Features

Menopause at work: time for change

07 February 2020

Three in five women aged 45 to 55 going through menopause say it has negatively impacted them at work. Journalist Linsey Wynton looks at what needs to change.

Women over 50 are the fastest-growing section of the UK workforce (Chartered Institute of Personnel and Development (CIPD), 2019a). Indeed, more than three-quarters of the NHS workforce are female (Noble, 2019).

Yet three in five women aged 45 to 55 experiencing menopause say it has negatively impacted them at work (CIPD, 2019a). And one in four women have considered leaving work because of the menopause (ITV, 2016).

The average age for menopause transition is 51, and almost 60% of British women experiencing it say it affected their concentration, stress levels and patience. More than a third took sick leave because of their symptoms. But only a quarter felt able to tell their boss why, for reasons including embarrassment and an unsupportive manager (CIPD, 2019a).

Clearly, there is still stigma attached to the menopause (Engender, 2019), and two employment tribunals have been won by women found to have been discriminated against during their transition (Henpicked, 2019).

This stigma may explain why ‘most women don’t admit the real reason for sickness absence’, says Professor Amanda Griffiths from the Institute of Mental Health at Nottingham University. But the result is that they ‘cannot access support and adjustments’, she explains. ‘This can lead to inappropriate disciplinary procedures.’

So what’s behind these disappointing figures and what needs to be done to ensure that peri- and postmenopausal woman are properly supported in the workplace as a matter of course?

The transition has begun

Back in 2017, Jo Brewis, professor of people and organisations at the Open University Business School, wrote a report for government on how the menopause affected women’s economic participation in Britain. ‘Unlike pregnancy or maternity, the menopause is not well understood or provided for in workplace cultures, policies and training,’ she wrote, adding: ‘Gendered ageism seems to be the cause of many of the problems which working women experience during transition.’

Yet Jo notes that the Equality Act (2010) covering England, Scotland and Wales ‘protects women against workplace discrimination on the basis of either their sex or their age’ (Brewis et al, 2017). Meanwhile, the Workplace (Health, Safety and Welfare) Regulations for England, Scotland and Wales (1992) and Northern Ireland (1993) cover an array of workplace requirements including ventilation, temperature and sanitary facilities, all pertinent to women experiencing menopause. Employers also have responsibilities to staff experiencing menopause under the UK Health and Safety at Work Act (1974) and the Management of Health and Safety at Work Regulations (1999) for England, Scotland and Wales and Northern Ireland (2000).

Jo also works with Menopause in the Workplace, which has provided line manager training for employers, including the NHS, since 2015. ‘When we were compiling the report for government there were very few examples of organisations working on this important area. Things look different today, although there is still progress to be made,’ she says.  

Thankfully, changes are afoot politically. Conservative MP Rachel Maclean raised normalising the menopause as a workplace issue in Parliament (Boseley and Osborne, 2019; Maclean, 2019) and Labour and the Liberal Democrats pledged to ensure employers provide support to menopausal women in their recent manifestos (Labour, 2019; Muller-Heyndyk, 2019). Meanwhile, Scotland’s SNP Government has promised action to support menopausal women at work (Gollan, 2019).

In May 2019, Unite highlighted a win by members in Wales after an energy firm committed to introducing a menopause policy following a campaign by union reps (Campbell, 2019). Unite national equalities officer Siobhan Endean says: ‘Unite wants to raise awareness and help women members experiencing the menopause at work through our network of safety reps and shop stewards.’  

Unite also works with employers regarding the menopause at work, and recently worked with the NHS Staff Council’s Health, Safety and Wellbeing Partnership Group on eight forthcoming organisational principles. Unite’s own menopause guidance encourages union branches on a number of points including having an equality rep (Unite, 2012).

‘Organisations have to be considering retention strategies, and doing so far and above anything else’

What needs to change?

Deborah Garlick, a Menopause in the Workplace trainer, says: ‘While there are more women in the workplace than ever before holding more senior positions, there are many who think “I worked hard for equality – I don’t want to show weakness.”

‘The only way to resolve that is to change the perception and the understanding around menopause and for people to talk about it openly. Biology and equality are different things.’  

