came forward and said, "I'm in menopause, I need support" or "I'm having these symptoms" — the answer is almost 85% yes, or emphatically yes. Even strongly agree. But when we ask a person if they're comfortable having that dialogue with anyone outside of their immediate workplace friend group, the answers go in the opposite direction.

Stacy London (10:02.170) Because the outcome — or at least the effects — of having that conversation are long-lasting. People are afraid of that.

Kacy Fleming (10:11.360) That's right. And so the nuance there is: stop waiting for people to come forward. If you see a colleague suffering — if you saw a colleague grabbing their arm or crying at their desk and they weren't sweating — you would be like, oh my God, are you okay? What's going on? How can I help you?

But because we get in our heads and we don't have the frameworks, we don't do that. And then we're like, sure, we'd be great if you'd come forward. And it's like — no, just look at the person, be a human, and say, "Hey, Stace, I've noticed in a couple of meetings you haven't seemed like yourself. Is something happening? What's going on?"

Stacy London (10:59.681) Yeah. I mean, normalizing that it's okay to ask somebody if they're okay — and also to admit that you're not — are big things. And it is really interesting. I also see a definite generational thing going on here. I remember very distinctly when my father was ill before he passed away, he didn't want anybody to know — as if somehow being ill or having symptoms or any kind of sign of weakness was to be avoided at all costs in a professional atmosphere.

And it really made me so sad. Because I feel like women were sort of expected to always do the same thing, behave that way, right? We don't have emotions at work. Work is unemotional, no matter how dedicated you are. And this idea that women being emotional would always be of disservice to us in the workplace, unless you're in some sort of therapeutic environment where empathy and compassion are really the priorities.

But I do wonder if bringing men into the conversation makes it even harder, without feeling like men have an understanding — in work or in their own relationships — of what menopause looks like up close. Because we're still teaching women how to deal with it. And I'm wondering if you think that what we're living through right now as Gen X — where we are the people missing out on work because of menopausal symptoms, because we're just learning how to deal with them and becoming more aware — if you think this is also going to be an issue as we come up against AI.

I mean, we've been talking about the issues with women in the workplace for a long time — making them more comfortable, whether it has to do with pregnancy or postpartum, we're starting to talk about menopause. But does this bode even more scarily now? Because we're not just up against creating a more compassionate workplace. We're doing that in the shadow of AI that doesn't have any feelings at all or doesn't have hot flashes. We already love saying that by a certain age you're being thrown out to pasture anyway. Are we going to come up against even more negativity or unwillingness to change the workplace because the workplace is changing so significantly in terms of AI? Is this going to be a bigger problem rather than a smaller problem?

Kacy Fleming (14:06.678) So it's a great question. I wish I had a crystal ball. I'm totally tracking it. I think this can go in a couple of directions, right? My theory for a long time — studying work for a living — has been that it's going to break into what we see as almost like sororities and fraternities. There are going to be companies that care more about employees and really build their cultures around how they take care of employees and the environment they work in. And maybe they can offer lower pay because if you work remote, you don't have to live in a city or a hub, you don't have to pay those huge salaries. But you're taking better care of people, you're making sure they have what they need, creating more inclusive environments — which we know from research actually makes for higher-performing companies. Like, that's the crazy thing.

Stacy London (14:59.788) Right. I just want to ask you one thing in there, because there's a distinction between the dot-comers in the early 2000s who started doing those campuses instead of offices where you never left — the ping pong tables and the parties and the WeWork model. That's really getting you to stick around to stay within the community of work. But that's very different from companies that are actually caring about the well-being of their employees.

Kacy Fleming (15:30.700) I mean, there are some campus-enhancement ways that you can make work settings more comfortable, more inclusive, more open for conversation. But what I'm talking about really is: are we offering flexibility? Are we understanding that someone may be better off when they are working hybrid or remote — having more flexibility and the ability to take care of some of the symptoms they may be having or some of the doctor's visits they may need to have without interrupting work?

Like, I talk to my partner about this all the time. He's got an hour-and-a-half commute in, four days a week. And I get to my desk at 8 a.m. I'm here an hour and a half before he is and an hour and a half after he is because I don't have to commute, right? So the research very clearly points towards flexible work.

And back to the sorority-and-fraternity model — I think you're going to see companies that are really built around how do my workers produce best, how do they work best, how do they feel their best? And then you're going to have the companies that are going to work you into the ground like they always have. In some cases they'll have to pay for extra benefits — things like egg freezing — because they're competing for talent that's going to insist on that. But they're not going to build it around wellbeing.

