Menopause in the workplace

IOSH recognises that people have diverse gender and gender non-conforming identities. In this digital material we are using the word ‘women’ to describe individuals whose sex assigned at birth was female, whether they identify as female, male, non-binary, or gender non-confirming. The content is intended to be inclusive and applicable to any person who is experiencing menopause symptoms.

Global relevance of menopause in the workplace

Worldwide there are an estimated 657 million women aged 45-59, around half of whom work during their menopausal years ¹. The menopause and its transition account for a significant period of a woman’s working career and at a time when she may be reaching or at her career peak.

Even though women account for more than 50 per cent of the working population, women’s health issues are under recognised and often a taboo subject in the workplace. As an under-recognised health condition in the workplace, the menopause may affect women’s productivity, damaging their careers and potential to .

Fourteen million lost workdays were reported in the UK in 2018 due to menopause². And the number of menopausal working women will escalate. With about a quarter of the world’s female population experiencing this biological transition, by 2030 menopause-related productivity losses could cost more than $150 (£110) billion a year. So, it’s imperative for employers to manage the associated health risks at work.

What is menopause?

Menopause is a natural physiological process defined as the end of the female reproductive function. It usually occurs between the ages of 44 and 55², with an average age of 51¹. A woman is said to be in menopause when she has not had a menstrual period for 12 consecutive months.

Menopause is preceded by the perimenopause or the menopausal transition, which may last two to 10 years. Women can experience unpleasant symptoms during this time. About one in 100 women experiences menopause earlier in life as early onset menopause. Reasons for this include chemical exposure, chemotherapy or pharmacological interventions, and surgery.

Symptoms of menopause

Menopause is associated with as many as 34 physical and psychological symptoms, which have the potential to negatively impact work ability. Not all 34 are experienced by all women and they are not experienced all the time. Symptoms are transient in nature and each women’s experience will be individual. The following table depicts some of the more common symptoms.  

The effects of these symptoms include a reduced ability to learn new tasks, difficulty paying attention to detail, and poor memory, all of which can negatively impact work productivity and quality. As many as 88 per cent of women will experience symptoms of varied severity during their menopause transition and as many as a quarter of these will experience severe symptoms^3,4. 

Symptoms bothering women the most include hot flushes, sleep disorders, night sweats and arthralgia, and those experiencing symptoms are eight times more likely to report low work ability⁵.

The experiences of women in the casual or informal economy differ from those of women in full-time employment. Women in casual employment say musculoskeletal symptoms in the legs, back, shoulders and neck are the worst, causing them to seek less physically demanding work. Women in full-time employment reported hot flushes as their main concern⁶. Those in lower-paid and more manual jobs experience significantly more psychological symptoms than women in higher status ‘white collar’ jobs. Casual work is not detrimental to the health of menopausal women but rather influences their experience of symptoms and resources available to manage them.

Menopause and work

Women’s experiences of menopause in the workplace are bi-directional, as menopausal symptoms can impact a women’s experiences of work and work factors can exacerbate menopausal symptoms. This causes women to experience negative and varying severity of symptoms, which can impact industry through decreased productivity, and increased absenteeism and presenteeism. In addition, 52 per cent of women consider leaving employment because of the symptoms they experience, threatening a further loss of skill, knowledge and expertise⁷.

Workplace factors that impact this bi-directional relationship include both the physical and psychosocial aspects of work. See Table 1 for examples. Employers should promote menopause-friendly workplaces by addressing these factors.

Table 1: List of physical and psychosocial factors that impact menopause

Women’s experiences and perceptions of menopause and work reflect that they:

• believe management labels them as weak, incompetent, unstable and depressed
• lack support in helping them cope with symptoms
• need to use annual leave or rest days to cope with their symptoms
• are not confident to disclose their status to managers or request accommodations for fear of embarrassment, stigmatisation and discrimination, and
• reduce their working hours or leave employment to cope with their symptoms.

