Employers encouraged to break through stigma of menopause

Despite affecting 50 per cent of the population, menopause remains somewhat of a taboo topic in the workplace. Employees and managers alike are often reluctant to discuss the condition’s symptoms or impact on women. 

But change is afoot, particularly when it comes to employers and the role they can play, according to Margaret Rees, executive director of the European Menopause and Andropause Society (EMAS).

“It is becoming an increasing hot topic that women need to talk about, and employers need to be aware about, and not to dismiss.”

It’s particularly important because there are more women in the workforce now, and they’re also working longer, she said.

“There’s awareness among employees but there needs to be more awareness among employers. This is a normal process and it’s not an issue that’s going to last a very long time but during that time, (it’s important) to make the workplace conditions acceptable.”

In late 2015, EMAS released recommendations on how to improve conditions in the workplace for menopausal women, pushing for greater awareness among employers, along with sensitive and flexible management.

It’s about helping everyone to approach this in a straightforward way, with less embarrassment, said Amanda Griffiths, co-author of the article and professor of occupational health psychology at the University of Nottingham in the U.K.

“After all, this is a perfectly normal thing that affects half the workforce. (It’s) time to talk and get rid of the taboo.”

In December, England’s chief medical officer, Sally Davies, made recommendations on a wide range of health issues including “taboo problems” such as menopause. Employers can lead the way, she said in the report, by making it more acceptable for female staff to discuss health issues.

“Women report that they do not feel able to discuss the issues of menopausal symptoms affecting their performance at work with their employer. Evidence-based advice for employers and women at work will help women working during the transition to the menopause. With an aging national workforce, positive action by employers would benefit those with symptoms, and contribute to employee engagement, productivity and retention.”

Overall, this period of hormonal change and associated symptoms can last from four to eight years, according to Griffiths. A 2011 U.K. study of nearly 900 working women by her university found the main symptoms that cause women difficulties at work include poor concentration, tiredness, poor memory, feeling low or depressed and lowered confidence. 

Hot flashes are also a problem.

“That’s a big one in that when women are having the flash, it’s from inside to out, essentially; it’s this internal heat that can be very distressing to the woman, not only because of the heat itself but because she starts sweating, so that can be visible to other workers, and it can happen frequently or infrequently,” said Unjali Malhotra, interim chair at the Canadian Foundation for Women’s Health in Vancouver.

A menopause “fog” can also mean cognition and memory are diminished because of an acute lack of estrogen, she said.

“That doesn’t mean they’re going through this permanent decline in cognition — it’s a temporary time period that can be very distressing, and they’re leaving sticky notes for themselves, they’re really just having to manage around it to maintain (their) work level… that can be something that’s embarrassing but also very scary for them where they themselves might think, ‘I’m losing my mind.’”

Vaginal discomfort and heavier periods are also common, said Malhotra.

“That’s something that people don’t want to, and often don’t, talk about because these issues are very intimate, and to be in a workplace discussing these is actually a challenge and really shining a light on a woman at a time when she’s struggling already.”

More serious gynecological issues could mean women have to take time off and accommodation may come into play if a woman requires several doctors’ appointments. If symptoms are particularly severe, a woman may need to go on disability, said Malhotra.

“But it depends on what the underlying issue is and what led them to that point. We can usually get people back on track pretty quickly and effectively,” she said, citing solutions such as hormone replacement therapy.

It’s important to deal with the issue as women need to continue in the workforce “and not be dismissed because they’ve got to take time off work, because they feel so awful because they haven’t had a decent night sleep because of the night sweats,” said Rees, co-author of the EMAS article. 

“The thing about concentration and memory is they are probably related to poor sleep and this is manageable. The whole thing is manageable as long as people talk about it.”

There is definitely a stigma around menopause, and around women’s health issues in general, said Malhotra.

“Even within one’s home, never mind at their workplace, so I think that we have a long way to go with the understanding, and I do agree fostering a culture is helpful.”

It’s about opening up the conversation and being more understanding, she said.

“This is a situation that pretty much everyone in the female population is going to go through and there’s nothing they can do about it. And they aren’t trying to cause issues within the workplace — they are more uncomfortable than you are, so understanding that and having some sympathy and empathy are always appreciated.”

Some women feel their menopausal status opens them up to being stereotyped and they prefer not to reveal age- and gender-related matters at work, said Davies in her report.

“When women take sickness absence because of menopausal symptoms, they do not always divulge the real reason to their manager. However, when women do disclose difficulties to co-workers and line managers, their subsequent support is highly valued.”

Women may encounter criticism and ridicule about menopausal symptoms from co-workers and managers, she said, so it’s important not to underestimate the accumulated and negative consequences for mental health.

“Women are generally reluctant to divulge their menopausal status or symptoms, but particularly so at work, where fear of stigmatization is common, and where poise and control are highly valued.”

Nearly one-fifth of the women in the U.K. study thought menopause had a negative impact on their managers and colleagues’ perceptions of their competence at work, and felt anxious about these perceived performance deficits.

The stigma remains because many people don’t know much about menopause and are embarrassed to talk about it, especially to male managers or younger managers, said Griffiths.

“And many women told us they were not aware of the menopause either, until it was upon them.”

To support women, working conditions should be assessed to consider the specific needs of menopausal women and ensure the working environment will not make their symptoms worse, according to EMAS.

Particular strategies might include: fostering a culture where employees feel comfortable disclosing health problems, allowing flexible working, reducing sources of work-related stress and reviewing workplace temperature and ventilation.

Information about menopause and strategies for coping with symptoms at work should also be provided, whether formally (by employers) or informally through networks of working women who have experienced menopause.

Networking among women can be a powerful solution, said Malhotra.

“Women do very well with communication and with really supporting one another… in the age of online communication, the ability to reach so far to each other and know that you’re not the only one, that is the biggest thing.”

Women who have previously suffered from mental health issues may go into full depression during perimenopause, not knowing it’s related to a drop in hormones, she said.

“All the psychological/psychiatric issues worsen at this time and that’s something that we might not know or be aware of but if they had other women to speak to and bring this forward to, they would probably be more inclined to see their doctor and tell their doctor and ask for therapy.”