A growing number of women in their 40s and 50s are leaving the workplace because they are struggling with menopausal symptoms, often in silence. Employers and health professionals must offer better support and education, enabling all women to flourish in their careers.
GP Justine Setchell often sees patients who say they have seen psychiatrists for anxiety, cardiologists for palpitations, and rheumatologists for aching joints. Rarely do they join the dots.
‘No one has thought to ask what is happening with their periods,’ she says. ‘Once you work out that all those symptoms are related to the menopause and then get their hormones right, all those symptoms disappear.’
A member of the British Menopause Society and an occupational health physician with expertise in hormone health, Justine is expertly placed to offer advice on such a sensitive topic – one that most employers and co-workers are still largely ignorant about. She says knowledge of the menopause is where mental health was 10 years ago.
‘People are able to talk about mental health much more freely now, and we are getting there with the menopause, but I’d like to see it on the table at the same level.’
Understanding the facts
Menopause is a natural stage in life and usually occurs between the ages of 45 and 55.
About one in 100 women will experience a premature menopause before they reach 40, according to workplace guidance from the Faculty of Occupational Medicine (FOM) (see Resources).
Women will also experience the perimenopause (when they have menopausal symptoms and still have periods), which can occur up to a decade before the menopause. Many will wait for their periods to change or stop before self-diagnosing or seeking help.
The FOM estimates that 30% to 60% of women experience intermittent physical and/or psychological symptoms during the menopause, which are associated with a decrease in the body’s production of the hormone oestrogen.
The menopause’s physical symptoms include hot flushes, sleep disruption, fatigue, migraines, muscle joint pains and poor concentration. Psychological symptoms include ‘brain fog’, anxiety, apathy, low self-esteem and depression.
On average, symptoms continue for four years from the last period, but the FOM notes that one in 10 women will experience symptoms for up to 12 years.
Time to step up
Karen Arthur hosts the Menopause Whilst Black podcast. A former teacher who left the profession at 52, she says women are giving up their careers for several reasons.
Partly, she says, it is because they don’t know what is happening to them and partly because the menopause makes them feel they can’t do their work, and they are scared to share that with colleagues. Karen says the first step is to acknowledge the impact of the menopause. Employers need to put a policy in place as part of a wider package of measures, with menopausal women informing the document.
‘The only way to do that is to talk to people in the workplace. But sometimes people feel concerned about opening up to their employer because this may adversely affect progression in the workplace.
‘People become more relaxed about speaking when the workplace opens up its policy, with managers saying they want to talk about it. This could be commissioning somebody to write a menopause policy.’
As an estimated 13 million women in the UK (one in three) are living with the menopause, World Menopause Month in October is a reminder that employers need to step up.
Only one in 10 companies has a menopause policy, prompting a parliamentary petition to be set up, recommending that all employers with more than 250 employees should introduce one.
A government report on the effects of menopause on women’s place in the economy reveals that ‘menopausal women are the fastest-growing workforce demographic’, with nearly eight in 10 menopausal women in work.
As the population ages and an increasing number of women fill senior roles, organisations will struggle to remain competitive if they don’t support these highly skilled employees.
‘I’m looking after top executives who are running multi-million-pound international companies and they are not ready to hang up their boots,’ says Justine.
‘They are doing high-powered jobs and they need to function at a top level. It would be an enormous loss for them to retire early.’
HRT medication: Menopause (Support and Services) Bill
Sponsored by Carolyn Harris MP, the private member’s bill was presented to Parliament on 16 June and receives its second reading on 29 October.
Its primary aim is for hormone replacement therapy medication to be exempt from prescription charges in England, as it is in Scotland and Wales.
The MP has also set up a Menopause All-Party Parliamentary Group (APPG) to look at workplace policies. It will examine what employers can do to support women who are struggling with the symptoms of perimenopause or menopause, identify good practice and determine whether any legal changes are needed.
The APPG plans to publish its findings and recommendations by early 2022.
This view is shared by Dr Louise Newson, founder of the Menopause Charity. She points to a survey that her not-for-profit company Newson Health Research and Education undertook with 3809 perimenopausal and menopausal women.
It found that 45% of respondents admitted that the perimenopause and menopause had made them less efficient at work.
‘What was staggering was half of those had taken at least eight weeks off work, and 20% more than eight weeks. Many later resigned or took early retirement.’
Part of the challenge for employers is that there is no one-size-fits-all approach. Although all women will experience the menopause, not all will find their working lives are affected detrimentally.
Although menopause can’t be diagnosed with a blood test, most women can diagnose it themselves. Louise created a menopause support app, Balance, that women can use to track their periods and record symptoms.
‘We recommend doing the symptom questionnaire on the app every three months,’ she says.
‘If your symptoms are changing, then you should go to your doctor or healthcare professional and say, “I think that I am menopausal or perimenopausal… and I really want to address my hormones.”’
Best practice at work
One of the positives associated with greater awareness of the menopause is the wealth of resources that menopausal women and employers can draw on.
