Menopause, Work and Occupational Health 

By Emma Persand

Published 15 October 2021

Work related stress and menopause

Did you know6
  • Every woman will go through menopause transition and 25 % will have symptoms that significantly affect their health and wellbeing.
  • 3 out 4 women experience hot flushes
  • 50% of women say work is more challenging
  • 47% of women do not tell their manager why they needed a day off
  • 25% have considered quitting their job

The workplace can support or make things worse
Less than 20% say their workplace provided information about menopause, only 10.2% said their workplace had a menopause policy or guidance and 77% would have liked more information about menopause at work

When working as a case manager within an NHS occupational health department, I was seeing more and more women* over the age of 40 experiencing symptoms of work-related stress, being perceived as underperforming and sometimes even dropping out of work with inconsistent GP intervention. Statistics from the British Labour Force surveys report that women between the ages of 45-54 years report a high incidence of work-related stress. The timing of midlife stressors of juggling a job with child and elder care combined with domestic and financial responsibilities means that women and health care professionals are likely to attribute some physical, psychological, and emotional symptoms to stress, rather than perimenopause oestrogen decline. Due to this, women did not access or were not offered correct evidenced based information, treatment, and support. 

In western society, menopause is viewed as a mid-life phase of a woman’s reproductive health and for a large part of the population this is the case, as the average age for a woman to reach menopause in the UK is 51.

However, premature onset can occur

  • in 1 in 100 women before 40 years of age
  • can be surgical induced after a hysterectomy, 
  • caused by ongoing treatment for poly cystic ovarian syndrome, endometriosis, and breast cancer 

The experience of lowering hormone levels within days or weeks instead of years can be particularly intense. 

Women suffer in silence and have poorer outcomes with menopause transition as their own attitudes and beliefs are influenced by the cultural attitude and media representation of menopause, alongside socio- economic, ethnicity, sexual and gender identity and lifestyle factors.

The perimenopause phase is little understood by women and health professionals.  Symptoms can begin up to 10 years before menstruation ceases and is caused when the sex hormones begin to fluctuate due to declining egg follicles – see diagram 1.

Diagram 1 Follicle production during women’s fertility cycle – courtesy E.R. Trevelde et al 1998

Occupational Health making a difference!

 

The Chief Medical Officer, Professor Dame Sally Davies in 2015, called on employers to create a culture where women feel comfortable discussing the menopause to promote an inclusive workplace. The workplace can influence a menopause experience, positively if the physical and psychological hazards are adequately risk assessed and managed6. Organisations have a duty of care to do so by educating and supporting their managers and employees to ensure fair and equal treatment, especially as legal cases under the Equality Act 2010 indicate severe menopausal symptoms meet the criteria as an impairment. Recognition of reproductive and sexual health conditions needs to be placed on a par with other potential workplace health issues. Women need to be empowered to get support for their health to prevent these from damaging their career and potential earning power¹.

Women over the age of 50 represent the fastest-growing demographic in the workplace, with nearly 8 out of 10 of natural menopause age women in work. Millions of women are entering menopause with 40 % experiencing symptoms affecting their health and wellbeing⁶. There are substantial differences in the working lives and employment situation of women and those who identify as women, trans men and non-binary. There is a need to consider gender, race and ability discrimination, informal work, and the care burden outside of work when looking at work-related risks and prevention strategies. Gender inequality inside and outside of the workplace can affect women’s occupational safety and health, psychologically and physically, compounding the already existing inequalities of health and work outcomes.

It is worth noting that men* taking testosterone hormone blockers for prostate cancer treatment can experience hot flushes and the same working conditions can affect the severity of the symptoms and quality of life. https://pubmed.ncbi.nlm.nih.gov/19962840/

Considering the bio/psycho/social approach to assessing women’s health.

Before the Covid-19 pandemic, the GP consultation rate for women was 32% higher than for men, in part, due to reproductive related consultation ²

Although women have a longer life expectancy, they are more likely than men to experience ill-health and require health services. In 2018/19, women made up 54.6% of admissions to hospitals. 

