What you are about to read is not a scene lifted from a Nollywood script — though it happened, quite dramatically, somewhere in Africa. And your columnist remains eternally grateful for the opportunity to hold space and offer support to a female executive whose body, quite literally, gave way in public.

It happened at a five-star hotel’s conference hall, minutes before she was due to walk on stage and open a major industry event. One moment she was reviewing her notes with the composed precision that had carried her to the top of her field. The next, she was pale, breathless, drenched in sweat that had nothing to do with the room’s temperature, gripping the back of a chair as her voice cracked mid-sentence.

As a healthcare professional who has spent years supporting over 200,000 professionals across diverse industries, I recognised what was happening almost immediately. This was not a panic attack, though it wore panic’s clothing. This was not simply exhaustion, though exhaustion had clearly done its groundwork. This was perimenopause — and it had chosen, with the cruel timing these things often have, to announce itself in front of a room full of colleagues and cameras.

The body keeps the ledger

We like to talk about burnout as though it lives entirely in the mind — a matter of willpower, boundaries, better time management. But burnout is not a metaphor. It is a physiological event, and it has a very specific address: the hypothalamic-pituitary-adrenal (HPA) axis, the body’s central stress-response system.

When someone lives for months or years under chronic occupational stress — back-to-back deadlines, constant availability, the quiet vigilance of being “the only woman in the room” — the HPA axis doesn’t simply tire. It recalibrates. Cortisol patterns flatten or spike erratically. And because the reproductive endocrine system shares regulatory pathways with the stress system, that recalibration doesn’t stay contained. It reaches into menstrual cycles, disrupts ovulation, dampens libido, and — for women entering the perimenopausal transition — can sharpen and accelerate symptoms that were already brewing beneath the surface.

This is the part rarely discussed in leadership development seminars: chronic workplace stress and reproductive health are not parallel tracks. They are the same track, running in both directions. Stress destabilises hormonal function. And unaddressed reproductive health conditions — perimenopause, PCOS, endometriosis, chronic pelvic pain — in turn intensify the very exhaustion we call burnout, creating a feedback loop that looks, from the outside, like someone simply “not coping.”

She was coping. She had been coping for months. Her body had simply run out of runway.

Why this is a systems problem, not a personal one

The instinct in moments like this is to individualise — to ask what she could have done differently, whether she should have “listened to her body” sooner. This instinct, however well-meaning, misses the point entirely.

Organisations are not passive bystanders to their people’s physiology. Meeting cultures that treat exhaustion as a badge of honour, workplaces with no language for menopause or reproductive health, calendars stacked without recovery time — these are designed conditions. And designed conditions produce predictable outcomes. What collapsed in that conference hall was not simply one executive’s hormonal system. It was the visible failure point of an invisible, unaddressed workplace design flaw.

Human flourishing at work cannot be built on a foundation that ignores the biology of the humans doing the working.

Four calls to action for business leaders

1. Build reproductive and menopause literacy into leadership training.

Most managers can spot a missed deadline. Few can recognise the signs of perimenopausal crisis, PCOS-driven fatigue, or endometriosis-related pain. Change that. Literacy is prevention.

2. Audit your calendar culture, not just your wellness budget.

A gym subsidy does not offset back-to-back meetings with zero recovery time. Examine how your organisation actually structures time — that is where chronic stress is manufactured or mitigated.

3. Normalise disclosure without demanding it.

Create policies and psychological safety that let employees name what they’re experiencing — hormonal, reproductive, or otherwise — without fear of being seen as less capable. Silence is not neutral; it is corrosive.

4. Treat reproductive health as core occupational health, not a private matter.

Fold menstrual health, fertility, pregnancy, and menopause support into the same seriousness afforded to any other chronic health consideration in the workplace. It already affects performance, retention, and safety — the only question is whether you address it by design or by crisis.

She recovered. She returned to the stage twenty minutes later, composed once more, and delivered her welcome address as though nothing had happened. But something had happened — and it deserves more than a story we tell quietly afterward. It deserves a response, built into how we design work itself.

If this piece raises questions about your own experience of stress, burnout, or reproductive health, consider speaking with a qualified healthcare professional. You are not required to carry this alone.

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Joshua Awesome

Dr. Joshua Awesome is a Coaching Psychologist/Executive and Business Performance Coach who has supported over 100,000 professionals across Africa and the globe. He can be reached via: joshua@africainmind.org