And where AI comes into this question — and I think why I'm not afraid as a midlife woman — is that in order to use AI, and I'm a big-time user of it, not to write, but to help me get my work done as a solopreneur, I know that AI cannot operate without me. And yes, it's moving fast. And yes, it's getting more agentic by the minute. But at the same time, if I hadn't spent 22 years building a career in corporate America — working all the different roles, learning how to navigate politics and power, knowing what landmine is going to come up or what risk I have to mitigate — I would be turning out work slop super fast.

Stacy London (17:53.774) Hmm.

Kacy Fleming (17:54.652) And so midlife women are the reviewers of AI. We're the ones that have been prepping for this. Our entire careers have been building the skills AI doesn't have. And while, yes, I do think it can be a disservice in some of those companies that are going to go the route of caring less anyway — yes. But they're already doing it. They're already replacing all workers with AI. It's not just midlife women.

Do I actually think there are positive uses? Where a male manager who isn't comfortable could ask an AI: "Hey, my employee Kacy just told me X, Y, and Z — how do I respond to her?" Those are some of the powerful uses. And there are a lot of companies using AI for coaching. And the nice thing about AI is it takes the emotion out of it, which actually helps people.

It gives them a framework, right? It doesn't replace the framework that I teach or the framework that someone else teaches. But in a pinch, if you have an employee come to you upset and you don't know what to say — hey, give me about 45 minutes. I want to check with HR and see what we've got. I want to think through what we could do together and I'll come back. Type it into an AI, talk to HR real quick, and come back with the beginning of the conversation — not with the solve. We're not looking to diagnose, we're not looking to solve. But AI can actually help in that case. So I don't think it's a black-or-white answer, a yes or a no.

Stacy London (19:40.270) No, but it's such an interesting answer. And I guess — and this is something I think you must have come across, Kacy, in all of this work and all of this research — what is the responsibility of the employer? Not from a legal standpoint, but from a moral one. What role do we want our employers to play in our lives? What is considered health? Financial? Emotional? Taking time off? Working hybrid? These are all fascinating questions to me.

But how do we come at this in a way that doesn't feel too invasive? I don't know that I want my company to know everything about me. Some of the things I've experienced during my menopausal experience were like suicidal ideation, right? I don't know that I want to share that with an employer. If I'm coming from that point of view, it feels not just difficult but scary — like I could be severely punished even for trying to talk about these things at work. What is your philosophy when it comes to this? How do we mitigate the risk in having these conversations while hoping that companies are going to want to do the right thing?

Kacy Fleming (21:41.098) Yeah. So first and foremost, I always tell anyone experiencing the menopausal transition: you never have to state your diagnosis or your symptoms. If you are not comfortable, you don't ever have to tell anybody at work what is going on with you. And when people say, "Well, how do I frame it?" I always say, "Well, how is it impacting your work? What about the symptom is impacting your work, and what would be helpful?" And then we can back into it: "Stacy, for a variety of reasons, I haven't been getting a lot of sleep and I'm really struggling with the 7 a.m. delivery. Is it possible we could push it back?" So we're tying it to the work. If we're comfortable, we can name it. But if we're not, we don't have to.

The bigger question you asked is: what is the employer's responsibility? And I think we have to start with where employers are in this discussion. Part of it is the lack of education that doctors have had — which I know you know — and the lack of education that we all had on menopause at the root cause. But then there's also the fact that employers hold the majority of our healthcare in this country, right? Most people get their healthcare from their company, whether they work at Walmart in retail or they work as a CEO somewhere else. They're getting their healthcare paid by their employer.

So there are protections put in place around your data and your healthcare that your employer can never see. Even if you're accessing it at work, they can see claims data, which is anonymized and aggregated, but they can't see your data. If you're calling your EAP, it is anonymized — no one will know. And I can tell you, having worked on that data, I could never see anybody's data ever — and I would have been one of the people who could, if that were the case.

So that's first and foremost. And the reason why the employer has a seat at this table is because they are responsible for cost containment. Healthcare is the highest line item — or one of the highest — on their budget every year, costing in the millions and billions. It went up 9.5% from last year. So employers are paying crazy amounts of money, meaning salaries are reduced and bonuses are reduced because they're trying to keep healthcare quality the same while the spend has gone up.

