Menopause is a universal female condition, for all women who go beyond their reproductive years either naturally or because of medication or surgery. Overall, almost 660 million women are heading for menopause worldwide, of which about half are in the workforce.
This is responsible for an increasingly vocal discussion about the importance of recognizing menopause as a syndrome contributing to workplace disability or requiring workplace support, to varying extents depending on the individual.
Menopause refers to the cessation of menstruation, but its impact begins years before this time and lingers for years afterward. This is because the hormonal influences underpinning this event precede it and continue to establish themselves until finally most of the female sex hormone secretion is lost over the next decade or so.
Menopause symptoms include vasomotor symptoms such as hot flashes and night sweats – the most common menopausal symptoms; period-related symptoms like heavy bleeding with the passage of clots; and others such as the lessening of libido, insomnia, mood changes, anxiety and other mental disturbances. Sleep disruption may in turn cause fatigue, irritable mood and lapses in concentration and short-term memory, as well as muscle and joint pain.
Surgical or medical menopause may occur inadvertently or as a planned consequence of therapy for many conditions affecting women, including cancer and endometriosis. In such cases, health-related experiences of cancer, as well as the practical aspects of cancer treatment schedules and complications, add to the difficulties of functioning normally at the workplace.
Premature ovarian failure is another illness that results in menopause before the age of 40 and is made more difficult by the accompanying lack of fertility. This contributes to feelings of distress beyond the physical symptoms of menopause.
Menopause induced for other reasons, including the switching of genders, is also associated with symptoms similar to those of artificial surgical or medical menopause, along with the societal discrimination against this group that is common in many communities.
Importance of menopause to function
The fact that over half of the world’s population will go through menopause, and that half of this group will be working through this period of change, has led to a debate about considering this condition as one that requires non-discrimination legislation and active measures to keep the workplace friendly to such women.
The rising visibility of the LGBTQ movement has contributed to this in a major way by insisting on the right of trans members to go through menopause by their own choice, with its associated effects on their workplace functioning, without impact on their rights and privileges at work.
Menopause may negatively impact work mostly via severe vasomotor symptoms, but not other features, in most cases. An Australian study showed that workplace functioning was preserved through menopause, but the presence of hot flashes often led to poor function, and if severe, to premature retirement from the current job.
Severe menopausal symptoms were associated, in a Dutch study, with an eight-fold increase in self-reported reduction in work function, and prolonged sickness absenteeism, while treating the symptoms led to higher work capacity. This has been echoed by research from all over the world.
Apart from vasomotor symptoms, cognitive impairment and low mood are responsible for the greatest disruption of smooth functioning at work. The inability to convey the true reason for absenting oneself from work, or for poor work capacity, on certain days, due to the social stigma surrounding menopause, makes it even more difficult for the women affected.
The increased tendency to quit jobs or work for fewer hours a day also has long-term consequences in terms of affecting the future pension, as well as diminishing savings during the working years and thus affecting economic security and overall well-being in the later years.
It is little appreciated among the general population that women at this phase of their lives are not just navigating the shoals of their own reproductive life coming to an end, with the associated symptoms, but are often newly responsible for caring for children or parents, may have other middle-age illnesses, may be struggling with relationship issues, or may be financially insecure. These factors contribute to the difficulties of coping with menopause.
How can employers help?
Employers have a duty of care towards their employees in terms of health, safety and wellbeing, as well as the duty to maintain equality of opportunity and remuneration irrespective of sex, age or disability. Menopause should be specifically mentioned in organizational policies to help apply them better to accommodate women going through this change.
Organizations are called upon to form supportive work cultures and frame policies that will shape institutional and organizational responses to this phenomenon, at all levels, from the top down. This should include occupational health and financial resources, if required, to help women cope with their symptoms at work, so as to promote high functioning.
It makes excellent business and legal sense to support women during this phase of their lives in the workplace. In order to attract and keep a talented and experienced workforce, employers need to take menopause and its demands into consideration during their formulation of workforce policy.
“Four major areas for organizational-level support emerged, none of which need be complex or costly: 1) greater awareness among managers about menopause as a possible occupational health issue; 2) flexibility in working hours and arrangements; 3) access to information and to formal and informal sources of support at work; and 4) attention to workplace temperature and ventilation.”
Jafari et al. 2017
Employers can make it a priority to make the workplace a safe and happy place for women passing through menopause with adverse symptoms. In case a woman displays aberrant behavior against workplace norms, and against other colleagues, which could be traced to the difficult symptoms she is experiencing, she should receive supportive training rather than punitive action.
For instance, women experiencing frequent severe hot flashes may feel unable to work properly and may be embarrassed and ashamed of the very obvious onset of perimenopause. Sleep disruptions may also cause fatigue or tiredness. Heavy or unpredictable bleeding during menstrual periods may be difficult to control, especially in public-facing jobs, and access to a clean and private facility for washing and changing, as well as to toilets is important.
Maintaining a comfortably cool temperature and good ventilation at the workplace, as well as allowing work uniforms to be adapted for coolness within a mutually acceptable limit, goes a long way in helping women work through the day despite hot flashes. When managers and supervisors are supportive and flexible, making attendance or participation in meetings with the higher-ups or high-profile presentations optional rather than mandatory, this reassures and empowers a woman to do a good job despite her symptoms.
The flexibility of working arrangements, including changing shifts to avoid night work, and work-from-home options, should be prioritized. Insurance cover should be available to cover sickness due to menopause, and if possible, this condition should be part of workplace healthcare provision.
Secondly, it should be easier for women to speak about their menopausal symptoms to their supervisors and managers. This requires employer training to have a supportive dialogue with their employees about such concerns. Orientation and training programs for staff at many facilities now include menopause-related awareness training.
Conversely, an atmosphere that belittles this life change and its associated phenomena, either in terms of mocking women for these symptoms (“making too much of them”) or deriding them as a sign of old age, is likely to worsen the experience of working through menopause. This can cause attrition of experienced and talented workers from such an organization, solely due to the organizational culture.
Bullying, harassment or stigmatization of women because they suffer from menopausal symptoms that affect their working behavior should not be tolerated, nor should such women be subject to discrimination for this reason.
“Of importance here is work exploring ‘gendered ageism’ whereby feminized ascriptions create unattainable and fantastical expectations surrounding ‘agelessness’ or problematic stereotypes of ‘cranky old women’.”
Riach et al. 2021
Conversations about this topic should be made possible if the woman desires to bring it up with her supervisor or manager in order to find solutions to menopause-associated impairments of work functionality. Advocacy by trade unions or professional associations will help support these women if their employers do not take them seriously. Occupational health therapists would be very helpful at this stage.
Many organizations have already framed recommendations and guidelines for their employees, especially at managerial levels, and modified their workplaces to cater to women’s needs at this time. Most of this has to do with white-collar jobs, however, leaving women in blue-collar jobs out of the loop, as well as women from minority ethnic backgrounds.
The European Menopause and Andropause Society (EMAS) has also released a Global Consensus Statement on Menopause in the Workplace. Collating data from a diversity of environments and with different environments in place would help employers identify the best ways to strengthen their workplaces for women in midlife, providing evidence that would stimulate proactive support from the top down to help them be more productive.