The impact of the pandemic on women’s health³

  • In England, January-August 2020, there were 4.7 million fewer people referred for routine hospital care compared to the same period in 2019 – a reduction of a third (34%) 
  • The ONS found that female gender was a characteristic associated with higher levels of depression during the pandemic.
  • Key workers, including those within the NHS, experienced high levels of exposure to COVID-19. The majority of these are women; 54% compared with 42% of men. 
  • 40% of female key workers in health and social care work in frontline roles which required face-to-face interaction (compared with 17% of men).
  • Ethnic minority women are overrepresented in both health and social care, with one in five NHS workers being from an ethnically diverse group. Ethnic minority nurses are also significantly more likely to be on the lowest nursing band than all other nursing grades put together with more exposure to the virus. 
  • Lone parents (the vast majority of whom are women) were twice as likely to have poor mental health, compared with other family types, immediately before and in the early stages of the crisis. Overall, 51% of single parents reported having depression, bad nerves or anxiety; compared with 27% of couple parents.

Preventing the negative impact of menopause in the workplace

Use of Occupational Health is a MAJOR opportunity in the workplace, not only to help with advice on managing the symptoms but to identify health risks and introduce preventative strategies. Menopause transition at any age and in whatever context is an important biomarker for an increased risk for various associated diseases and problems. Early menopause raises concerns about the longer-term effects of spending more years without oestrogen such as bone  density loss, musculoskeletal symptoms, vaginal, bladder and sexual effects, which influences quality of life contributing to personal and work-related stress. Chronic disease can begin 10 years after the onset of natural menopause such as cardiovascular disease and osteoporosis. These diseases and poor quality of life can be prevented with early identification, timely intervention, lifestyle modification, supplements, and therapeutic options.  

Using the date of ‘last menstrual period’ provides limited insight into the whole life course of reproductive health according to the Royal College of GP’s menopause toolkit, who recognise that 25% of women of reproductive age will have menstrual health issues that will seriously impact their health and wellbeing. However, use of a gender sensitive assessment, such as the The menopause rating scale ²  (Diagram ) will identify any menopause  red flags to the OH professional, increasing awareness, and enabling signposting for further support and information. The key objective is to measure the quality of life, severity of complaints and to measure changes over time and across different cultures. Outcomes are measured as an impact on the individual’s life and work to gauge severity but are of most use when assessing interventions such as treatment and/or self-management strategies and/or work adjustment, over time.

Other tools and information to be signposted towards:

Frax: fracture risk assessment

Diabetes

Men, prostate treatment and hot flushes

Diagram 2 Tools to support Occupational Health practice

Occupational Health should be part of the wider health and wellbeing strategy and can provide a vital role in ensuring it is inclusive to meet the needs of all employees. A sign of a healthy organisation is demonstrated with the skill of managers knowing when to involve occupational health in the health and wellbeing management of employees. An inclusive health and wellbeing strategy that includes reproductive and sexual health could assist in addressing operational concerns of absent management, presenteeism and attrition through:

  • Access policy and/or a management guide for menopause and women’s health,
  • Encourage the inclusion of these topics in wellbeing conversations, 
  • Educate all key personnel, 
  • Conduct a risk assessment to identify hazards that can be reduced (include environment and welfare)
  • Liaise with Occupational Health
  • implement reasonable adjustments with the use of a WRAP (Wellness Recovery Action Plan),
  • Support flexible and agile working 
  • Encourage Women’s Wellness networks

Inclusive signposting based on the diverse needs of your employee.

https://www.womens-health-concern.org

https://www.nhs.uk/conditions/menopause/

https://www.menopausedoctor.co.uk

https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women/menopause-and-your-heart

Royal Society of Osteoporosis

https://www.daisynetwork.org

https://patient.info/news-and-features/pelvic-floor-exercises

https://www.squeezyapp.com/

https://www.nutrition.org.uk/healthyliving/lifestages/menopause.html?start=2

Emma Persand is a qualified nurse and Director and Founder of Lemur Health – an organisation that provides consultancy, education, and training to support and retain women employees.
Emma delivers group cognitive behavioural therapy sessions to women suffering from physical and psychological symptoms brought on by the menopause transition.
 

 

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