Improving recognition in the UK for menopause-related challenges to women’s working life

Introduction

Over the past 10 years there has been a growing recognition that menopause may have an impact on women’s working lives. This paper is based on an invited presentation to the British Menopause Society conference in May 2016, about the author’s research on women’s experience of the menopause and work in the UK. It aims to summarise that work; highlights what remains to be explored; and considers the implications for employers, women and healthcare practitioners who advise them.

In 2017, the employment rate for women in the UK was the joint highest since records began in 1971. ¹ And at some point in their working lives, all women – who now comprise nearly 47% of the labour force – will experience menopausal transition. Yet until very recently, the topic has been largely taboo in the workplace and subject to very little systematic investigation. Given that symptoms attributed to menopause may last for many years, and there are currently over four million working women aged 50–64, a picture emerges of a large group of women whose experience at work has been the subject of little recognition or investigation.

What is the experience of working women in the UK?

A consultation with health and safety representatives in the UK by the Trades Union Congress in 2003 ² highlighted their concerns that menopause can present difficulties at work for some women. A small study commissioned by the British Association of Women in Policing in 2006 ³ explored the difficulties experienced by women police officers when dealing with the menopause in their working lives. And a later study involved an in-depth exploration of the experience of women of menopausal age working in 10 UK-based organisations. ⁴ In these latter two studies, women were pleased to be asked about this topic, grateful that it was being taken seriously and volunteered willingly, in large numbers, to participate. In the second study, the researchers sought senior managers’ permission to approach potential participants in various organisations. In some, managers were reluctant to be involved as this was thought to be a ‘sensitive’ issue. In others, it was thought ‘not an issue’ or managers were fearful that by raising awareness it might become one. However, our final group of collaborating organisations were characterised by the presence of a strong and committed project champion, usually from an occupational health, or an equality and diversity function, supported by senior managers with an interest in employee health and well-being who appeared relaxed about such an enquiry.

In these organisations we conducted over 60 semi-structured interviews with women aged 45–55 and explored their experience. We asked whether and how they felt their symptoms impacted on working life and how work impacted on their menopausal symptoms. We explored whether they talked to their line managers and co-workers about any difficulties and whether they had found it necessary to take time off work. And, most importantly, as this was the main aim of the study, we asked what their employers could do to enable them to work comfortably and productively during this period of their lives.

It was clear from the interviews that while some women felt they had ‘sailed’ through their menopause, for others it presented challenges. Many confessed they were ignorant about the menopause until it was well upon them, and found themselves behaving uncharacteristically at work. ‘I sort of doze at my desk in the afternoon … It’s very disconcerting because it’s not like me.’ Some struggled, but even once they had established the cause of their difficulties, were too embarrassed to admit it at work. A few wanted to reduce their working hours and work part-time for a while but dare not ask because of a feared impact on their career. Others reported that they felt less confident at work than normal and that this impacted on their behaviour.

It certainly affects my confidence from the point of view of speaking at meetings because I am not as fluent … That concerns me. I don’t want to … suddenly not have the word that I need so I am perhaps sort of withdrawing a little bit.

Menopausal transition was reported as causing difficulties at work by 40% of our sample of just under 900 women. The main problems that they attributed to menopause were poor concentration, tiredness, poor memory, low mood and low confidence. Hot flushes at work were also reported as challenging for some. Situations that made hot flushes worse included working in hot or poorly ventilated environments, formal meetings and presentations, doing high visibility work and demanding tasks that involved learning new procedures, attention to detail, or tight deadlines. These latter situations might arguably be those that are experienced as stressful, and it is known that stress can exacerbate hot flushes. ⁵ Working in shared offices without adequate control over workplace temperature was also a source of difficulty for women experiencing hot flushes at work. The main reason, or one of the main reasons, participants reported trying HRT was to help them cope with work.

Although the majority of women reported that their menopause did not impact on their work performance, some believed that their work performance was negatively affected. There were no objective measures of work performance – such indices would be remarkably difficult to ascertain in a heterogeneous sample of employees – but clearly some women perceived detriments to their performance, and were concerned about it. What was also notable is that of those women who believed their performance was not detrimentally affected by their menopause, a third said that it would have been had they not worked particularly hard to overcome their difficulties. So, for some women, albeit a minority, a picture emerged of a challenging and potentially stressful time. And since menopausal transition can last many years, for those women who do experience difficulties, this can represent a significant part of their later working lives.

What will help?

