How much closer are we to gaining equality for people experiencing perimenopause and menopause symptoms? Journalist Anna Scott reports.
Most organisations in the UK employ people who are experiencing the menopause – close to four million women aged from 45 to 55 years are employed, and a growing proportion of the workforce is aged 50+ (Department for Work and Pensions (DWP), 2024). What’s more, 40% of all employees in the NHS are menopausal women (Fawcett Society, 2022).
Yet a recent survey of 11,000 Unite reps found that 83% of menopausal women lack access to support in their workplace (Unite, 2023). Another survey found that nearly three quarters of women aged from 40 to 60 years have experienced menopause or perimenopause symptoms, yet more than half have been unable to go into work at some point as a result (Chartered Institute of Personnel and Development (CIPD), 2023).
The most common menopause and perimenopause symptoms are psychological: mood disturbances, anxiety, depression, memory loss, panic attacks, loss of confidence and reduced concentration (CIPD, 2023). These generally have a negative effect on women at work, according to 67% of those with experience (CIPD, 2023).
An employment tribunal awarded a female office manager £37,000 after her managing director told her she used menopause symptoms as an ‘excuse for everything’, and to ‘just get on with it’ after being ill and off work (BBC, 2023). But it’s not just about the work context: if women don’t get help for symptoms, it can affect their entire lives.
THE ‘DAVINA EFFECT’
In 1989 the British Menopause Society (BMS) was established to educate, inform, and guide healthcare professionals on all aspects of post-reproductive health (BMS, 2024). The charity’s patient arm since 2012 – Women’s Health Concern – was established in 1972 to provide a confidential and independent service advising, informing and reassuring women about gynaecological, sexual and post reproductive health (Women’s Health Concern, 2024).
Now perimenopause and menopause are in the public consciousness more than ever. They feature in TV and radio programmes, podcasts, magazine and online articles, books, advertisements and on social media.
Prescriptions for hormone replacement therapy (HRT) in England almost doubled to 11 million from 2021 to 2023, with an estimated 2.3 million patients prescribed HRT – an increase of 29% from 2021 (NHS Business Services Authority (NHSBSA), 2023). Known as the ‘Davina effect’, the rise followed the airing of a series of Channel 4 documentaries presented by Davina McCall in 2021 and the subsequent publication of the award-winning book Menopausing, which she co-wrote with Naomi Potter (Petrie, 2023).
The question is, has this all translated into greater equality, awareness and support? And is it as good as it can be?
GREATER UNDERSTANDING
We are more comfortable talking about the menopause now. ‘It used to be known as “the change” – people didn’t even want to say the word,’ says Janet Taylor, CPHVA Executive chair and a nurse manager for children’s services at South Eastern Health and Social Care Trust, Northern Ireland. ‘Now it’s quite acceptable, for example, to have a mini-fan sitting in front of you – nobody bats an eyelid,’ she says.
Increased awareness and better understanding of how symptoms work have meant significant strides in workplace equality for women, according to Dr Rebecca Lewis who is a GP, menopause specialist and co-founder of Newson Health Menopause Clinic. ‘Workplaces are now more aware of the economic costs associated with menopause,’ she says.
And those economic costs haven been big. Women leaving the workforce due to menopause symptoms has cost the economy £10bn (Fawcett Society, 2022). Untreated symptoms result in increased absence and reduced productivity, especially in the NHS (Fawcett Society, 2022).
‘We hear from women that the workplace is where they can struggle to manage their menopause symptoms, which is why we launched our Menopause Workplace Pledge,’ says Janet Lindsay, chief executive of charity Wellbeing of Women (WOW).
‘We are encouraged that over 3000 employers have signed up, and hope many more will see the value in signing.’ More than nine in 10 employers said they felt the pledge has contributed to improvements in support at work, Janet reveals.
WOW wants to see more support from small and medium-sized enterprises (SMEs) which lack the resources of larger organisations to drive this change. It plans to launch specific SME resources later this year.
