Working through the menopause
I’m getting to an age when a few of my friends are experiencing symptoms of menopause. For most of them, the onset of hot flushes, sudden memory loss, headaches and night sweats came as a great shock. The impacts on their work were the hardest, as they felt unable to talk to their colleagues about what was happening to them.
“The symptoms were so insidious,” said Sarah, 52, who works for NHS England. “I was forgetting things, so I was very stressed and anxious. I put it down to other challenges in my workplace, and I didn’t link it to menopause until quite a bit later. When I figured it out, I wondered how women of my age held down jobs.”
Sarah moved into a different job before she’d realised that she was experiencing symptoms of menopause. Along with memory loss, she struggled with hot flushes. “One of the most debilitating things was waking up at night, drenched in sweat. I’d get up and undress to cool down, then I’d go back to a damp bed and wake up freezing. I was exhausted.”
Tiredness can contribute to lack of concentration, memory loss, migraines and feeling low. None of these make us want to spring into work in the morning. Sarah had to change her whole approach to work. “I knew that when I got anxious I would have a very visible hot flush. If I was giving a talk, I would have to think in advance about what I was wearing, and how hot or cold the room would be. I had to factor these things into my presentation.”
Despite working in a healthcare environment, with 'a lot of women of a certain age,' menopause was never discussed. “I didn’t think I could ask for help because I hadn’t been offered any by my GP. There wasn’t that empowerment that comes with pregnancy, when there are medical and professional processes that focus on you."
Hearing this, I was reminded of how I felt as a 13 year old girl, hiding in the school changing rooms. I was too embarrassed to tell my PE teacher that I had my period, my pants and shorts stained with blood. My teacher was a woman, and my girlfriends were going through the same (completely normal) changes to our bodies. I didn’t feel able to ask for help or time off. Now I hear my friend talking about similar feelings in her late 40s, confused and isolated by a natural process of growing older.
Most women experience menopause around the age of 50, though some women have symptoms in their 30s or 40s (classed as early menopause). In the lead-up to the menopause, our oestrogen levels drop, so our ovaries stop producing an egg each month. Periods will eventually stop altogether. This happens at a time when we’re more likely to have reached a senior level in our careers, or at least be more confident in our role.
In a society where more and more women are working, and staying in work after having children, menopausal women are the fastest growing demographic group in the workforce. We work in jobs where (you’d think) our employers would want us to be on form. According to a House of Commons research briefing, 79% of jobs in the health and social work sector and 70% of jobs in education are held by women.
Surely employers should place extra value on women of this age, who have more experience, more responsibility and more value to the business than junior staff? Yet we can’t just blame employers. We have a culture that has only recently embraced public conversations about the menopause. We've seen a rash of books by famous names from Liz Earle to Christa D’Souza (on a side note - why did all the menopause books come after the vagina books? Did we need to accept one to deal with the other?).
I spoke to Laura Shuckburgh, a menopause coach and business consultant. Laura set up Marvellous Midlife after her own experience with menopause. “There are many women who don’t feel supported at work and are not willing to speak up. If menopause is a taboo subject and there is no obvious policy to help them, even confident women won’t ask for help. Many employers don’t realise that women are absent or even leaving their job due to menopause. A little bit of support and understanding could save thousands in recruitment costs. Awareness raising and simple workplace adjustments could save productivity and retain talented women.”
So what can we do to improve our workplaces?
“If you feel able to speak up about your experience, you could become a menopause champion for your workplace.” says Laura. “Put up posters, share flyers or host an informal menopause cafe once a month. The more people talk about it, the easier it will be for employers to give women the support they need.”
Menopause is something I’ve never talked about with my friends. It seemed so far away. As we get into our 40s, how can we prepare ourselves for coping with the menopause at work?
Learn about symptoms
“Menopause brings both physical and mental, ‘invisible’ symptoms. It can change your whole personality,” said Laura. “I became very anxious, I had to cancel meetings because of the fear of losing my words.” Laura told me that menopause and work can have a circular effect: “If you are suffering from insomnia, you’ll be less effective at work. If you are losing confidence at work, you’re only going to become more stressed. This doubles back on your sleep and your mental health.”
For many women, menopause symptoms can have a negative impact on day to day life and work:
hot flushes, which can be uncomfortable and embarrassing
night sweats and disturbed sleep
anxiety or a low mood
trouble concentrating and memory loss
vaginal dryness
loss of libido
You may experience some of these things during peri-menopause. This is when your body is starting to produce less oestrogen in the run up to the menopause. Peri-menopause can last for several years. During this time you may also see changes in the timing and heaviness of your periods.
The menopause can affect how you feel about your body and your sense of self. You might be like Kristen Scott-Thomas’s character in Fleabag: “the menopause...the most wonderful f-ing thing in the world...you’re free”. Not all of us are so ready to move on. You might have struggled with fertility, and feel a deep sense of loss or grief as your body changes. You might enjoy having periods. You might be horrified by the natural processes of aging. However you respond to the onset of menopause, it pays to be informed. Too many women are taken by surprise and have their confidence knocked as a result. We just don’t talk about it enough.
Ask for adjustments
Laura is determined that we talk about menopause more openly. “Women tend to cover up their symptoms and make excuses, which adds to how bad we feel about ourselves. We need to talk more and raise awareness so that employers understand how to help.”
