Symptoms of the menopause can have a negative effect on women in the workplace. This article explores how employers can support staff to manage with their symptoms and remain in the workforce
The menopause is a natural life event but women can struggle with a number of different symptoms which can affect their ability to work. Its impact on mental health is often underestimated and, while in some cultures menopause is celebrated, in Western cultures there is a stigma associated with a loss of fertility that accompanies the menopause. This article explores the problems women can encounter in the workplace and offers advice for managers on steps they can take to support their staff.
Citation: Noble N (2021) Helping and supporting staff to manage menopause symptoms at work. Nursing Times [online]; 117: 6, 39-41.
Author: Nikki Noble is advanced nurse practitioner (menopause), Aneurin Bevan University Health Board.
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Menopause is a natural life event experienced by all women and, as there were over 4 million women aged 45 to 60 in employment in 2019, it is likely that a significant number of them will be experiencing their menopause transition (Hardy, 2020).
The average age for menopause is 51 years, although 1 in 100 women experience it before the age of 40 and 1 in 1000 experience menopause before the age of 30 – in these cases it is termed primary ovarian insufficiency (Hillard et al, 2017). Menopause occurs when there is a loss of ovarian follicular activity, which leads to oestrogen deficiency, resulting in permanent cessation of menstruation and loss of reproductive function (Royal College of Nursing, 2019a). Key definitions are outlined in Box 1.
Box 1. Definitions
The National Institute for Health and Care Excellence (2019) offers the following definitions:
Perimenopause: The time in which a woman has irregular cycles of ovulation and menstruation leading up to menopause and continuing until 12 months after her final period. The perimenopause is also known as the menopausal transition
Menopause: A biological stage in a woman’s life that occurs when she stops menstruating and reaches the end of her natural reproductive life. Usually, it is defined as having occurred when a woman has not had a period for 12 consecutive months for women reaching menopause naturally. The changes associated with menopause occur when the ovaries stop maturing eggs and secreting oestrogen
Post menopause: The time after menopause has occurred, starting when a woman has not had a period for 12 consecutive months
Eighty five per cent of women will experience menopausal symptoms ranging from mild to severe, with varying degrees of disruption to their lives and up to 20% of women report severe symptoms (O’Neill and Eden, 2017). Some women may not recognise that their symptoms are related to menopause or may deny they have them as there is stigma related to menopause and ageing (Matova, 2017).
The impact of the menopause on mental health is often underestimated and there are cultural differences which can affect women’s experience of menopause. In some cultures menopause is celebrated while in others, particularly Western cultures, there is a stigma related to it involving loss of fertility and youth (RCN, 2019b).
Symptoms of menopause
Symptoms such as hot flushes and sweats are the most common symptoms of menopause (Holloway, 2017). Flushes are a sudden feeling of heat, usually felt in the face and neck but that can spread through the whole body. Often the face can become red and the heart rate can increase. Both symptoms can result in feelings of embarrassment and can be disruptive. The frequency of them can vary but they often occur at night and sweat can soak through clothing and bedding.
Other symptoms include psychological symptoms such as low mood, irritability, lack of confidence, anxiety and cognitive changes, such as difficulties with memory and concentration. Many women experience joint pain and stiffness and genitourinary symptoms such as:
- Frequent urinary tract infections;
- Frequency of micturition;
- Vaginal itching, dryness and soreness.
There can be changes to bleeding patterns with periods becoming more irregular, heavier and lasting longer – their irregularity means they can be unpredictable and harder to prepare for.
A lot of women experience sleeping difficulties, which can be due to night sweats and/or anxiety, such as finding it difficult to get to sleep, waking in the early hours and not feeling refreshed after sleep, leading to fatigue and tiredness.
These symptoms can have a negative impact on healthcare staff, particularly those working shifts. They may find it difficult to get up for early morning starts or may find the fatigue unbearable if working night shifts. Problems with memory and concentration can also negatively affect work, as more time may be needed to complete tasks. Anecdotally, staff have told me that they frequently need to double check or triple check their work to make sure it has been completed correctly. This may have an impact on confidence in work or relationships with colleagues.