In March 2019, the CIPD launched guidance for employers entitled Let’s talk menopause (CIPD, 2019b). Claire McCartney, CIPD senior policy adviser for resourcing and inclusion, says: ‘We also did a poll of HR professionals and asked them if they had any support in place – a policy framework or guidance – and less than 10% had anything.’ Now lots more organisations are talking about the menopause and what they can do, so it is going in the right direction. But more needs to be done.’

So what do the CIPD want to see happen to improve the situation? Claire explains that the organisation has called on the government to action three main points:

  • Create a menopause ambassador to work across government departments
  • Mention the menopause in workplace policy papers
  • Support an employer-led awareness-raising campaign.

They’re hopeful these will come about, since it’s a cross-party issue.

Claire says this approach is better than legislation: ‘Often legislation can result in a tick-box approach. We want organisations thinking about getting people talking about the menopause and educating managers so they can properly support staff.’

Deborah reinforces two of the main issues that need to be addressed: ‘Line managers, male and female, don’t understand enough about menopause or how to support a woman. And women don’t know how to ask their managers for help.’

Deborah trains many NHS managers and says: ‘You’d think in the NHS they’d know all about menopause. They certainly don’t.’ She adds: ‘I have had a lot of nurses saying to me: “That’s me – I am at that point now – can I cope with this?” Organisations have to be considering retention strategies far and above anything else.’

What can employers and managers do?

The CIPD says there are simple steps employers can take that will make a huge difference to individuals (CIPD, 2019a). And they recommend that these are clearly outlined to managers and employees so they know what’s available. The guidance includes giving women a later start time if their sleep pattern is disturbed, providing a desk fan to help with hot flushes, ensuring women can take regular comfort breaks, and allowing them to adapt their uniform to improve comfort.

Claire from the CIPD suggests a ‘cafeteria approach’ where women can choose options to best manage their symptoms: for example, allowing more breaks including for those driving to different locations. She says it’s also important to treat each staff member as an individual, as of course not everyone has the same symptoms.

Claire reveals that to date, some organisations have ‘resourced a confidential helpline for an hour per month; held focus groups to learn what would be useful for staff; created menopause discussion packs for line managers; and set up buddy schemes and social network groups for women experiencing menopause to share their experiences’.

Jo adds: ‘Community practitioners [put in] a lot of emotional labour supporting clients, which might prove challenging if they are feeling depressed or anxious because of menopause. So increased support from management, including decompression time would help.’ She also says that ‘record-keeping might become more difficult too as menopause symptoms can include foggy brain, difficulties in recall and poor concentration. Reasonable adjustments, such as more time to update notes, can help.’

Other reasonable adjustments Jo suggests include access to cold drinking water, decent toilets, informal support groups (online or in person), appropriate uniforms and tailored absence policies. She also says line managers should be trained in having sensitive conversations.

‘Remember costs [of improving life at work for women] will be low and returns significant,’ adds Deborah. ‘It will pay off if you stop one or two colleagues leaving the workforce unnecessarily.’

‘You saved my job’

There are also some leading examples from individuals in healthcare. Nikki Noble is lead nurse on menopause at Aneurin Bevan University Health Board. In 2018, she launched a pioneering scheme offering staff access to specialist menopause clinics. She started it off with menopause awareness sessions and then set up an appointment-based menopause service. She recently received an award for improving staff wellbeing. Learn more about her scheme in the panel In practice on the opposite page.

Helen Downie, an occupational health nurse at NHS Greater Glasgow and Clyde, is helping to develop a menopause guidance document, which she hopes will be implemented this year. It will aim to inform managers so that staff reporting menopause-related issues can be supported.

Kathy Abernethy is co-leader of the NHS Menopause Service in Harrow, London, which women have to be referred to. ‘I’ve had women in tears because they are so relieved to have someone to talk to,’ says Kathy. ‘Women say to me “You saved my job.” I also have staff knocking on my door informally asking for advice. They have the stress of work and the public sector and the menopause.’

What does Kathy think is the way to improve working life for women? ‘Training about the menopause could be included in existing mandatory training,’ she says. ‘Currently, the will is lacking, partly because mangers don’t understand the benefits and it goes to the bottom of the pile because of the pressures of the NHS. We also need a web-based menopause resource for NHS staff. A few women will also need access to one-on-one advice.’

