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The perimenopause: shining a light

20 September 2021

Once taboo, the perimenopause is now a public health issue – with campaigners calling for free NHS prescriptions for HRT in England. Journalist Jo Waters asks why the perimenopause has turned political.

Suddenly, the rocky road women can travel in their perimenopause – the months and years running up to the menopause, when their periods stop – is being talked about in high places.

Fed up with suffering in silence, often soldiering on when they are plagued by heavy periods, concentration problems and anxiety, and worrying if even admitting to being perimenopausal will lead to discrimination at work or ridicule from younger colleagues, women are saying they want recognition for the health and psychological problems the perimenopause transition can cause.

Menopause was much in the headlines over the spring and summer. TV presenter Davina McCall spoke about her experience of the perimenopause in her Channel 4 documentary Sex, Myths and the Menopause. An All-Party Parliamentary Group (APPG) on Menopause was set up, launching an inquiry into menopause in the workplace and other controversies – such as why women have to pay prescription charges for hormone replacement therapy (HRT) in England. Labour MP Carolyn Harris’s private members’ bill on menopause – the Menopause (Support and Services) Bill – had its first reading in June. Employers such as Vodafone began announcing menopause policies for women in the workplace. There’s even a World Perimenopause Day coming up on 11 October, as well as World Menopause Day on 18 October.

Deep impacts

Diane Danzebrink, founder of Menopause Support, successfully campaigned for menopause to be added to the relationships and sex education curriculum in schools from September last year. The #MakeMenopauseMatter online petition calling for a raft of measures to support women in the workplace and improve education about symptoms among health professionals and women 
themselves was spearheaded by Diane and had collected 150,000 signatures by the end of July.

Diane says: ‘It’s absolutely heart-breaking to read how perimenopausal symptoms affect women. I printed off 500 A4 pages of comments left by women about their experiences when they signed the campaign petition and presented them to the APPG on Menopause so they could get some idea of the scale of the problem.’

Around 13 million women in the UK are peri- or postmenopausal, and the symptoms can last up to 15 years, with one in four experiencing severe debilitating symptoms (Menopause Support, 2021). Many people associate the menopause with hot flushes and periods stopping, assuming it all takes no more than a couple of months from start to finish. But for significant numbers of women, the perimenopause can be peppered with multiple, seemingly unrelated symptoms that heavily impact their daily life. These include irregular and heavy periods – sometimes flooding clothing or containing blood clots – anxiety, mental fogginess, urinary symptoms, muscle and joint problems, heart palpitations, dry vagina, hair thinning and depression.

 

‘Just your age’?

‘Many women don’t associate their symptoms with the run-up to the menopause, particularly if they are still having periods,’ says Dr Heather Currie MBE, gynaecologist at Dumfries and Galloway Royal Infirmary, founder of Menopause Matters and a past chair of the British Menopause Society. ‘Some women have even told me that their doctor has said their symptoms are not connected to the menopause because they are still having periods. But the perimenopausal period can mean women experience fluctuations in their hormone levels for several years – even from their early to mid-40s. These hormone imbalances can mean their periods can be heavy, irregular, unpredictable and troublesome.

‘It’s a transitional period though, and once women are told that their symptoms are connected to their fluctuating hormone levels, they’re often relieved to know there is a reason for how they are feeling, and treatments are available, including hormonal contraceptives and HRT.

‘Increasingly, women are not putting up with being told it’s “just your age”.’

Around 13 million women in the UK are peri- or postmenopausal, and the symptoms can last up to 15 years

Low awareness among health professionals

Katie Taylor, 52, says it took her four years to get a diagnosis for her perimenopause symptoms. ‘I suffered from brain fog, memory problems, low energy, anxiety and heart palpitations from the age of 43. But I had four kids and a busy job, and I just put it down to that. Then my periods became shorter and heavier, and I gained a lot of weight. My GP said I was stressed and depressed, and suggested I take time off work and take antidepressants.’

Katie says the antidepressants didn’t work, and she ended up leaving her job and developing yet more symptoms, including hair loss and joint pain.

‘I was then referred to a neurologist, a cardiologist and a rheumatologist for different symptoms – I felt I was either going mad or was a hypochondriac. It was my father (a retired breast cancer surgeon), who suspected all my symptoms were down to hormones. When I eventually saw a gynaecologist who specialised in the menopause, she said my oestrogen levels were on the floor and it was suggested I went on HRT immediately. My diagnosis was the first time I’d heard the word perimenopause – I cried with relief that night.’

Katie gradually weaned herself off antidepressants and began to feel normal again. She set up a Facebook group for women going through the same symptoms – ‘The Latte Lounge: Top Tips 4 Women Over 40’ – which now has more than 20,000 members.

‘Some women don’t want to take HRT and will try anything else – they’ve been scared off by the Women’s Health Initiative trial in 2002, which found there was a slightly higher risk of breast cancer in those undergoing HRT, but which has since been shown to be flawed,’ she says. ‘But HRT, for those who can and want to take it, is really the only thing that addresses all the symptoms.’

The evidence now suggests that the risks of HRT are small and usually outweighed by the benefits (NHS, 2018). ‘The difference it made to me was like flicking a switch back on,’ says Katie. ‘I really think the word “menopause” should be renamed “oestrogen deficiency disease” – I intend to take HRT forever and I say that as the daughter of a breast cancer surgeon.’

