Understanding the Impact of Menopause on Women in the Workplace

A 2022, Women and Equalities Committee Report reported on the specific impact of menopause on women in work, which fell into three main categories: problematic symptoms; lack of support and discrimination; and loss of income/reduced work. A survey of 1,000 women by Health and Her estimated that menopause costs the UK economy 14 million working days per year, in terms of time spent alleviating menopause symptoms.

There are several phases to the Menopause that can all cause women to experience problematic symptoms at different points in their life leading to reduced income/work, which we will discuss below.

Premature Menopause

If a woman’s menstrual cycle stops before the age of 40, this is considered early menopause, or premature menopause. They may experience a number of symptoms from a younger age and this is more common in those who have family members who have been through early menopause. This can happen naturally and it is also sometimes called premature ovarian failure.

Causes

Premature ovarian failure can be caused by:

·       Surgery to remove the ovaries including a Hysterectomy or Oophorectomy

·       Autoimmune disease

·       Cancer treatment such as radiotherapy and chemotherapy can cause premature menopause

How do I know if I have early menopause?

You might experience some of the following symptoms, but it’s important to check with your doctor to ensure there are no other alternative causes:

·       Hot flushes

·       Night sweats

·       Intimate dryness

·       Discomfort during sex

·       Difficulty sleeping

·       Low mood

·       Anxiety and depression

·       Reduced sex drive

·       Problems with concentration and memory (brain fog)

Treatment for early menopause

Doctors may prescribe a combined contraceptive pill or HRT to manage the effects of early menopause. It is likely you will be recommended to take the treatment until the natural menopause age. Those who have had certain types of cancer may not be able to have hormonal treatment but your GP can advise on this after further detailed discussion.

Peri-Menopause

What is Perimenopause?

Perimenopause is the period when the body begins to transition into menopause. It marks the end of the reproductive years and does not have a fixed age when it begins. Everyone is different, so it is important to make a note of any changes to discuss with your doctor. Some people can experience menopause symptoms as early as their thirties, most will be in their 40s.

What happens?

During the transition to menopause, your body will change and there are a number of changes you may notice:

·       Irregular periods, or changes in menstrual loss

·       Mood changes and changes in mental health eg increase in anxiety

·       Hot flushes and/or night sweats

·       Sleep disturbance

·       Recurrent cystitis (UTIs), thrush or BV infections

·       Reduced or loss of libido

·       Brain fog

·       Increase or onset of migraines

·       And much more

On discussion with your GP, HRT can be prescribed even if still having periods. Areas to discuss will include contraceptive needs, family history, past medical history, smoking and alcohol habits. If there are no contra-indications; HRT will help and some women may benefit from additional vaginal oestrogen too.

For women where HRT is contra-indicated, then other things to consider include keeping active with regular exercise, a consistent sleep schedule, reducing caffeine and alcohol intake, practising mindfulness and stress reduction and maintaining a healthy diet.

Some may even benefit from supplements, antidepressants or gabapentin (all licensed for use in menopause)

Menopause and post menopause

What is it?

Following perimenopause, your periods will stop, often between the ages of 45 and 55. Post-menopause is when you have not had a period in 12 months or more, signalling the end of ovulation. There are a range of symptoms that are most common, however, every individual is unique, so your symptoms may differ.

Mental Health Symptoms

·       Low mood, anxiety and self-esteem problems

·       Memory and concentration might become more common also known as brain fog

Physical Symptoms

·       Hot and cold flushes

·       Trouble sleeping

·       Heart palpitations

·       Headaches or migraines

·       Muscles and joint aches

·       Dry and itchy or oily skin

·       Body shape and weight changes esp around the waist

·       Vaginal dryness, pain, itching or discomfort during sex

·       Recurrent UTIs and possible stress incontinence

How long do symptoms last?

Everyone is different and symptoms can last anywhere from a number of months, with the average menopausal transition lasting for around 7 years. Symptoms can last for up to 14 years, depending on lifestyle factors. Symptoms can alter in severity as time goes on, with some long-term symptoms levelling out and others continuing throughout the entire transition.

Primary Management Through HRT

Evidence overwhelmingly is in favour of prescribing oestrogen trans dermally, through patches or gel or spray. If progesterone is needed then this can be prescribed as a patch, as a tablet or as a Mirena coil.

Managing Menopause

·       Reduce alcohol intake

·       Stop smoking

·       Rest and keep a routine

·       Eat a healthy diet

·       Include calcium-rich foods

·       Weight-bearing exercise

·       Relaxation

·       Speak to others including support groups

·       Speak to a doctor about supplements and medicines

Managing hot flushes

·       Wear light cotton clothing

·       Keep your bedroom cool at night

·       Drink plenty of water

·       Try to manage stress

·       Avoid triggers such as spicy food and smoking

·       Manage your weight

·       Cognitive behavioural therapy

Managing bone health

·       Build up muscle strength through exercise – Learn more about bone density here.

·       Include calcium-rich foods in your diet like yoghurt and kale

·       Spend time outdoors and in the sun

·       Vitamin D supplements – Learn more about Vitamin D here.

Managing intimate dryness

·       Over-the-counter moisturisers and lubricants e.g. Sylk, Replens or KY

·       Doctor prescribed hormone replacement therapy

·       Oestrogen Pessaries, gel and vaginal rings areavailable on prescription but now Gina is available over the counter.

Management with HRT

HRT uses two hormones; Oestrogen to manage the symptoms of menopause and is available as skin patches, gel or spray for skin, implants and tablets. Progesterone is also offered, if a woman has a womb, as a (combined) patch, coil (Mirena) or tablets.

HRT has been shown to reduce the risk of

·       heart disease

·       stroke

·       type 2 diabetes

·       brittle bones

·       bowel cancer

·       dementia

Women can now remain on HRT indefinitely but would be advised to see their doctor each year for review. Need to check the suitability of dose, suitability of regime, any concerns, and check up to date with a mammogram.

Post-Menopause

During post-menopause, your symptoms should subside significantly. Some people will continue to experience symptoms for longer, but they should be more manageable.

Post-menopause health risks

Post-menopause brings about an increased risk of health conditions including heart disease, weak bones and urinary tract infections.

Important changes to make

·       Diet is critical to keep your body healthy and functioning correctly

·       Keep active and maintain muscle strength and a healthy weight

·       Regular cancer screenings for breast and cervix

·       Speak to your doctor about calcium and vitamin D supplements

·       Reduce alcohol consumption

·       Drink plenty of water and use the restroom whenever you need to

·       Manage your weight to reduce stress on your muscles and bones

What about incontinence?

You may experience loss of urine when coughing, laughing or lifting, which can be frustrating, but there are preventative measures to try:

·       Pelvic floor exercises can help strengthen the muscles

·       Oestrogen preparations are used to improve vaginal thinning

In conclusion, menopause significantly impacts women in both their personal lives and in the workplace. The various phases of menopause, including premature menopause, perimenopause, menopause, and post menopause, can bring about a range of symptoms that disrupt women's daily lives and hinder their professional success. Fortunately, there are numerous treatment and management options available to help women navigate these challenging menopausal phases. From hormone replacement therapy to lifestyle adjustments and emotional support, women should have a multitude of resources at their disposal to alleviate menopausal symptoms and maintain their productivity and overall quality of life. The onus is on employers to recognise the value of ensuring these resources are provided and are available to women to ensure their maximum operational success is achieved. The median age of 51 to experience symptoms of menopause coincides with the stage of most women’s careers where they are some of the most experienced and knowledgeable professionals in their workplaces in senior leadership/mentoring positions.

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