Participants in our survey ranked, from list of 20 actions that had been suggested by them at interview, the things that had been, or would be, most helpful for them at work. The top five were awareness among managers that menopause can present an occupational health problem; flexible working hours; formal information and advice about menopause and coping strategies at work; better ventilation, air conditioning and temperature control; and informal support at work, for example, from a women’s network or telephone advice line. Based upon these recommendations made by women, the British Occupational Health Foundation published guidance for managers in layperson’s language to help them understand what the menopause is, and how they can support those women who need it during this stage of their working lives. ⁶

However, we found in our survey that the majority of women had not or would not disclose their difficulties to their managers. ⁴ When asked why not, the main reason was that their line managers were male or were younger than them (regardless of gender). Furthermore, when women felt that they needed time off work because of menopausal symptoms, very few told their managers the real reason. These factors represent potential and significant barriers to easing difficulties, as line managers cannot offer support or practical changes to work (adjustments) if they do not know what the problem is. And without that knowledge, managers may make erroneous assumptions about the cause of any change in behaviour at work. Anecdotal information reveals that women have been subject to disciplinary procedures about job performance where they have been too embarrassed to admit that the cause of these difficulties is menopause related. Disclosing a health-related issue may actually afford them some level of protection. Some of the guidance published (see below) suggests that women with particularly severe and long lasting menopause-related problems may meet the legal definition of a disability. Under the Equality Act 2010, ⁷ a person is disabled if they have a physical or mental impairment which has a long-term (usually lasting more than 12 months) and substantial adverse effect on their ability to carry out normal day-to-day activities. Clearly, an important way forward involves not only raising the awareness of managers but empowering them to provide support.

The precise nature of appropriate support and helpful manager behaviour has been explored in a further study with working women in the UK. ⁸ In this study, women suggested that it would be helpful if managers recognised that the menopause is a normal and natural stage of life, that it may cause problems for some women, but that such effects are temporary. Furthermore, since the effects of menopause were highly variable between women, they proposed that an individual, rather than ‘one size fits all’, approach to supporting them at work is advisable. Women felt that in order to support those with menopausal symptoms, managers needed to demonstrate concern, empathy and respect. They should avoid a flippant approach and the use of terminology such as ‘women’s problems’. And to do this, they may also need training in communication skills, particularly in how to have potentially difficult conversations about sensitive issues. This latter point was noted in a report by The Institute of Employment Studies in 2016 ⁹ who also recommended that employers should create environments where employees with health problems feel able to disclose them to line managers.

Are employers obliged to help?

It is increasingly recognised that occupational health and safety policies should recognise the different needs of men and women. ¹⁰ Employers have a general duty of care for the health and safety of their employees ¹¹ and where an employee’s health problems are considerable and meet the legal definition of a disability, employers should provide adjustments wherever reasonable to enable employees to continue to work effectively. ⁷ However, routine good management will usually enable employers to help. In fact, many of the suggestions made by women for a ‘menopause-friendly’ workplace would arguably be welcomed by, or at the very least acceptable to, all employees. These would include a culture where health problems that impact on work can be disclosed, informed line managers, the provision of support and signposting to further sources of advice, flexible working hours, a comfortable physical working environment and, where the job requires it, uniforms and personal protective equipment that enable women to keep cool. These are matters of designing work and working environments that are inclusive. In this respect, arguments as to whether or not the problems that women attribute to menopause are in fact related to menopause become less important; good employers take the reported health concerns of their employees, whatever the cause, into consideration.

Guidance about menopause and work

In the UK there has been growing recognition of the need for accessible guidance about menopause and work, not only for women, but also for their managers. Since the publication of online guidance by the British Occupational Health Foundation, ⁷ there have been various online publications by unions and employee representative groups, for example, the Trades Union Congress, ¹² UNISON, ¹³ UNITE, ¹⁴ the National Union of Teachers ¹⁵ and Royal College of Nursing. ¹⁶ In 2015, the UK’s Chief Medical Officer included a chapter about menopause in her annual report about women’s health. ¹⁷ And at her request, the Faculty of Occupational Medicine ¹⁸ produced online guidance on menopause and work that provides straightforward suggestions about what employers and line managers can do to help, as well as tips for women themselves in how to cope. In 2017, the Work Foundation ¹⁹ published a report about various issues affecting women’s health, including menopause, suggesting that it was time to stop dismissing them as ‘women’s issues’ and recognise and support them as workplace health concerns. This report made recommendations for employers, government departments and for those working in healthcare. In addition to these developments, in the past few years employers are developing their own internal polices and guidance about menopause.

One thing that is not yet clear is to what extent the various recommended actions would help. There is a need for evaluated interventions. The charity Wellbeing of Women is funding an RCT of self-help cognitive behaviour therapy for working women that aims to help them deal with menopausal symptoms and work. ²⁰ This project also includes a feasibility study of an online training programme for managers designed to raise their awareness about menopause, suggest ways they can support women who experience problems and increase their confidence in having conversations with their staff about menopause at work. These studies should be completed in 2018.

It satisfying to see that over the past decade, that there is growing recognition of the potential for menopause to impact on women’s working lives, as well as increasingly available guidance for women and those who support them. Recent media coverage of the menopause and work may also help further understanding of the menopause as a normal stage of life. Whilst no doubt it remains taboo in many workplaces, there is now evidence of an increasing willingness to provide support at work for those women who experience menopause-related difficulties.