And when we look at that $26.6 billion cost — we know that comes from missed or under-diagnosed women who are going to six to eight visits before they're getting any kind of diagnosis or care. They're missing work or they're suffering through work. So their work isn't the same quality it would be if they didn't have the symptoms and were getting a decent night's sleep or getting help for anxiety or whatever is going on.

So the employer has a huge fiscal stake in ensuring that midlife women are cared for adequately — which is what we're studying right now with the Society for Women's Health Research. What does this look like? What are the data that these decision-makers need to actually move the needle forward for employees all across the United States?

That's the non-moral cost side. From a moral or humanistic perspective, I love a paper called the Menopause Penalty by a brilliant economist named Dr. Gabriella Conti and a whole group of other economists who got together. They looked at a shockwave event — there was a film in Sweden about menopause. Women ran to their doctors to get diagnosed. And then we were able to study the cost.

What the data found was that women who, four years after being diagnosed, were still symptomatic earned 10% less than those who had not received a diagnosis. So 10% less is the number, right? But it gets worse. If you were educated, you were less likely to experience the penalty. If you were less educated or in a lower socioeconomic bracket, you were more likely to experience the penalty and less likely to get education and support.

And here's what's even crazier about the data: the women who were supported — and they looked at HRT as an intervention, though there are others, and we know not everyone can take HRT — the penalty was eradicated. So we have a penalty being assessed on women that is systematic and structural — not biological at all — that is unavoidable and unnecessary, and that can be mitigated with good support.

And good support does not mean expensive training programs or big point solutions. We have to get deliberate with what we do have. I call it the 3H Framework, but it's what most employers already have.

The first H is healthcare — making sure all of the benefits are organized around life stage care. So that when I'm having hot flashes, I'm not going, "Where do I go? Where do I go?" I'm going, "Midlife care. Got it." And it's midlife care — so it's not just women. I don't feel weird accessing it because everybody's got midlife care.

The second H is help — compassionate leadership training or some kind of framework that gets people having tougher discussions. Let's face it, no one's real good at having performance discussions either, and that's straight-up work. So let's just get at these hard conversations.

The third H is HRT and non-hormonal therapy access — making sure that what's on your formulary is covered and accessible. We have two things: access to meds and affordability. If you are not making generic HRT the lowest possible copay, what a mistake. It's pennies and it's shameful. That is something the government could actually look at — and they are in the UK. But you asked about employers, so I'll stick there.

So that's a long answer, Stacy, but that's the why: why employers should do it fiscally, why they should do it morally, what the obligation is, and what happens.

Stacy London (28:04.150) Right. I think that's really my question. Because you were talking about the fact that egg freezing is going to be part and parcel of insurance because talent is going to require it — they're going to ask for it. So I find it really interesting — this idea of midlife care, that we're just accessing that as part of healthcare. It's almost like saying, "I'm going to insist on egg freezing if you want me for my talent."

And if you're at a company and you want to retain me for my talent, you've got to consider the other things that I would need in order to stay. I mean, we've been talking about childcare for years. What about if you don't have kids and you are still going through this and you still need some sort of care? What's so interesting to me is this idea that this care is somehow less important than the care around pregnancy. That having another child is what you're supposed to be doing.

Kacy Fleming (29:17.896) Or a lot less children. I don't know.

It's true. And I always say to employers — my favorite thing to say to them when they push back, because they inevitably do — the good news is most of them get that they need to do something. They're just not sure what to do, how to do it, how much it's going to cost, or where it comes from. I always say: you can pay now or you can pay later. Paying now means you have the best cared-for, most engaged, highest-producing, most grateful workforce you've ever seen. Because if you give a midlife woman anything, she will be like, "Woohoo, I love you!" And she'll tell all her friends, and everybody's coming to work for you, right?

Or you can pay later in the costs of diabetes, heart disease — and all of these things don't happen necessarily when we're 70. They're happening when we're in our late 50s and 60s and we're still at work. And oh, by the way, we weren't productive during a period of time when we felt like garbage and you could have helped. So you can pay now or you can pay later.

Stacy London (30:33.400) I love that — pay now, pay later. It's sort of like the pain of discipline or the pain of regret. And both hurt. You just have to decide which kind of pain you want more.

Okay, I just want to make sure we haven't lost anything. We talked about the emotional mislabeling, we talked about this kind of invisibility that women experience when they're going through this. But I want to make sure I haven't lost the thread.

