Why High-Performing Women in Leadership Burn Out — And What to Do About It
From the Integrity Over Scale podcast, conversation with Alex Simmons, posture therapist and former Microsoft program manager
There is a pattern I see in almost every high-performing woman I work with, and it seldom gets named directly.
She is a director or senior director. She is excellent at her job. She is the person her team comes to, the person her peers rely on, and the person her leadership trusts to get things done without making noise about it. By every visible measure, she is succeeding.
She is also running on empty. She has been running on empty for a while. And she has normalized it so completely that she has stopped noticing it as a problem.
Women in leadership burnout does not usually arrive as a dramatic collapse. It arrives quietly, in the form of never quite recovering between weeks, of chronic low-grade exhaustion that gets filed under "this is just what the job requires," of putting yourself last so consistently that self-last stops feeling like a choice and starts feeling like who you are.
That is what I want to talk about. Not the dramatic version. The quiet, high-functioning, competent-on-the-outside version that the women I coach are actually living.
The Story That Started This Conversation
I recently sat down with Alex Simmons on the Integrity Over Scale podcast. Alex is a posture therapist trained in the Egoscue method. He spent 20 years as a program manager and people manager at Microsoft before leaving to pursue a career that came directly from his own chronic pain experience. He now works with people who have tried everything for chronic pain and found that the answer was simpler than any specialist had told them.
The concept is straightforward. Muscles position the bones. When your body is out of alignment, it is because certain muscles are overworking and others have essentially shut off. Alex identifies which ones, gives his clients a targeted routine, often just 10 to 15 minutes a day, and the body begins to restore itself.
That part of the conversation was fascinating. But it was a story he told midway through that I have not been able to stop thinking about.
Alex described a client. An 87-year-old woman who was active, social, and in significant pain. She came to him hoping for relief. He told her that most of his clients see real results with 10 to 15 minutes of targeted exercises a day. She paused. Looked at him. And said, with complete sincerity:
"I don't know how I'm going to fit that into my schedule."
Alex was floored. He still thinks about her.
I could not stop thinking about her either. Because I have heard a version of that sentence from women in leadership many times. Not 87-year-olds. Women in their 30s and 40s. Directors and senior directors with full calendars and real results, and not one spare minute that they feel they are allowed to spend on themselves.
Women in Leadership Burnout Is Not a Time Problem
Here is what I want to say directly, because the framing matters: women in leadership burnout is not caused by having too much to do. It is caused by a behavioral pattern in which you have made yourself the last item on every list, for long enough that the pattern has become invisible.
You take the extra meeting because stepping back feels like disengagement. You stay on the thread until 10 pm because the issue might escalate. You cancel the thing you had planned for yourself because something more urgent came up, and something is always more urgent. You eat lunch at your desk because walking away for 30 minutes feels indulgent when there is still so much to do.
None of those individual decisions feels significant. The pattern they build, over months and years, is the thing that quietly undermines your voice, your presence, and your ability to lead at the level your role actually requires.
Alex made a point during our conversation that hit differently than I expected. He said that good posture is not about thinking about how you should be standing or sitting. It is about your body knowing how to do it without your brain being involved. A four-year-old sits up straight, not because anyone told them to, but because their body has not been screwed up yet by screens and sedentary environments and years of compensating for misalignment.
Leadership presence works the same way. When you are resourced, rested, and not running on empty, it shows up in the room without effort. When you are depleted, you compensate. You work harder to appear present than you would if you simply were present. And that effort is invisible to everyone around you, which makes it even more exhausting.
The Pause That Changed Everything: The Ultra-Runner Story
Alex told another story that illustrates this even more clearly, and I think it is the one that actually defines what integrity over scale looks like in practice.
He worked with a man in his 20s. An extreme athlete. Triathlons, 400-mile running races, the kind of physical output that most people cannot imagine. This person had been dealing with sciatica for years. He had been making slow progress, trying different approaches, none of it moving fast enough.
He came to Alex. Did a 15-minute routine. Not once a day. Two or three times a day, because that was his personality. And in one week, between his first and second sessions, he went from looking painful when he stood to standing straight. The pain dropped significantly. He came back and said: How did you do that?
What actually happened was not complicated. Someone who was accustomed to pushing through everything finally stopped and asked: what is the right thing for me in this moment?