Who is affected?
It is important to remember that it is not just middle-aged women who are affected by menopause. Although menopause usually affects women aged 45-55 years, younger women can be affected too – this may be due to premature ovarian failure or a surgical or induced menopause. Members of the transgender, non-binary and intersex communities may also experience menopause. There is little data on the number of people affected but anyone with a female reproductive system, regardless of transgender status will experience menopause. Some transgender people may be reluctant to discuss menopausal symptoms in the workplace if doing so would require them to disclose their trans status (TUC Wales Cymru, 2017).
A healthy lifestyle can have a positive impact on menopause symptoms and unhealthy eating, stress and an unhealthy lifestyle can increase some symptoms. Regular exercise can help with weight loss and cardiovascular health; exercise such as yoga can help with symptoms such as mood changes and poor sleep (Abernethy, 2013). Women who smoke are more likely to have an earlier menopause and more hot flushes. For some women, hot flushes can have triggers such as spicy food, alcohol intake and caffeine, and reducing these triggers can offer relief. Relaxation techniques such as meditation and mindfulness, as well as cognitive behavioural therapy, can also be helpful (Faculty of Occupational Medicine of the Royal College of Physicians, 2016).
If symptoms are having a negative impact on health and wellbeing, women should be advised to seek medical advice and support (Royal College of Nursing, 2020).
Menopause and the law
There is no specific legislation relating to menopause at work (NHS Wales, 2018) but there are several regulations that employers should be aware of, such as the Health and Safety at Work Act (1974) and the Equality Act (2010). The Health and Safety at Work Act requires employers to ensure that the health and safety of employees is protected and includes women experiencing menopause. There have been several successful cases brought to employment tribunal for unfair dismissal due to menopause (Bit.ly/WorkMenopause).
What can employers do to help?
Many employers are putting workplace menopause policies in place. NHS Wales was one of the first large employers in the UK to implement a policy (NHS Wales, 2018) and other employers such as Channel 4 have followed suit; NHS England is also developing a policy. Recognising that menopause can have an impact on work and implementing a workplace wellbeing policy is a good starting point (RCN, 2020). All workplaces should strive to have a policy that is understood by employees and supported by managers.
The NHS Wales (2018) policy is a good example of a workplace menopause policy. It is very comprehensive and outlines why menopause is a workplace issue, how to support employees, menopause and the law, where to seek help and self-help.
Women should be encouraged to talk to their colleagues and line managers if their symptoms are having an impact at work, and managers should be aware that the symptoms of menopause are an occupational health issue. Negative stereotypes and attitudes about middle-aged and older women should be challenged. Employers should provide access to counselling services for women with psychological symptoms, although there are cost implications to providing a counselling service and in some areas availability may vary. It should also be acknowledged that some women may be reluctant to discuss their issues with a manager and access to occupational health services should be an option if this is preferred by the employee (Faculty of Occupational Medicine of the Royal College of Physicians, 2016).
Employers can take steps to help staff manage their symptoms at work, such as looking at working patterns and allowing flexibility of working hours. When staff work shifts, it is important to consider whether they can work day shifts rather than night shifts. Is there flexibility on start times so they can start later if they have had a particularly bad night’s sleep? Some staff may benefit from a temporary reduction in hours and should be supported to do this if possible. Line managers should listen, support and respond compassionately to requests for adjustments at work, but flexibility is needed on both sides, and the needs of the service will need to be considered when accommodating these requests.
Improving the workplace
Risk assessments of the workplace should be undertaken and focus on issues including environmental temperature, ventilation and uniforms.
Making the workplace a ‘menopause friendly’ environment can have a positive impact on staff when they know support is available. Practical suggestions are listed in Box 2. Some NHS workplaces run menopause cafes where women can come together to discuss their symptoms and issues in a supportive environment. The Chartered Institute of Personnel and Development has some helpful printable resources and posters available for use in the workplace, which encourage people to talk about menopause and aim to reduce the stigma around menopause (Bit.ly/CIPDMenopause).