Kacy Fleming (31:04.693) We get so excited, we go all over. Me too.

Stacy London (31:24.928) Okay, I actually think this is really important: is there a version of leadership that actually works? So this is interesting — we were talking about this idea of power and perception and age and this intersection of menopause and age bias and ageism. There can be, I think, a loss of perceived authority for women who are at the managerial stage or above, where other people are looking to them.

And I certainly know this for myself — with my menopausal experience, I lost a lot of confidence. For somebody who is pretty confident, who has accomplished enough in my life to look back with pride — there is a deep loss of confidence I felt in menopause because it's such a transition, it's such a transformation, it's such a change. How do women who are both experiencing symptoms and negotiating how to manage that in the workplace — how do you maintain a sense of confidence? How do you give them a sense of confidence to keep going? Because we don't have any framework around that. We just tell women to go into therapy. What are your thoughts about perceived power versus this almost personal sense of loss of power — when you're trying to hold your wits about you, do your job, and manage other people while you're going through this?

Kacy Fleming (32:52.076) Yeah. When I went through my own perimenopause journey — and you and I talked about this briefly — it was dysphoric. It was literally like overnight, it felt like. And if you'd told me this was going to happen, I'd have been like, yeah, right. But almost overnight, I had total anhedonia — a loss of joy. Like I liked nothing and no one anymore. Like it was just gone.

I didn't know why I was here anymore. I was in my so-called dream job and I was miserable. And my partnership — which thankfully is back on track — was really suffering. It was relational, systemic, and physical, this transformation, and confidence-shaking.

And I always talk about this — it's one of the most popular things I talk about because it's so relatable — losing your train of thought one time and making that cute little, "If it was important, it'll come back," right? And then three times in the same meeting, you start to be like, I've lost the plot. Like, this is it.

And I was on this exact pink couch in a different house, contemplating what the end of my life looked like and why I was still here. And that is why I think this conversation is so important.

The things that helped me — and I don't have the rote answer because every person's different. But one is that there's a point, at least for me, where I had enough information that I accepted and knew what was happening to me, and it became a little bit less scary. And I started being able to take care of myself. There's an acceptance and a naming of what is happening that helps people get to the other side.

I think storytelling is such an important part of this. I'll say things like, "Talk is cheap," because I'm trying to get companies to go beyond talking and actually take action. But I will always follow it up with: it's where everything starts. It's how we know about things. It's how we have awareness. Finding somebody who's been through it — like you, who are going through it — was one of the most helpful things for me.

And that's not everybody's way. Community is not everybody's way. But I can promise you — wherever you are working — there is a coworker who has been through this and will entertain the conversation. And you pick the one where you feel safe. You don't pick the one where it feels like a job risk or a threat. You pick the person who's either talked to you about their journey or said something that makes you think they might listen, and you kind of toe into the conversation.

Stacy London (35:55.182) I think about this quite a bit. You're familiar with Perry — the Peri menopausal community that Laurie Okafor created. And that makes sense to me — they have menopause mentors, these kind of sherpas who are on the other side who can talk to you when you have questions.

What I struggle with a little bit now is that "community" was the key word or catchword for the menopause vertical, right? We were building this whole idea of the menopause vertical on community. And I feel like that is now so forced that it almost becomes a difficult way to describe what we're going for. You want community to be based on things that happen organically. I don't know if saying "we're all in menopause" is the thing that binds us.

But what I do think is really interesting in what you're talking about is this idea of mentorship. That part of midlife care could be talking to somebody who has had this experience — doing something that allows for compassion and empathy without so much intimacy that it feels inappropriate. There's your doctor, and then there's work, and they somehow all have to work together.

It's a connection rather than building communities. Because now I feel like there are a ton of grifters out there — everybody's trying to get somebody to buy a product they don't necessarily need. And this whole idea of the menopause community is what allows companies to kind of get away with that. And yet what you're talking about is based in the reality of menopause — finding somebody to help you through it in a way that allows for communication without an inappropriate amount of intimacy.

Kacy Fleming (37:26.890) Yeah, it's a connection.

Kacy Fleming (38:03.424) Well, I think it's shared experience too, Stace. Because one of the really interesting things I learned when I launched a community — and have since made it a menopause vault, which isn't a community — is that women didn't really want to come together. They wanted information, right? They wanted access to me because I had done all the research and had been going through it.

Stacy London (38:15.532) Which is The Fuchsia Tent. Yes, I want to talk about that.

