Look Who's Talking: Menopause in the Workplace

Article | Dr Toni Hazell, GP, Freelance Medical Writer, Blogger and Editor

The menopause is defined as “a biological stage in a woman’s life when menstruation stops permanently due to the loss of ovarian follicular activity”. [1] It marks the change in a woman’s life from the reproductive years into the non-reproductive years, and it occurs, on average, at the age of 51 in the UK. [1]

Turning off a woman’s ovarian activity isn’t like turning off a light switch. It’s a gradual process and starts with the perimenopause (around menopause), a period of time during which a woman’s periods may become irregular and she may start to have menopausal symptoms. The length of the perimenopause can vary (and it may last for several years), but it is considered to have ended, and the menopause begun, when one year has passed since a woman’s last period. [1]

What Are the Symptoms?

If you conducted a quiz on the street and asked “What are the symptoms of the menopause?”, most people would say “hot flushes and night sweats”, these being the symptoms commonly associated with the menopause. Hot flushes and night sweats (collectively known as ‘vasomotor symptoms’) can be very disabling. Night sweats can interrupt sleep and cause tiredness the next day.

We know that fatigue can have a significant effect on performance at work – the Health and Safety Executive [2] lists “slower reactions, reduced ability to process information, memory lapses, absent-mindedness, decreased awareness, lack of attention, underestimation of risk [and] reduced coordination” as known consequences of fatigue at work.

Hot flushes that occur during the working day may have an impact on work productivity, and some flexibility might be needed – for example, around deadlines or uniform requirements. It is important to remember that vasomotor symptoms are not the only symptoms of the menopause. There are oestrogen receptors in many areas of the body, and symptoms can therefore affect various body systems. A full list of symptoms associated with the menopause is shown on page 23. [3]

A woman who is having some of the symptoms overleaf, but is not having severe vasomotor symptoms, may not realise that she is going through the perimenopause. She may attribute her symptoms to a variety of other conditions, including depression or fibromyalgia.

Early Menopause and Fertility Treatment

As well as the group of women going through their menopause at an average age, there is another group who will go through it early.

Premature ovarian insufficiency is defined as “the transient or permanent loss of ovarian function before the age of 40 years, characterized by menstrual disturbance… and potential spontaneous resumption of ovulation, menstruation, and spontaneous pregnancy”. [1]

This group of women can have any of the same symptoms listed on page 23, but they also have other issues to consider. They might still have wanted to have children or have more children, in which case going through an early menopause can come as a significant shock, with potential psychological ramifications. Some women may then decide to attempt fertility treatment with egg donation, which can have physical and psychological side-effects.

Fertility treatment can involve multiple appointments during the working day, sometimes at short notice; employers need to consider how they manage this and what they can offer their employees.

While there is no statutory right to time off work for fertility treatment, [4] it should be treated as sick leave and managed in the same way.

Once an embryo transfer has taken place, the woman acquires the employment rights to do with pregnancy. [4]

A bill currently going through parliament would make time off for fertility treatment a statutory right, [5] but even without the legal requirement, some employers offer more paid time off for this reason. [6]

How Long Does it Last?

We have already discussed the myth that the only symptoms of the menopause are vasomotor ones; another commonly believed myth is that menopausal symptoms always resolve themselves within a year or two.

It is common for symptoms to last for 5–7 years, but some women can experience them for 10–15 years; for example, one large longitudinal study found that women of Hispanic or Afro-Caribbean ethnicity had symptoms that persisted for longer on average. [7]

How Can Employers Help?

There is much that employers can do to help women going through the menopause.

To start with, it’s important to understand that a woman may not have ‘proof’ of her menopausal status. Guidelines from the National Institute for Health and Care Excellence (NICE) state that the menopause in a woman aged over 45 is a clinical diagnosis and blood tests are not necessary. This is because the follicle-stimulating hormone – the hormone that is used to diagnose the menopause – fluctuates in the perimenopausal years and so if we relied on it for diagnosis, many women would have a false negative result.

It is understandable that a manager or an HR professional with no medical knowledge might feel uncertain of what to do if faced with a request for flexible working or other changes due to the menopause.

The answer to this is not to ask for a letter from the GP (we are under unprecedented stress at the moment and don’t have time for unnecessary admin), but to make sure that the company has good access to an occupational health physician.

These doctors specialise in the interface between work and health, and they can advise on reasonable adjustments for a woman who has menopausal symptoms.