Diane says better education for health professionals is key and wants a mandatory module in menopause added to medical school curriculums and then again as part of their GP training. ‘I’d love to see all healthcare professionals have more education about the perimenopause and menopause, including health visitors and school nurses – they are ideally placed to help women recognise their symptoms and advise them about getting treatment,’ she adds.

One of the most difficult things is having conversations about the menopause at work because people don’t want to ask about it

What’s the impact on women at work?

Research by the UK’s Chartered Institute of Personnel and Development (2019) found that 59% of women aged between 45 and 55 experiencing menopausal symptoms said their work was impacted. The same study found around 900,000 women aged 45 to 53 left their jobs because of their symptoms. And a survey published in August of nearly 500 women found 42% of them had considered leaving their jobs because of the perimenopause (Latte Lounge, 2021).

Siobhan Endean, Unite national officer for equalities, says: ‘One of the things the union is doing is organising events for union reps to talk about menopause and perimenopause, and to encourage workplace conversations about it and what workplace adjustments can be made to accommodate not just the medical impact but also the social issues.

‘I think it’s still a taboo issue, and one of the most difficult things is having those conversation openers about the menopause at work because people don’t want to ask about it – partly because of the double whammy of sex and age discrimination attached to perceptions of women and the menopause.

‘There are lots of health issues – heavy and irregular periods, weight gain, headaches, irritability – and all of those things have a major impact on women’s work and health and safety issues. One of the issues is access to toilets and toilet breaks, as well as uniforms, PPE and ill-fitting uniforms. Employers should also consider ventilation and workplace temperatures.’

One of the biggest issues is sick pay, adds Siobhan, because of the taboo nature of perimenopause. ‘Women may be reluctant to give their reason for absence,’ she says. ‘There is also the fear of being harassed, ridiculed or of facing age discrimination. Employers should have a menopause policy in place and make adjustments to working conditions to make working through the menopause easier.’

Siobhan says Unite’s model agreement for employers (see Resources) sets out key areas for negotiating rights for menopausal women. It includes paid time-off for medical appointments and screening related to the menopause and recognition of menopause symptoms. Sickness absence policies should not penalise women who have to take time off work because of ill health. She says it’s important employers recognise their legal responsibilities under health and safety legislation and have equality and health and safety reps trained to carry out risk assessments in the workplace around the menopause.

‘A lot of this is not hard to do, but it can make such a difference. At the end of the day, if you are supported you are more likely to stay in your job and feel you have a future there. There’s still a mountain to climb, but I think we are finding more and more that companies are wanting to talk about putting menopause policies in place.’

 

Change afoot?

More employers are now coming on board to launch menopause policies and guidelines. The insurance company Aviva has introduced a menopause support phone app for its employees, offering 45-minute one-to-one appointments with a specialist. Sherwood Forest Hospital NHS Foundation Trust in Nottingham is just one of several trusts to recognise that female staff need support for the menopause, and has launched a research project, several sold-out conferences and monthly menopause support groups for staff, among other measures (NHS Employers, 2019).

Diane says we need more awareness that symptoms can start in the early 40s, and women need more support and adjustments at work during this transitional period. ‘Women in public-facing professions such as nursing, the police and teaching often really struggle during their menopause and many end up leaving their jobs – we lose so many good people because their symptoms are not recognised by themselves, their healthcare professional or their employers,’ she adds.  

Speaking after the APPG inquiry was announced, Carolyn Harris summed up the zeitgeist: ‘It is really appalling in 2021 that women are still suffering in silence without the support they need to continue working and live life to the fullest. I’m determined the inquiry will lead to real change in practices and understanding across the workplaces and within society.’


Resources  

NHS Employers round-up of resources and support for menopause bit.ly/NHS_Employers_menopause

Unite’s model menopause agreement for employers is on pages 59 to 60 of Women’s health, safety and wellbeing at work bit.ly/Unite_menopause_agreement

Faculty of Occupational Medicine guidance on the menopause in the workforce bit.ly/FoM_menopause_guidance

Menopause Support is a website with information to support women who are peri- and postmenopausal menopausesupport.co.uk  

The Latte Lounge is a website offering evidence-based advice and support to women over 40 lattelounge.co.uk 

Menopause Matters menopausematters.co.uk


References

CIPD. (2019) Majority of working women experiencing the menopause say it has a negative impact on them at work. See: https://www.cipd.co.uk/about/media/press/menopause-at-work#gref (accessed 3 August 2021).

Latte Lounge. (2021) 42% of women consider leaving job due to menopause. See: https://www.lattelounge.co.uk/42-of-women-consider-leaving-job-due-to-menopause (accessed 18 August 2021).

Menopause Support. (2021) Facts. See: https://menopausesupport.co.uk/?page_id=60 (accessed 3 August 2021).

NHS Employers. (2019) Sherwood Hospital Foundation Trust: improving menopause support for staff in Sherwood Hospital Foundation Trust. See: https://www.nhsemployers.org/sites/default/files/2021-06/Sherwood%20-%20menopausejjedits.pdf (accessed 3 August 2021).

Image credit | Shutterstock

 

 

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