Box 2. Practical adjustments
- Ensure adequate breaks, which may need to be taken as needed, rather than at a set time
- Provide a comfortable working environment with ventilation-controlled areas or desk fans, and an appropriate rest area
- Ensure cold water is available
- Easy access to toilet and washing/shower facilities
- Limits on the amount of time personal protective equipment is worn can be a helpful adjustment (RCN, 2020)
It should be noted that not all women want to discuss their symptoms at work and they may need support from other sources, for example, support from online chat rooms and social media. Research by the TUC Wales Cymru (2017) has shown that Black and minority ethnic women employees are more likely than White workers to be in insecure work, for example, on zero hours or casual contracts. They found that a number of those on insecure contracts were reluctant to raise the issue of their menopausal symptoms or ask for adjustments at work, due to concerns that doing so might affect their job security.
Menopause awareness sessions
In Aneurin Bevan University Health Board I run menopause awareness sessions for staff employed within the organisation. Updates are added to the intranet page and occupational health also signpost staff. Everyone is welcome and the sessions discuss the following topics:
- Understanding menopause;
- How to self-manage symptoms;
- Where to get more information;
- When to contact a health professional.
I also run a menopause clinic and staff can self-refer for support and advice for their menopause symptoms. The clinic has moved to a virtual format, via telephone, since the coronavirus pandemic and this has worked well for busy staff who may not always have time to attend appointments during working hours. This model of care is likely to continue even when restrictions have lifted. Staff can also be referred to the clinic by occupational health or by their line manager with their consent.
Box 3 includes a list of useful information and resources.
Box 3. Information and resources
Although menopause is a natural life event, the symptoms can have a negative impact on some women, which significantly affects their life. As there is a large number of women in the menopause age range in employment in the UK, menopause in the workplace needs to be addressed. Many employers are now putting policies in place to support women to manage their symptoms and there are a variety of toolkits available for workplace risk assessments. However, not all women feel comfortable or want to discuss their menopause because of the perceived stigma or worry about their employment being affected. GPs are able to help with menopause support and there are doctors and nurses registered as menopause specialists with the British Menopause Society who are available to provide help and support to women.
- There were over 4 million women aged 45 to 60 in employment in 2019
- The average age for menopause is 51 years but 1 in 100 women experience it before the age of 40
- 85% of women will experience menopause symptoms ranging from mild to severe
- There is no specific legislation relating to menopause at work
- Employers can help staff by risk assessing working patterns and allowing flexibility of working hours
Abernethy K (2013) Managing menopause naturally. independentnurse.co.uk 21 January.
Chartered Institute of Personnel and Development (2019) Let’s Talk Menopause. CIPD.
Faculty of Occupational Medicine of the Royal College of Physicians (2016) Guidance on Menopause in the Workplace. FOM.
Hardy C (2020) Menopause and the workplace. Guidance: what to consider. Post Reproductive Health; 26: 1, 43-45.
Hillard T et al (2017) Management of Menopause. British Menopause Society.
Holloway D (2017) Managing Women’s Health in the Menopause. nursinginpractice.com 1 June.
Matova K (2017) Stigma around menopause still exists – but it shouldn’t. peoplemanagement.co.uk 30 August.
National Institute for Health and Care Excellence (2019) Menopause: Diagnosis and Management. NICE.
NHS Wales (2018) Menopause Policy. NHSW.
O’Neill S, Eden J (2017) The pathophysiology of menopause symptoms. Obstetrics, Gynaecology and Reproductive Medicine; 27: 10, 303-310.
Royal College of Nursing (2020) The Menopause and Work: Guidance for RCN Representatives. RCN.
Royal College of Nursing (2019a) Nurse Specialist in Menopause. RCN.
Royal College of Nursing (2019b) Menopause and Mental Health. RCN.
TUC Wales Cymru (2017) The Menopause in the Workplace: A Toolkit for Trade Unionists. TUC.