HEALTH KNOWLEDGE
The recognition and management of perimenopause and menopause symptoms among GPs and other healthcare professionals has also improved significantly – and continues to grow. So says Geeta Kumar, a consultant gynaecologist, menopause specialist and vice president of the Royal College of Obstetricians and Gynaecologists (RCOG). ‘This includes better awareness and use of all available options including the use of HRT to treat common symptoms and provide holistic care.’
The expansion of women’s health hubs announced in the previous government’s Women’s Health Strategy for England (Department of Health and Social Care (DHSC), 2022) will further boost menopause treatment in primary care settings, Dr Kumar says. ‘The hubs will serve to better integrate all the services and provide support that women require throughout their reproductive life course, into one place.’ The DHSC’s ‘core specification’ guidance on women’s health hubs was updated earlier this year (DHSC, 2024).
However, for now, menopause expertise often depends on an individual GP’s interest rather than mandated education. ‘Historically, medical students have received minimal training on hormonal issues, which needs to be addressed,’ Dr Lewis says.
Janet Taylor agrees: ‘Don’t assume that every GP is an expert in [the menopause], because they’re not.’ She describes a conversation with a colleague who got information on her symptoms from an ITV programme website, before describing what she found to her GP. ‘It’s about taking ownership,’ Janet adds.
GROWING SUPPORT
‘There are so many toolkits and education programmes available now, says Professor Janice Rymer, chair of the British Menopause Society. As former national specialty adviser for gynaecology with NHS England and Improvement, Professor Rymer worked on a menopause awareness training module for NHS managers and staff.
‘Previously you’d have a manager who was a 25-year-old man and had absolutely no idea,’ she says. ‘In a way, [thanks to the numerous toolkits available] there’s no excuse now for people not to be aware of women going through perimenopause and menopause.’
Professor Rymer also helped set up a clinic for staff at Guy’s and St Thomas’ NHS Foundation Trust in London, where she is a consultant gynaecologist. ‘Those of us who run the [patient] menopause clinic did evening telephone clinics for staff. We gave them advice after a 15-minute consultation, which they could then go to their GP with,’ she adds. The successful clinic has received full funding and other NHS trusts are beginning to introduce similar staff clinics (Rymer et al, 2022).
The introduction of HRT pre-payment certificates in England has helped improve access to it, reduce costs for women and made prescriptions more readily available. ‘I’ve been involved in this area since 1990 and I’ve seen women who need HRT have their lives transformed,’ Professor Rymer notes.
| MENOPAUSE INEQUALITIES |
| 20% Women experience earnings losses amounting to 20% relative to pre-menopausal levels |
| 22% of disabled women who have been employed during the menopause said they had left because of their symptoms compared to 9% for non-disabled women |
| 23% of female key workers say their uniforms are uncomfortable, given their menopause symptoms |
| 45% of Black and minoritised women say it took many appointments for their GP to realise they were experiencing the menopause, compared to 30% of white women |
| 94% of postmenopausal women were never taught about the menopause at school |
2024; Fawcett Society, 2022
WHAT INEQUALITIES EXIST?
HRT is not the only treatment option, though. ‘It’s about menopause management, a holistic approach. We’ve got to help women lose weight, stop smoking, have a good diet, reduce alcohol – all those sorts of things as well,’ Professor Rymer says.
‘The media have done a lot to help. But one problem is that everybody thinks HRT is going to solve every perimenopausal and postmenopausal woman’s problems. Other diseases can occur at the same time and are not going to be solved by HRT,’ she points out.
Equally, there is still a need for broader education about HRT to reinforce its evidence-based safety and effectiveness, Dr Lewis adds. ‘Although there has been an increase in the last few years of prescriptions for HRT, only 14% of women are taking HRT with much lower levels in areas of social deprivation. This low level of uptake means an enormous amount of women will be suffering needlessly.’