Positive impacts on work ability are derived from a supportive work culture where women:

• feel they are heard and can express their concerns
• have better supervisor support
• believe management pay attention to women’s health issues through a health-wise culture
• can adopt flexible working hours and hybrid working models.

Women are often unable to address psychosocial factors such as negotiating working hours. But, where this is possible, and they have control over the physical workplace, there is reduced reporting of menopausal symptoms and less severity of symptoms when these are experienced.

Managers need to understand the symptoms of menopause and its transient nature and have open discussions with women. A workplace champion (menopause ambassador) could be identified. This is a person who is nominated to represent the interests of women experiencing the menopause transition and who can support all levels of employees in a confidential manner while providing that link between management and worker where necessary.

How workplaces can enhance women's experiences

Organisations can support women during the menopause and the menopause transition in the following ways. Please use the below as guidance on what action can be taken in workplaces.

1. Age and gender specific policies and procedures

• Use a gender-based approach when developing and implementing a workplace policy, programme or practice.
• Firmly integrate menopause management in existing policies instead of producing a separate menopause policy.
• Incorporate advice from occupational health professionals to strengthen the content of existing policies and practices.
• Create supportive and inclusive cultures based on effective policies that educate managers, supervisors, occupational health professionals and the general workforce about the menopause.
• Review and adapt these policies and procedures as the organisation matures to retain relevance to the scientific evidence of menopause.

2. Management support

• Provide managers with the support and training to have open and honest conversations around menopause and symptom management.
• Educate managers to improve their knowledge and awareness of the symptoms of menopause and the possible solutions.
• Empower managers to offer women the flexibility they need to better manage menopausal symptoms on an individual basis.
• Develop inclusive and supportive workplace cultures and managerial styles that make women feel comfortable disclosing symptoms or requesting adjustments if required.

3. Age and gender specific health risk assessments

• Ensure risk assessment processes are in place that consider specific risks to peri- and menopausal women/people (eg endocrine disruptive chemicals) and have arrangements in place to identify reasonable adjustments for an individual.
• Consider the physical environment as well as psychosocial risks in the risk assessment process.
• Ensure the outcomes and recommendations are implemented to mitigate risk and regularly review with the employee.
• Engage with competent who can provide guidance on what should be covered in the health risk assessment, if necessary. Where these services are not available in-house, they can be sourced externally. Please research and review provider options for where you are based. Within the UK, information can be sourced from ACAS, and SOM has a list of occupational health providers that can be used to locate service providers, for example.

4. Training and awareness strategies

• Develop awareness, training and education strategies that raise understanding of the menopause, associated symptoms, impact on work, potential solutions and communication skills.
• Provide information or sources of information for employees to access self-help solutions and sources as necessary.
• Cover the bi-directional influence of menopause and work in training, which will provide managers with the awareness, knowledge and understanding needed to support women during this phase.
• As an employer, ensure that not only managers and supervisors but also those with a people-facing function are trained to be aware of this bi-directional influence.
• Improve communication skills to create trusted relationships allowing managers to confidently have frank discussions with women who, at the same time, feel empowered to disclose their needs.
• Educate managers about stereotypes to address gender disparities.

5. Health-orientated culture

• Women should be able to access evidence-based advice and healthcare and share their experiences.
• Health promotion activities should address issues earlier in the life cycle and not only during middle age (ensuring that promotion activities are inclusive of non-binary, trans and gender non-conforming people).
• Programmes can be offered that encourage healthy lifestyle activities such as regular exercise, healthy eating habits, smoking cessation and monitoring and controlling chronic health issues.
• Organisations might also provide financial support for resources that allow menopausal women to self-monitor symptoms, eg blood pressure monitors.

6. Work attire

• Review the work attire/uniforms and personal protective equipment (PPE) and adapt fabrics as necessary to prevent unnecessary heat generation and allow for absorption.
• Allow for layering and removal of layers, eg jackets and neck scarves, as needed.
• Be flexible in allowing workers to wear looser clothing for improved comfort.
• Much PPE and clothing is not designed for women. Ensure suitable fits to ensure protection and comfort.