The Chartered Institute for Personnel and Development (CIPD) has published a best practice guide to managing menopause at work (see Resources).
In June, the House of Commons Library published Support for people experiencing menopausal symptoms to tie in with a parliamentary debate initiated by Carolyn Harris MP, ahead of her private member’s bill (see box, above and Resources).
Chloe Hughes, health and safety graduate at Rolls-Royce, argues that creating an open, inclusive, supportive and psychologically safe culture is critical to help break the stigma associated with the menopause.
She examined the experiences of menopausal employees for her MSc and PhD, and says that there is an organisational responsibility to increase managerial knowledge of menopause, and elevate transformational leadership.
‘What we know is that when managers have regular, informal one-to-ones with employees, employees are more likely to disclose personal health challenges, including those related to the menopause,’ she says.
Karen concurs, saying it is critical that management takes the lead. ‘If people want to change, they will find a way, but it does have to come from the top down. People who don’t have positions of power don’t feel that they can take the lead.’
‘Often managers are men. It shouldn’t be that it is the woman who is menopausal who is driving this. Sometimes men will say, “I’m a man, it’s nothing really to do with me”, but from my experience, some of the women who have spoken to me about where they work have said that the men that are driving this have said, “My wife is going through the menopause.” That is important.’
However, there are still difficulties experienced by women talking to male managers, and not all male managers feel comfortable about discussing the issue. One option might be to have a female in the organisation to talk to, or perhaps a more direct role for occupational health.
Louise welcomes employers being proactive, but warns that some workplace policies can make women feel more of a failure.
She also feels that the onus on reducing hours and offering flexible working that some employers offer can be counterproductive because menopausal women have financial commitments to meet, such as paying off the mortgage.
‘If you were worried that one of your colleagues was depressed,’ says Louise, ‘you wouldn’t say, “There, there, let’s look at reducing your work.” If you were a good colleague, you’d say, “How are you going to get help?” Treatment is available and signposting to evidence-based information is what companies should do.’
Louise adds that education for health professionals about the menopause and hormone replacement therapy (HRT) prescribing urgently needs to improve. The Menopause Charity is already helping to address this by giving free menopause training to all GP practices.
The Newson Health survey found that only a quarter of women had discussed their hormones with their GP. Just under 30% were prescribed antidepressants instead of HRT, which the menopause guidelines are clear benefits most menopausal women.
‘People worry about breast cancer but most types of HRT do not have a risk for breast cancer associated with them,’ Louise says. ‘We know that women who take HRT are less likely to have symptoms because you are treating the underlying cause but they are also less likely to have heart disease, osteoporosis, diabetes, dementia and the diseases that increase with the low hormones that occur during the menopause. However, only about 10% of women take HRT.’
Inclusivity is key
One of the biggest hurdles to overcome is creating an open, inclusive and supportive culture in challenging or hostile environments. The British Medical Association (BMA) circulated a survey to all its members in November and December 2019 and published the findings in its Challenging the culture on menopause for working doctors report (see Resources). From the 2000 responses received, the BMA found that 16% had discussed their symptoms with their manager, while 47% said they did not feel comfortable doing so.
The menopause is also difficult for minority groups. As the BMA report notes, people who are nonbinary, transgender or intersex may also experience symptoms as a result of menopause or treatment related to gender transition. Although some trans people may find it easier to obtain hormones from their GP than the general population, Louise adds that it’s often harder for them to be recognised, acknowledged and taken seriously.
While some employers may be reticent about supporting menopausal employees, under the Equality Act 2010, employers could be prosecuted at employment tribunals for sex, age or disability discrimination against menopausal women (see Resources). Under the act’s terms, employers must make reasonable adjustments.
‘These might cover things like allowing time off to attend appointments, adjusting work patterns and providing support networks, such as menopause cafés, where women going through the menopause can access resources,’ says Justine.
Another practical measure is adjusting risk assessments to ensure they take gender issues into account.
Chloe, who is undertaking academic research into the menopause and reproductive health at work (and has
set up Rolls-Royce’s first menopause café), is supportive of tailored risk assessments but argues they should be targeted more at the ageing workforce so they are inclusive of all employees. She says OSH professionals can help create a more supportive work environment.
‘We want to retain our menopausal talent, so it is essential that organisational leaders create a psychologically safe work environment, build employee confidence, lead with empathy and are transformational in their approach. This will lead to significant change, and a reduction in menopause stigma and taboo.’
Image credit | iStock
- CIPD, managing menopause at work: bit.ly/CIPD-menopause-guidance-for-managers
- BMA, Challenging the culture on menopause for working doctors report: bit.ly/BMA-challenging-workplace-culture
- House of Commons briefing: bit.ly/support-services-bill
- Faculty of Occupational Medicine advice: bit.ly/menopause-guidance
- The Menopause Charity: bit.ly/own-your-menopause
- Women in OSH report in IOSH magazine: bit.ly/women-in-osh
- Dr Louise Newson’s free menopause support app: balance-app.com
- The Guardian: bit.ly/menopause-employment-tribunals