Kacy Fleming (38:32.714) But they didn't really want to commune with each other about it, right? Which was one of the first takeaways and a great lesson as a business owner. And I don't see it as a failing. We pivoted into a vault where there's education and great resources — people can go in there if they want to — but that's a small part of what I do. Most of what I do is a menopause research consultancy and workplace consulting. That's where I work.

And I love the vault because when I go into companies, I can leave their workforces with this incredible body of work for them to pursue on their own. I don't want to come in, talk to your people, get them thinking, let them see a friendly face that understands — and then go disappear into the ether. I want to leave them with something they have access to.

Because what I found is that most working people with menopause wanted to talk to someone who had a shared experience. They feel like: if I see Kacy and she works in corporate and she can talk about this — here's how she's verbalizing it in corporate — there's a path for me. But if I see somebody that has nothing to do with the kind of work that I do and they're loud and proud about it, well, great for them. That's their life. It's very different from mine.

So community is great, and it is for a lot of people. But it's really about finding somebody with shared experience who's been there before that you can talk to.

And I think the other thing that is really important — and I love teaching this, it's totally separate from menopause — is power and influence. I love teaching on power and influence because people are so put off by the word "power" with good reason these days. And whenever groups of people — men, women, however you identify, wherever you are in your career — come into my classroom, I start with the question: "Tell me what you think of when you hear the word power." And it's always coercion, control, they'll name a terrible leader, something horrible, whatever. And when we are ten minutes into the training, I'll ask again, and everybody is at least halfway, if not all the way, over to embracing power and influence.

And I think if we can get comfortable with power and influence and how they play into our lives conceptually — regardless of where we work or what we do — then we can carry that with us into midlife, and it can transform how we look at our own power as we're going through this transition. But that was not something I was ever raised to think was okay for women — to be powerful or influential.

Stacy London (41:42.582) And I wonder about that because it really does go back to what I was asking earlier — how to view this without feeling like you're being robbed of your confidence is really understanding the positive power of power and influence. Like I love to call menopause a reckoning turning into a Renaissance. It's hard when you're going into it, but there's so much you can do with it and so much to be proud of coming out of it, and where you want to go with your life.

I guess the last thing I want to end on is: what is your prediction for the future? What do you hope for in terms of what companies are willing to do? And realistically, how comfortable do you feel being hopeful about that?

Kacy Fleming (42:41.772) I mean, that's a whole chapter of a book. A lot of it depends on what happens in the world. But I'm going to take this in the vacuum of work.

What makes me really hopeful is that the percentage of companies that want to do something already have three-quarters of what they need to support midlife women and other individuals appropriately — they just aren't packaging it right. And the small tweaks needed to make those differences are real.

I'm also hopeful because there are a lot of ways we can improve midlife care for employees without another line item or another point solution. If I can say to a company: "Bring me in, let's talk, let's look at everything you have, let's look at your population, let's get under the hood and see how we can integrate or organize what you have" — and only if we need to add something additional do we do that — there's like this huge relief. Because as I said, healthcare costs have already gone up 9.5%. So for everybody running in there with a shiny point solution, that's alarming to them, right? So I feel hopeful.

It's actually a body of work on my website called the 3H Framework. It's called Menopause at Work: Why Integration Beats Innovation. Download it — it's free. I did research on 25-plus peer-reviewed studies. It's a full review of the academic literature to this point on menopause interventions at work. It is totally free.

Stacy London (44:18.328) Wait, is this on thefuschiatent.com? I want to make sure we all know. Okay — thefuschiatent.com.

Kacy Fleming (44:32.308) And it gives you the framing of how to look at your business and what to think about. And if you're an employee, how to talk to an employer if you want to get involved on the policy side or in making changes to benefits. Just doing that research — just writing that paper, just seeing the conclusions — that's where I recognized that we already had all of the pieces, or most of the pieces. We just hadn't put them together. And that gives me a lot of hope for the future.

So I do think in most places, midlife care will become something like maternity care or mental health. We're going in that direction. We just have a long way to go. And it really has to be a discussion with everybody who works, who's over the age of 18 — not just midlife women, not just one group of people.

Stacy London (45:31.448) Or even just the menopause thing, right? Because the case you're making — to have this kind of midlife care for women and men and non-binary folks, it doesn't matter. Just this idea that we're not making that distinction, that midlife health would include hormonal care. There are easier ways to name this stuff and put it under an umbrella. I find that very exciting.

