23 Janaury 2017:
Menopause is a normal life event for women and so it is not an illness or a medical condition. This often means that the symptoms of the menopause are too often under recognized, undervalued and not taken seriously. The psychological symptoms associated with the menopause such as loss of self-confidence, low self-esteem, anxiety and depressive symptoms are the ones that often affect women the most.
On average, women spend nearly one-third of their life being postmenopausal. The retirement age is increasing and elderly people are far more active, both physically and mentally, than they were in the past. Symptoms of the menopause last far longer than most women anticipate; the average length of time is 4 years and many women still have some symptoms for longer than 10 years.
Around 3.5 million women aged between 15 and 65 years are currently in employment in the UK. The employment rate for women in the UK has actually increased in the past few decades and women now represent nearly a half of the UK labor force. This means that many more women are being affected by symptoms of their menopause, often to the detriment of their families, work and life in general. Clearly, the symptoms vary between women with around 25% of women suffering severe symptoms. Not only can this have a significant impact on the individuals, but also on their work colleagues.
As many women still do not recognize that it is the menopause (or perimenopause) causing their symptoms, they will not talk about it and, more importantly, they will not ask for help. In addition, if their colleagues do not know enough about the menopause, then it potentially makes it very hard for women to talk about symptoms they are experiencing at work.
It is no surprise that around half of women have been reported as finding work difficult due to their symptoms of menopause. Poor concentration, tiredness, poor memory, depression, feeling low, lowered confidence, sleepiness and particularly hot flushes are all cited as contributing factors [1]. In addition, perhaps more worryingly, it has been estimated that around 10% of women actually stop work altogether because of their severe menopausal symptoms.
Research has shown that the more frequently women reported experiencing menopause-related symptoms and the more bothersome the symptoms were, the less engaged they felt at work, less satisfied with their job, the greater their intention to quit their job and the lower their commitment to their employment.
Studies have shown that menopause symptoms can have a significant impact on attendance and performance in the workplace, with some women being misdiagnosed as suffering from mental ill-health or other conditions, and the impact on their work can be wrongly identified as a performance issue. A study commissioned by the British Association of Women in Policing found that some women police officers reported that the tiredness and insomnia they associated with menopausal transition affected their capacity to function normally at work [2].
Menopausal symptoms can also contribute to women deciding to leave their jobs early, or not put themselves forward for specialist posts or promotion, thus affecting the diversity of teams within their organizations.
It is very likely that early diagnosis, education and adjustments can act as a preventative measure for menopause-related sickness. When menopause is managed correctly, not only can it reduce absenteeism (for example, reasonable adjustments being put in place), it enables women to talk about their concerns with their work colleagues and managers. There should be measures in place to provide some support in what is considered a significant physical change, in line with puberty or pregnancy.
Employers have responsibilities for the health and safety of all their employees, but there are also clear business reasons for proactively managing an age-diverse workforce. Some employers have been slow to recognize that women of menopausal age may need specific considerations and many employers do not yet have clear processes to support women coping with menopausal symptoms [3]. Recommendations from research in this area are for employers to best support menopausal women as part of a holistic approach to employee health and well-being and include risk assessments to make suitable adjustments to the physical and psychosocial work environment, provision of information and support, and training for line managers [4].
In November 2016, the Faculty of Occupational Medicine introduced new guidelines for women entitled 'Guidance on menopause and the workplace' [5]. These practical guidelines aim to help women experiencing troublesome menopausal symptoms, and to support them and their colleagues and managers in tackling the occupational aspects of menopausal symptoms. The guidelines provide clear recommendations about working conditions for menopausal women which are based on the guidelines produced by the European Menopause and Andropause Society (EMAS) [6]. These recommendations include advocating the introduction of training in the workplace to increase awareness of the potential effects of menopause in the workplace, adapting the workplace environment where appropriate (for example, changing temperature of rooms and having fans available), making flexible hours for some women an option and perhaps, most importantly, creating opportunities to facilitate discussion about symptoms that are impacting on the ability to work. There is also clear guidance for women whose menopausal symptoms are affecting them at work. The recommendations include encouraging discussions to take place with managers about practical needs, speaking with the occupational health service and also talking with other colleagues. Advice regarding healthy lifestyle and well-being is also mentioned, which are clearly very important when considering the management of the menopause.
The guidance also recommend that women seek advice regarding available treatment from their GPs. Many women are still suffering in silence and do not realize how effective hormone replacement therapy (HRT) can be at dramatically improving both their symptoms and also their quality of life, with an effect of being able to help them function better at work.
I strongly feel that, as GPs, we should give our patients the time they need and the information they require to make informed choices regarding their menopause and its management. Many women still feel helpless and despondent when they discuss their menopausal symptoms with their GPs and this has to change. There are now excellent guidelines available which should be empowering us in primary care with more knowledge and confidence to diagnose and manage the menopause [7-9]. They provide clear statements regarding benefits and risks of HRT.
Despite these guidelines, it is important that a woman’s menopausal status is not an automatic indicator of their likely perceptions of work and also their performance in the workplace. There is clearly a real need for much more work to be undertaken in this important area.
Louise Newson
References
- Kopenhager T, Guidozzi F, Working women and the menopause. Climacteric 2015;18:372–5
http://www.ncbi.nlm.nih.gov/pubmed/25830628 - Griffiths A, Cox S, Griffiths R, Wong V. Women police officers: Ageing, work and health. Bordon: British Association of Women in Policing, 2006
http://www.bawp.org/Resources/Documents/BAWP%20Menopause%20Extract.pdf - Griffiths A, MacLennan SJ, Hassard J. Menopause and work: an electronic survey of employees’ attitudes in the UK. Maturitas 2013;76:155–9
http://www.ncbi.nlm.nih.gov/pubmed/23973049 - Jack G, Riach K, Bariola E, Pitts M, Schapper J, Sarrel P. Menopause in the workplace: what employers should be doing. Maturitas 2016;85:88-95
http://www.ncbi.nlm.nih.gov/pubmed/26857886 - Faculty of Occupational Medicine. Guidance on menopause and the workplace.
http://www.fom.ac.uk/press-releases/fom-launches-new-uk-guidance-on-menopause-and-the-workplace (link expired) - Griffiths A, Ceausu I, Depypere H, et al. EMAS recommendations for conditions in the workplace for menopausal women. Maturitas 2016;85:79-81
http://www.ncbi.nlm.nih.gov/pubmed/26857884 - Menopause: diagnosis and management. NG23. November 2015.
https://www.nice.org.uk/guidance/ng23 - Baber RJ, Panay N, Fenton A; IMS Writing Group. 2016 IMS Recommendations on women's midlife health and menopause hormone therapy. Climacteric 2016;19:109-50
http://www.ncbi.nlm.nih.gov/pubmed/26872610 - Sarrel P, Portman D, Griffiths A. Work and the menopause: A guide for managers. London: British Occupational Health Foundation, 2010
http://www.bohrf.org.uk/downloads/ accessed January 2017