Kathy, also director of menopause for Peppy Health, a new online and telephone support resource (peppy.health/menopause), says: ‘It’s the first service [of its kind] in the UK. Employers only pay for it if a woman uses it. Staff register with their work email, but your manager does not need to know you’ve been in contact. So far it’s being used in the private sector but it lends itself well to the public sector.’

‘Menopause, alongside menstruation and gynaecological conditions, are not discussed sufficiently – we need to break the taboo in society’

Moving on

What’s the answer moving forward? ‘Employers should try to create an open culture for women who want to talk [about the menopause] – but without forcing those who don’t,’ says Claire at the CIPD.

Recently people in the public eye, including actresses Emma Thompson, TV presenter Trisha Goddard and Olympian Sharron Davies, went public about their menopause experiences. Experts agree this openness benefits all women.

‘Menopause, alongside menstruation and gynaecological conditions like endometriosis, are not discussed sufficiently – we need to break the taboo in society’, says Jo.

‘We are making progress to get the menopause on the secondary curriculum because girls and women don’t get that much information about it – and it’s happens to us all,’ says Claire.

Unite advises women to seek advice from their union rep to make changes to working environments, which can benefit everyone. Siobhan says: ‘Women can play an important role in raising workplace standards for all.’  


Menopause realities

In the ‘peri-menopause’ phase, a woman’s hormone balance begins to change, typically in her late 40s but sometimes much earlier. Symptoms can include mood changes, sleep disturbance, weight gain, night sweats, hot flushes, dryness of the skin, eyes, mouth and vagina.

The menopause typically happens between age 45 and 55 when a woman’s oestrogen levels decline and her periods stop. About one in 100 women have it before age 40.

Symptoms typically last for four years from a woman’s last period, but in a tenth of women they can last for 12 years. They can include:

  • Anxiety, depression, memory loss, panic attacks, reduced confidence and concentration
  • Hot flushes and headaches  Sleep disturbance and night sweats
  • Muscle and joint stiffness, aches and pains
  • Recurrent urinary tract infections (UTIs)
  • Weight gain
  • Heart palpitations
  • Skin dryness, acne, itchiness.

Self-help

  • Increase exercise: improves memory and concentration, reduces anxiety
  • Reduce weight/maintain healthy weight: women with BMI over 30 are more likely to have hot flushes
  • Improve diet: to reduce BMI, stay healthy and maintain bone health
  • Stop/reduce smoking, and be aware of triggers such as spicy food to reduce flushes (Noble, 2019)
  • Wear layers when out and about to help with symptoms such as flushes and sweats, says Nikki Noble.
  • A change of clothing can help, suggests Kathy Abernethy. Think about access to toilets when you are visiting homes. And drink plenty of water to avoid UTIs.

HRT shortages

Recently there have been shortages of HRT.

Nikki says: ‘It’s best to check the British Menopause Society website for updates on stock availability.’

Kathy says: ‘HRT patches have been the most difficult to get. Good GPs should know the best alternatives.’


In practice

Nikki Noble is lead nurse on menopause at Aneurin Bevan University Health Board. In 2018, she launched a scheme offering staff access to specialist menopause clinics.

‘My first step was setting up menopause awareness sessions, allowing staff to find out more about the menopause for themselves, patients and the staff they manage. These are held across the trust – in hospitals, day care premises and community clinics. They include a presentation on lifestyle factors that can exacerbate menopausal symptoms and treatments including hormone replacement therapy (HRT), then questions and discussion.

‘Next, I set up an appointment-based menopause service for staff in three locations across the trust. Staff refer themselves by phone. At their appointment they have their blood pressure, height, weight and body mass index (BMI) recorded, and their medical and gynaecological history taken.

‘After discussing symptoms and lifestyle factors, they get the option to try HRT either in patch, gel or tablet form, depending on their BMI and medical/ family history. This is reviewed after three months. If they are happy, they will be discharged to their GP but offered an annual review.  