I mean, it really does sound like you are in the process of revolutionizing something that actually won't take the amount of effort everybody thinks it will. The kind of rethinking and reassessing you're talking about could make us all a lot happier and save us all a lot of money. So why wouldn't we do it?

And I'm assuming that companies get really interested when they realize that the bottom line isn't about raising their costs, but about using costs more efficiently based on population.

Kacy Fleming (46:42.040) I mean, it's early days. But yeah — it's interesting. When we first met, I was in a totally different place. I knew I wanted to help midlife women but I wasn't sure what to do. I knew I wanted to provide simplicity, clarity, access, and support for all — I can still rattle it off. But I hadn't found my way to do that yet.

And I think when I really started to understand the path that my work has taken over 22 years — there was this triangle of access, reimbursement, working on the employer side of healthcare, and then my expertise in menopause — that all came together. And I was like, okay, let's look at the problem, the root cause, and see if we can find where this is generating, what we could do about it that isn't super expensive, and how we can bring this to the forefront.

And my life took off in an amazing way. Not just financially — I mean, yes, I've had more financial success than in year one. But it's so fulfilling to feel like the work I'm doing is aligned with my core values and my mission in life. And while, yes, I'm making a living because I have to, like everybody else —

Stacy London (48:18.670) You can't get away from capitalism. You kind of have to participate.

Kacy Fleming (48:21.676) It feels right to me and it has the most benefit. And I love that I can put the paper up and know that there are small employers that can't afford to bring me in — even though I'm not that expensive — but they can take the paper and reorganize their benefits, and people are going to do better. That's what this is about.

And I'm anxious to see how the survey with SWHR comes out, because it's going to benefit all of us. We have an audacious goal — 1,500 people in the U.S.: people of color, men, frontline workers, decision-makers, women. Basically: if you are over the age of 18 and you work, please take the survey. I don't care if you think you're bored. You're doing this for your future self, you're doing this for a family member, you're doing this for a friend you don't know about, and you're doing this to be the best boss you can be. Take the darn thing. It's nine minutes. I don't want to hear it.

Stacy London (49:31.470) Nine minutes. I think we can all spare nine minutes.

Also, Kacy — let's talk about the fact that you started The Fuchsia Tent in midlife. You left your job and said, this is what I want to be doing. So you're sort of a case study, in a funny kind of way, for what can happen when you go and do fantastically helpful, compassionate work. You went from being the employee to being the person who says, no — I'm going to make this better for all employees.

Kacy Fleming (50:16.140) I heard this and I definitely didn't make this up, but: your pain becomes your passion if you're smart. And my pain has always been the path in a way, right? Leaning into something that was hellacious for me — and for you, the same reason you're here — that's what gave me life.

I think so many people think that midlife is the end, that menopause was always this going-out-to-pasture thing. And I think it is so cool that we can live our second, third, fourth, fifth chapters and be smarter doing it. Like, I see these young entrepreneurs and I'm like, I don't know how you did it. Because I'm turning 50 this year, and becoming an entrepreneur has been the biggest lesson of my life. The biggest ego death. The most audacious challenge.

And the best thing I've ever done is really taking a bet on myself for other people. And that is what I want everyone to do.

Stacy London (51:47.818) Yes. And that really does come from lived experience. That comes from wisdom and age.

And I really will constantly give credit to Gen X. I think what you're doing — what we have been doing — to make the menopause experience one that is expected and understood and researched and supported — I think that has really made the difference in the way that care is going to look after our lifetimes. If there is one legacy, that is truly what I think we have accomplished.

And now the idea is to get people 18 and older to care about what's going to happen to them at 45. And I always think that's the hard thing — how do you make people care about things they haven't experienced? And how do you make people care about things where you're like, one day this will matter to you?

If we can get that out there, it just becomes part of the conversation, right? It becomes that easy, habitual thing that isn't so difficult to talk about at work or at home. It's hard to democratize something that has been so gate-kept.

So I think it is really interesting to see everything that's happening, and it must be so satisfying to work with companies where you're really seeing change take place.

Now, if you are an employer, go to thefuschiatent.com and definitely look into working with Kacy for your company to discuss all of these options with you. And if you are an employee and want to explore what happens in midlife healthcare, please go to thefuschiatent.com and look at what you can do as an employee to create a safe environment for this conversation — which is the entire point.

Kacy, thank you so much for your time. Thank you for taking us through all of this. It was so helpful.

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