The RCOG (2018) supports longer prescribing cycles for HRT so women don’t need to visit the doctor as often. ‘Booking doctors’ appointments and paying for HRT can be prohibitively expensive for poorer households and may act as a barrier to some women when it comes to accessing prescriptions,’ Geeta notes. ‘Removing barriers like this are important in reducing already entrenched women’s health inequalities.’
Women of colour need more support and treatment too. ‘There is limited research on experiences of menopause by ethnicity but there is thought to be a variation in symptoms,’ Geeta adds. ‘More research is needed to identify differences in menopause experience and symptoms for all ethnicities to improve our knowledge, recognition of symptoms and treatment across all groups.’
REMAINING CHALLENGES
‘To enhance overall care, it is crucial to expand training beyond GPs to include a broader range of healthcare professionals and improve general societal understanding,’ says Dr Lewis.
While the RCOG (2023) supported the development of the UK’s first menopause education programme last year, ‘there is still more work to be done to improve education around menopause for women, healthcare professionals and members of the public to address the challenges and inequalities faced in accessing menopause care and treatment,’ Geeta adds.
And there still isn’t enough awareness generally about the perimenopause, with calls for menopause education to start from school-age onwards (Aljumah et al 2023, Harper et al, 2022, Munn et al 2022, Patel et al 2023).
Dr Lewis adds: ‘Overall, there is still a huge amount of work required to ensure comprehensive knowledge in all healthcare practitioners to enable them to provide effective treatment for all.’
YOUR RIGHTS IN THE WORKPLACE
The Equality and Human Rights Commission (EHCR) clarified this year how women experiencing perimenopause and menopause symptoms at work are protected by the law.
Under the 2010 Equality Act, workers are protected from direct and indirect discrimination, harassment and victimisation on the basis of disability, age and sex (among other protected characteristics) (EHCR, 2024).
Menopause symptoms could be considered a disability if a long term, substantial impact on a woman’s ability to carry out normal day-to-day activities arises. Women may also be protected from receiving less favourable treatment on the grounds of age and sex (EHRC, 2024).
Direct discrimination would include treating an employee’s menopausal symptoms less seriously than a male counterpart’s health condition, if performance issues are related to the condition (Martin Searle Solicitors, 2024).
Indirect discrimination would include a strict uniform policy, if the uniform makes menopause symptoms uncomfortable (Kennedys, 2023).
HELPING CPs
‘Menopause policies are embedded in the NHS [and] we’ve had one for about five or 10 years,’ Janet Taylor says, adding that she tells everyone who talks to her about symptoms to read the policy first.
‘Policies usually include how your employers can best support you with your working environment or flexible working. I’d also advise them to get occupational health support. It is crucial that care and understanding is given to women who are struggling with the menopause,’ Janet stresses.
‘Sometimes we never look at something until we might need it. And sometimes people don’t realise they are perimenopausal or menopausal,’ she adds. ‘I would advise them to talk to their manager; they may want to reduce their hours for a short time. And I would be encouraging them to visit their GP.’
Community practitioners also have an important role as a trusted source of information and support for the local population, says Geeta. ‘Health visitors are well-placed to support tailored information provision.’
| RESOURCES |
| > British Menopause Society Guidance for healthcare professionals |
| > Menopause Support Information and advice for all |
| > Unite Menopause at Work guidance |
| > Women’s Health Concern |
| > Wellbeing of Women |
Dr Lewis agrees. ‘Making sure people experiencing menopause symptoms are informed on the full spectrum of symptoms beyond hot flushes, can be instrumental in helping educate patients and improve awareness overall.’
Unite campaigns, organises and represents women affected by perimenopause and menopause symptoms in the workplace. The union publishes a range of guidance materials for members, including a Menopause Model Agreement with Checklist, Risk Assessment Checklist, and Menopause Health and Safety Briefing (see Resources).
While much progress has been made in understanding and helping people with perimenopause and menopause symptoms, significant challenges remain – not least in understanding contrasting experiences of different groups of women and making life better for them.
SHARE YOUR EXPERIENCES
Simply email editor Aviva Attias aviva@communitypractitioner.co.uk
REFERENCES
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