Coping with the menopause in the workplace – your career doesn’t need to be over

Dr Cheryl Lambe, Consultant Fertility Specialist at The Agora Clinic, discusses the impact on careers as well as symptoms, treatment and workplace best practice.

The menopause is a normal, natural part of ageing, which affects all women and is defined as the last menstrual period. It is a retrospective diagnosis that can be confirmed when a woman has missed her periods for 12 consecutive months. The gradual transition over the preceding years is known as “the perimenopause”. During this time, which can last up to 10 years, the ovaries gradually produce less oestrogen, periods may become irregular, fertility decreases and women may begin to experience menopausal symptoms.

Most women (around 80%) will have symptoms relating to their menopause. One in four women define these symptoms as having a severe impact on their family, work, and home lives but despite this, less than 50% of perimenopausal symptomatic women will access medical help.  The British Menopause Society cites 55 common symptoms attributable to the menopause. These include changes in menstrual cycle, vasomotor symptoms (sweats and flushes), sleep disturbance, fatigue, sexual dysfunction, urinary symptoms, vaginal dryness, mood changes, poor concentration, weight gain, headaches, palpitations, joint pain, impaired cognitive function “brain fog”, low self-esteem, and difficulties in decision making. No one symptom is diagnostic and many other symptoms are possible.

Due to changing demography, the menopause is having an increasing impact on the workforce. In 1850, female life expectancy was only 45. By 2018, when the average age of menopause was 51, our life expectancy had increased to 83. Women are now spending greater than 30% of their life in a post-menopausal state. Given that around 3.5 million women aged between 50 and 65 are currently employed in the UK, the menopause has huge socioeconomic implications. Menopausal women are now the fastest growing workforce demographic.

Coping with menopause in a workplace environment can be challenging and many women still feel reluctant to talk openly to their employers about the impact their symptoms are having on their productivity and performance. The menopause hits at an age when many women are enjoying more senior and substantive roles. Perimenopausal loss of confidence can lead to avoidance of promotion and stagnated career progression and have detrimental effects on professional relationships. Many women feel ill prepared to cope and need additional support. Although some workplaces are now acknowledging the impact of the menopause and putting into place workplace strategies, many remain poorly equipped. 90% of female staff report that their organisation offers no menopause support. Women still feel that certain symptoms e.g. dysfunctional uterine bleeding remain shrouded in stigma and taboo and are often unwilling to disclose the extent of their problems. Many will go to lengths to try to mask symptoms at work. One study showed that 47% would take time off work without disclosing the true reason for their absence. Many women drop their hours during the menopause and up to 10% stop working altogether, resulting in loss of talent and increased staff turnover. 

Ideally, all women should be encouraged to access individualised specialist advice on how they can optimise their menopause transition.

The rationale for hormonal replacement therapy is not only to treat symptoms and improve quality of life but also to minimise the impact of chronic diseases such as cardiovascular disease and osteoporosis. A major opportunity exists at the onset of the menopause to identify longer-term health risks and initiate prevention strategies.

Oestrogen replacement can be taken in the form of tablets, patches, gels or sprays. It can also be administered vaginally, which is useful for local urogenital symptoms. A second important hormone is progesterone. If we give oestrogen alone in women with a uterus it can thicken the lining of the uterus leading to an increased risk of endometrial cancer. The progesterone can also be administered via a tablet, patch or a Mirena coil. Other hormones, such as testosterone can be considered for women with persistent troublesome low libido.

There are very few absolute contraindications to HRT treatment but there are some indications when HRT needs to be prescribed with caution. In these cases, or for those wanting to avoid HRT, non-hormonal alternatives can be used.

Alternative remedies, cognitive behavioural therapy and lifestyle intervention such as diet, exercise, smoking cessation, alcohol reduction and stress management all play an equally important role.

So, what can businesses and organisations do to help?

• Recognise the extent of the problem.

• Create a safe culture- challenge negative stereotypes, end stigma and encourage communication.

• Develop a menopause policy. Currently only a quarter of all employers have a menopause policy in place. A robust policy minimises the risk of litigation and reputational damage. Although there is currently no specific legislation relating to the menopause, cases have been brought against employers on grounds of direct and indirect discrimination, unfair dismissal, harassment and personal injury. A policy provides management with clear direction and can reduce absences and maintain productivity.

• Provide educational and training resources in the workplace for all staff members.

• Appoint a menopause champion who can provide empathy and can signpost women to appropriate resources.

• Consider reasonable workplace adjustments for those in need eg table fans/ quiet spaces, altered hours/ menopause leave where appropriate.

Finally, It should also be remembered that the menopause can also affect younger women – those suffering from premature ovarian insufficiency, as well as trans men, non-binary and intersex people and although this article focuses on women, there is increasing evidence for a male equivalent “the andropause”, when men can suffer from depression, loss of sex drive and erectile dysfunction along with other physical and emotional symptoms in their late 40s/ early 50s.

Let’s move away from the workplace as the “final frontier” in terms of menopause recognition. Nurture staff who are struggling and prioritise the inclusion of menopause management as part of all workplace health and wellness strategies.

To find out how we can help you or your staff please go to https://agoraclinic.co.uk/reproductive-health/managing-the-menopause/ or call 01273 229410 to book a Menopause Assessment