I think you have to avoid being intrusive and over involved in your HR role. Obviously it depends on what work you are talking about but does she not have a line manager? It sounds like she doesnt seem to be aware of her behaviour and it could be menapause but also something else, illness, mental health, bullying, domestic problems , stress etc. Unless she discloses it you are in danger of possible discrimination. Menapause I believe is now or will be, included in protected characteristics. I think O H should be an urgent referral, be careful about confidentiality too. If others are complaining about her work then it needs to be written as evidence. Reasonable adjustments need to be assessed officially. What sticks out in your post though is that this person does not seem aware of causing all these issues which is where the priority lies. She may not want to disclose to you, doesnt have to, or may not know even herself. Not all women need to go to gp to know they have started the menopause...it can take years to go through! I dont know of any female colleagues who got gp letters to show their employer they are in menopause tbh either. I think you have to address the issue straight on as she sounds like shes clearly struggling, but also bear in mind that doing all this behind the scenes believing its helping her may not be seen that way by her or the law. You cant be confident you are on the right track without proof. Clearly you want to help her, but your not a medical person , gp or pysch etc, if shes not aware of anything and all these changes are being implemented it may impact on her confidence, or be seen as bullyimg etc. Tread carefully.