‘I surveyed attendees anonymously and the feedback was positive. Some women had considered retiring early or looking for less demanding work before attending the clinic. Some had taken sick leave because of menopause symptoms and were supported to return to work.

‘This has been cost-neutral. There will have been a cost saving in terms of fewer GP visits and less sick time.’


Resources:


References:

Boseley S, Osborne H. (2019) Workplaces must protect women going through the menopause, say MPs. See: theguardian.com/society/2019/aug/25/mandatory-workplace-menopause-policies-uk (accessed 8 January 2020).

Brewis J, Beck V, Davies A, Matheson J. (2017) The effects of menopause transition on women’s economic participation in the UK. See: gov.uk/government/publications/menopause-transition-effects-on-womens-economic-participation (accessed 8 January 2020).

Campbell, A. (2019) Not just a physical change. See: unitelive.org/dont-underestimate-the-effects-of-the-menopause-on-your-mental-health/ (accessed 15 January 2020).

CIPD. (2019a) Majority of working women experiencing the menopause say it has a negative impact on them at work. See: cipd.co.uk/about/media/press/menopause-at-work (accessed 8 January 2020).

CIPD. (2019b) Let’s talk menopause. See: cipd.co.uk/knowledge/culture/well-being/menopause (accessed 8 January 2020).

Engender. (2019) Engender parliamentary briefing: It’s time to end the stigma of the menopause. See: https://www.engender.org.uk/content/publications/Engender-Parliamentary-Briefing---Its-Time-to-End-the-Stigma-of-the-Menopause.pdf (accessed 8 January 2020).

Equality Act. (2010) See: http://www.legislation.gov.uk/ukpga/2010/15/contents (accessed 16 January 2020).

Gollan J. (2019) Together we are working to break down barriers and advance equality for all. See: snp.org/together-we-are-working-to-break-down-barriers-and-advance-equality-for-all/ (accessed 8 January 2020).

Health and Safety at Work Act. (1974) See: legislation.gov.uk/ukpga/1974/37 (accessed 16 January 2020).

Henpicked. (2019) Menopause tribunals: what can employers learn? See: menopauseintheworkplace.co.uk/employment-law/tribunals-employers-best-practice-2/ (accessed 8 January 2020).

ITV report. (2016) Quarter of women going through menopause 'considered leaving work'. See: itv.com/news/2016-11-23/quarter-of-women-going-through-menopause-considered-leaving-work/ (accessed 8 January 2020).

Labour. (2019) Labour announces plans to break stigma of the menopause at work. See: labour.org.uk/press/labour-announces-plans-break-stigma-menopause-work/ (accessed 8 January 2020).

Maclean R. (2019) Watch my House of Commons menopause debate. See: rachelmaclean.uk/2019/02/14/watch-my-house-of-commons-menopause-debate/ (accessed 15 January 2020). 

Management of Health and Safety at Work Regulations. (1999) See: legislation.gov.uk/uksi/1999/3242/contents/made (accessed 23 January 2020).

Management of Health and Safety at Work Regulations (Northern Ireland). (2000) See: legislation.gov.uk/nisr/2000/388/made (accessed 23 January 2020).

Muller-Heyndyk, R. (2019) Lib Dems pledge ‘skills wallet’ for all adults. See: hrmagazine.co.uk/article-details/lib-dems-pledge-skills-wallet-for-all-adults (accessed 8 January 2020).

Noble, N. (2019) Nurse-led scheme in Wales making the menopause more manageable. See: personneltoday.com/hr/nurse-led-scheme-in-wales-making-the-menopause-more-manageable/ (accessed 8 January 2020).

Unite. (2012) Negotiator’s guide: women’s health, safety and well-being at work. See: https://unitetheunion.org/media/1480/womens-health-safety-well-being-at-work-unite-guide.pdf (accessed 15 January 2020)

Workplace (Health, Safety and Welfare) Regulations. (1992) See: http://www.legislation.gov.uk/uksi/1992/3004/contents/made (accessed 16 January 2020).

Workplace (Health, Safety and Welfare) Regulations (Northern Ireland). (1993) See: http://www.legislation.gov.uk/nisr/1993/37/contents/made (accessed 16 January 2020).

 

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