7. Physical environment

• Hazards within the physical working environment – such as high temperatures, poor ventilation, working in confined spaces, excessive crowding and insufficient rest areas – can all contribute to an environment that is problematic for menopausal women.
• Workplace adjustments or modifications can prevent and/or mitigate these factors and are often cost-effective.
• Ventilation and temperature – allow for the opening of windows, moving a workstation closer to the window, the use of desk fans to control the individual’s workspace or the introduction of air conditioning.
• Rest areas, access to cold water and ablution facilities should be available and easily accessible.

8. Psychosocial risks

• Provide workers with opportunities to work flexi hours, where possible, around their symptoms, with time allowed to attend medical check-ups.
• Allow work from home and hybrid options of work, where possible, while ensuring support through regular, supportive contact with managers.
• Review employment types and, where possible, provide more secure options of work offering structure and financial security.
• Assess work demands and increase the control the worker has through job-sharing, paced working and task scheduling.
• Meeting and presentation rooms should be well ventilated and not overcrowded to prevent exacerbation or triggering of symptoms.
• Allow breaks to manage fatigue and provide private rest spaces, where possible, for this purpose.
• Improve the culture around managing and reporting psychosocial problems at work.

Significant areas for the OSH professional

• Consider how existing policies and procedures cater for the psychosocial needs of menopause-related issues – eg sickness absence and medical appointments, flexible working hours, work patterns and hybrid models of working – and work with your organisations to ensure they are fit for purpose.
• Governments, trade unions and employers have addressed issues concerning menopause and work through the adoption of ‘menopause at work’ policies (or within other policies), yet women employed in precarious settings such as casual work, informal, sessional and the so-called grey economy may not enjoy these protections. Ensure these issues are addressed within your operation and across your supply chain.
• Ensure to undertake risk assessments, which may be through managers or others, such as occupational health and safety and health professionals, depending on the level of support, advice, guidance or recommendation required. It may be necessary to commission competent and knowledgeable professionals to conduct health risk assessments designed to identify physical and psychosocial factors that have the potential to impact women’s work experiences.
• The needs of trans men and women, non-binary, non-gender and gender non-conforming people need to be considered. They are a group who may also experience a natural or surgical menopause, depending on ovarian retention and use of hormone therapy, and this can exacerbate experiences of exclusion or discrimination in a work setting.

Example of an assessment to support adjustments in the office environment 

Resources

• IOSH: Inclusive and supportive workplaces needed to help menopausal women
• NHS: Menopause
• NHS: Menopause fact sheet
• SOM: Guidance on menopause and the workplace
• UNISON: Menopause: the menopause is a workplace issue: guidance and model policy
• ACAS: Menopause at work
• CIPD: Let’s talk menopause
• BSI: Menstruation, Menstrual Health and Menopause in the Workplace guide

References

1. Rees, M., et al., Global consensus recommendations on menopause in the workplace: A European Menopause and Andropause Society (EMAS) position statement. Maturitas, 2021. 151: p. 55-62.
2. Steffan, B., Managing menopause at work: The contradictory nature of identity talk. Gender, Work & Organization, 2021. 28(1): p. 195-214.
3. Vaccaro, C.M., et al., What women think about menopause: An Italian survey. Maturitas, 2021. 147: p. 47-52.
4. Viotti S, et al., Fostering work ability among menopausal women. Does any work-related psychosocial factor help? Int J Womens Health, 2020. 12: p. 399-407.
5. Geukes, M., et al., Improvement of menopausal symptoms and the impact on work ability: A retrospective cohort pilot study. Maturitas, 2019. 120: p. 23-28.
6. Yoeli, H., J. Macnaughton, and S. McLusky, Menopausal symptoms and work: A narrative review of women's experiences in casual, informal, or precarious jobs. Maturitas, 2021. 150: p. 14-21.
7. Hardy, C., et al., Work outcomes in midlife women: the impact of menopause, work stress and working environment. Women's Midlife Health, 2018. 4(1): p. 3.