There is no clear data about what percentage of employees currently have access to occupational health, but it is probably under 50%. [8,9]

However, access to occupational health can help an employer to manage health-related issues, including those that are due to the menopause, and may well cut costs and improve overall productivity.

If access to occupational health is difficult, workplaces could consider what are the most common reasonable adjustments that might be made for a woman going through the menopause: [11]

• For vasomotor symptoms, significant benefit might be gained from moving to a cooler part of the office, having ready access to a toilet or having a fan available; a change in uniform may also be needed if the material is not breathable.

• With advances in remote working technology, flexible working with a few days from home may be helpful, particularly if the woman has a long commute on crowded public transport.

• Technology can also help with cognitive issues; for example, setting up electronic reminders.

• In-house counselling may be useful for those with anxiety or depression related to their menopause. This could also be used by other staff who are suffering from mental health issues at any time in their life.

It is important that women have the option to talk to someone in confidence about what they would find helpful. All of those who go through the menopause are of the female sex, but not all will identify as female, so the issues covered in this article are also relevant to staff who identify as non-binary or as a trans man. [12]

The menopause is a natural stage in life for 50% of the population. A good employer will have policies in place to help their valued staff through this phase and by doing so they will increase staff retention and position their organisation as an attractive place to work.

Dr Toni Hazell

GP, Freelance Medical Writer, Blogger and Editor

Toni is a GP in North London and works for the Royal College of General Practitioners (RCGP) as an eLearning fellow, writing and editing eLearning. She also does similar work for a variety of other organisations and is a regular presenter and chair at GP educational events. She is a GP appraiser and sits on her local individual funding review panel.

Her blog can be found online at www.tonihazell.co.uk

1. National Institute for Health and Care Excellence. Menopause: What Is It? (Last revised March 2022). https://cks.nice.org.uk/topics/menopause/ background-information/definition (Last accessed June 2022)

2. Health & Safety Executive. Human Factors: Fatigue. (no date). www.hse.gov.uk/humanfactors/topics/fatigue.htm#:~:text=Fatigue%20results%20 in%20slower%20reactions,and%20injury%2C%20and%20reduced%20productivity (Last accessed June 2022)

3. National Institute for Health and Care Excellence. Menopause: When Should I Expect a Diagnosis of Menopause or Perimenopause? (Last revised March 2022). https://cks.nice.org.uk/topics/menopause/diagnosis/diagnosis-of-menopause-perimenopause (Last accessed June 2022)

4. Acas. Your Maternity Leave, Pay, and Other Rights: Having IVF Treatment. (no date). www.acas.org.uk/your-maternity-leave-pay-and-other-rights/ having-ivf-treatment# (Last accessed June 2022)

5. Aiken N. (2022). Nickie Aiken MP: Women Going Through IVF Need Statutory Leave at Work. City Matters, 11 May. www.citymatters.london/nickieaiken-mp-women-going-through-ivf-need-statutory-leave-at-work (Last accessed June 2022)

6. Imperial College London. Leave for Fertility Treatment. (no date). www.imperial.ac.uk/human-resources/leave/family-leave/fertility-treatment (Last accessed June 2022)

7. National Institute for Health and Care Excellence. Menopause: What Is the Prognosis? (Last revised March 2022). https://cks.nice.org.uk/topics/ menopause/background-information/prognosis (Last accessed June 2022)

8. Nicholson PJ. (2021). Challenging the Data About Access to Occupational Health Services. SOM [blog], 12 August. www.som.org.uk/challengingdata-about-access-occupational-health-services (Last accessed June 2022)

9. Howlett E. (2019). Majority of UK Workers Don’t Have Access to Occupational Health. People Management, 4 July. www.peoplemanagement.co.uk/ article/1744835/uk-workers-do-not-have-access-occupational-health (Last accessed June 2022)

10. Invest Northern Ireland. Occupational Health and Welfare: Benefits of Promoting Occupational Health. (no date). www.nibusinessinfo.co.uk/ content/benefits-promoting-occupational-health (Last accessed June 2022)

11. NHS Inform. Menopause and the Workplace. (Last updated May 2022). www.nhsinform.scot/healthy-living/womens-health/later-years-around- 50-years-and-over/menopause-and-post-menopause-health/menopause-and-the-workplace/#:~:text=You%20can%20request%20 reasonable%20adjustments,or%20asking%20for%20a%20fan (Last accessed June 2022)

12. Acas. Menopause at Work: Talking with Staff About the Menopause. (no date). www.acas.org.uk/menopause-at-work/talking-with-staff-about-themenopause (Last accessed June 2022)