According to the TUC, employers have ‘a duty to prevent workplace discrimination and to make adjustments to ensure women can work safely through the menopause.' This might mean allowing more flexible hours or making changes to the layout of your office.
Adjustments are unique to each person and each workplace. Talk to your employer about what would work for you. If, like Sarah, you find that you get hot flushes when you have to stand in front of a group, find out whether you could give your presentation remotely. Your employer should have a conversation with you about what is reasonable for both you and your colleagues. They shouldn't make you feel like you are causing a problem.
“I would have loved it if my employer had asked everyone to tell them when the room was too hot or too cold, so that they could make it comfortable for all of us. I didn’t want to be singled out because I was experiencing the menopause,” said Sarah.
“In larger companies, talk to HR or your Occupational Health rep,” said Laura. “They can make small adjustments that don’t cost a lot of money, such as giving access to cold water, providing desk fans, or using well-ventilated meeting rooms. If you have a uniform, some materials can get very hot and sweaty, so your employer should take this into account.”
“Menopause is covered under the Equality Act 2010,” says Laura. “There have been tribunals against employers under the Disability Act and as a result of discrimination. Employers need to stay within the law. But wouldn’t it be brilliant if every company had a proactive menopause policy? Even one tagged onto existing health and wellbeing policies?”
Only about 1 in 10 employers in the UK have a specific menopause policy. If you don’t feel comfortable talking to your manager about your symptoms, ask the person who deals with HR to discuss what support (if any) is available.
If you are self-employed, you could make changes to your working environment to ease things up a bit. Change your hours to fit your sleeping patterns; there’s no point forcing yourself to your laptop at 8.30 if you’ve only had 3 hours sleep. Make time for exercise during the day. Even a quick walk at lunchtime can reduce stress and lift your mood. And dress to undress - wearing thin layers gives you the option to remove a few and keep cool.
Get treatment
There are various treatments that can ease the symptoms of menopause. Hormone Replacement Therapy (HRT) is very effective at relieving symptoms, though it can have some side effects. HRT replaces oestrogen in your body. It comes in the form of skin patches, tablets, an implant or a gel. Current NICE guidelines say that all women experiencing symptoms of menopause should be given appropriate information about HRT, as well as other treatments.
Sarah felt she wasn’t given the choice by her GP. “My periods had stopped suddenly, and I’d been getting quite hot at night. The GP suggested that if I was only getting a bit hot then there was nothing to worry about, I should just carry on. He never explained that I might get other symptoms that could go on for years. He didn’t tell me that HRT was available to me.”
Other treatments to relieve menopause symptoms include a healthy diet and exercise, cognitive behavioural therapy (CBT), and alternative therapies like acupuncture. HRT is not suitable for all women, and some women may prefer not to use it, or to manage symptoms on their own. For Sarah, it was life-changing.
“I’d read media horror stories about HRT, and I hadn’t explored it. It was only when a friend told me about the benefits that I went to a different GP to find out more,” Sarah told me. “I went through a series of tests before being given a course of treatment. Within a week I started to feel better. My memory came back and the hot flushes and night sweats stopped. I feel ten years younger, much more energetic and more effective at work.”
Websites like Menopause and Me have been set up in response to the lack of information about coping with the menopause. They can help you think about what to ask your GP, and give you the tools to make informed decisions about your body.
Talk about your experience
Sadly, many of us won’t feel comfortable talking to our employer. But we need to make menopause a normal part of health and wellbeing conversations at work.
“We need to have open conversations,” said Laura. “Women need to feel able to talk to a trusted line manager. It can be tricky, especially if their manager is a younger man, for example. But employers can do a lot with training and awareness sessions. These can help managers spot symptoms and have sensitive conversations.”
In Laura’s awareness-raising sessions for employers, she finds that most people want to help. “Many men are surprised; they had no idea about menopause symptoms. Some of them tell me that they suddenly understand why their wife or colleague has changed. For women, it’s like a great weight has been lifted. They realise they are not alone.”
If you don’t feel able to talk to your employer, start by talking to your friends, your sister or your mum. Find an online support group. Peer support and shared experience can be vital in keeping your confidence up. It can give you the confidence to ask the right questions of medical professionals and your manager. Women are experiencing this every day. The more we talk about it, the more we can help other women.
“If I hadn’t moved jobs and had some time off before my next role, I would have gone off with stress.” said Sarah. “I thought my symptoms were a result of being completely overwhelmed and overworked. I was so low and had lost my confidence. I now realise that I had a medical condition. I talk to as many friends as I can about my experience so that they can get treatment faster, without going through what I did.”
How employers can help
Most employers can take small steps to make a big impact for women. “It’s about normalising the conversation around menopause,” said Laura. Best practice around menopause at work includes:
training for all line managers in menopause awareness
highlighting menopause as part of occupational health
ensuring that sickness, absence and performance policies take menopause symptoms into account
appointing a menopause champion, who is able to raise awareness and signpost employees to treatment and support
setting up informal menopause cafes or including menopause in wider wellbeing initiatives
Laura is determined to change the conversation about menopause. "It’s only a phase of a woman’s life. We need a bit of time and understanding to help manage our symptoms, and we can be just as productive as before.”
It’s frustrating that so many women feel they have to hide their symptoms or deal with them on their own. We’re losing a valuable and experienced part of the workforce. Women should never feel like they have to leave their jobs because of this natural, normal life change. So get talking.