That pause, Alex said, was itself a form of intelligence. And I agree. For high-performing women in leadership, the pause is often the hardest and most important move. Not because you do not know what you need. Because you have been in environments that have trained you to treat your own needs as secondary to the work, the team, the stakeholder, and the deadline.
The ultra-runner did not slow down because he was weak. He paused because he was smart enough to recognize that pushing through was not going to get him where he wanted to go.
What Alex's Own Career Transition Teaches About Self-Prioritization
Before Alex was a posture therapist, he spent 20 years at Microsoft, rising from program manager to people manager. He said the part he loved most was helping the people around him grow. That filled him up more than his own achievements.
He also left. Not because he failed, but because his body, injured in a serious car accident in college, had reached a point where the environment was no longer sustainable. He had chronic back and neck pain, sciatica severe enough to keep him in bed. Spinal surgeons were recommending fusion. He tried physical therapy for years with modest results.
When he finally found posture therapy, his pain dropped two full levels in a single session. He went back. He kept improving. And eventually, he made a decision that changed everything: he got certified himself and built a new practice from the ground up.
What I want to talk about, Alex's story, is not the pivot itself. It is what preceded it. He described reaching a point where he realized what he was doing was no longer sustainable, that it was actively detracting from his health, his relationships, and the life he wanted to be living. He had enjoyed his time. He had accomplished real things. And he decided that the version of him that could continue was not the version of him he wanted to be.
That is not a failure of commitment. That is a high level of self-knowledge. And it is exactly the kind of self-knowledge that most high-performing women in leadership are too busy to develop because there is always something more urgent in front of them.
The Self-Last Problem Is a Behavioral Pattern, Not a Character Flaw
I want to be clear about something because I see it misunderstood regularly.
Women in leadership who chronically deprioritize themselves are not doing it because they are weak, disorganized, or do not know better. They are doing it because it has worked, in a specific way, for a long time. Being maximally available and minimally demanding of attention or resources is a pattern that gets rewarded in many male-dominated environments. It reads as team-oriented, low-maintenance, and professional.
The cost is paid privately. In the quality of your sleep, your energy levels, your ability to be present in the rooms that matter, and your capacity to advocate for yourself when no one else is doing it for you.
Alex said something near the end of our conversation that I keep returning to. He talked about people who have tried so many things for chronic pain that they have arrived at a quiet acceptance. Not giving up exactly, but settling into: maybe this is just how it is going to be. He said: "On one hand, that is beautiful, but on the other hand, it is a tough place to be.
That is also an accurate description of where a lot of high-performing women in leadership end up with their own capacity. They stop expecting to feel resourced. They stop expecting to have enough energy. They accept the depleted version of themselves as the version that is available for leadership.
It is a tough place to be. And it is not inevitable.
One Question Worth Sitting With This Week
Alex asked every new client a version of this question before they started working together: " Are you on board with what I am going to ask you to do?
The 87-year-old was not. Not because she did not want to feel better. Because 10 minutes a day for herself was genuinely not something she could locate in her own life.
I want to ask you a version of the same question.
Not: are you busy? You are. Not: do you wish things were different? You do.
The question is: what are you currently treating as optional that is not actually optional?
Not the next deliverable. Not the next leadership meeting. The thing you keep deprioritizing because it feels like it belongs to you and therefore it can wait. The workout. The actual lunch break. The conversation with someone who asks how you are doing and means it. The 10 to 15 minutes that could be done consistently change the baseline you are leading from.
Your answers will tell you something. Not about your schedule. About the gap between the leader you are and the leader you are capable of being when you are actually resourced.
That is what integrity over scale looks like in practice. Not a bigger calendar. A clearer one. Not more output. Better presence. Not shrinking until something gives. Deciding, intentionally, that you are not the last item on the list.
If this landed and you are a director or senior leader who keeps running on empty, the Voice Pattern Audit is a four-minute starting point. It names the specific behavioral pattern most likely costing you visibility right now. Take it here.
Or if you are ready to talk directly, the discovery call is 30 minutes and free. Book it here.
This post was drawn from a conversation with Alex Simmons on the Integrity Over Scale podcast. Alex is a posture therapist trained in the Egoscue method, working with clients in chronic pain who have tried everything else.
Dr. Leili Sadaghiani is the founder of InVivo Leadership Strategies and the host of Integrity Over Scale. She works 1:1 with high-performing women in male-dominated industries who are done shrinking in the rooms that matter.
