Over the past decade, women have broken many glass ceilings in the workspace. 9.74 million women are working full-time, and 5.92 million women contribute with part-time work in the UK and 4.5m working women are in the 50–64-year-old age bracket
Female entrepreneurship and businesses contribute £104bn to the UK economy (report by Federation of Small Businesses) and C-suite female leaders continue to grow (17% to 21% between January 25 to 2020, according to McKinsey & Leanin.org women in workplace report).
Figures released by the Office for National Statistics have shown that women aged 50 to 64 are the fastest-growing economically active group.
The fast progress of women in the workplace coincides with most women continuing to undertake most of the housework, childcare and other caring commitments (elderly relatives); In the UK, 40% of women responded that their partner rarely or never helps with household tasks.
It is fair to say that companies may have been caught unprepared, with suboptimal knowledge on menopause, lack of policies and support mechanisms and an organisational culture somewhat lagging.
A survey of 1004 women aged 50+ commissioned by Health & Her® found that 10% of women considered leaving their job because of menopause and a third found that menopause has affected their working life; when asked who women have turned to for finding help 41% reported ‘friends’ and only 0.6% felt comfortable talking to their employer. It is estimated that 14 million days of work are lost in the UK due to menopause.
Worryingly, even among doctors, senior female leaders also often feel unsupported, and many leave their careers behind at menopause, highlighting the magnitude of change needed in knowledge, attitudes and culture, not just among the public but amongst the body of doctors as a whole.
A survey done by CIPD (led by YouGov) shows that two thirds of women were substantially less able to concentrate during the menopause transition and a third had taken sick leave because of their symptoms. However, only a quarter of them felt able to tell their manager the real reason for their absence. Hot flashes affected 72% of women whilst psychological issues including low mood and depression, affected one in two of the women surveyed; 64% had sleep disturbances.
BIOLOGY OF MENOPAUSE
Female biology has remained unchanged and the age of menopause remained at an average of 51 years since records began. Menopause, the cessation of ovarian function, is defined as 12 months after the last menstrual period. Perimenopause – a time of wide hormone fluctuation preceding the cessation of periods, has the largest burden of symptoms and often occurs 5-10 years prior to the periods finally stopping. Hormone levels for oestradiol and progesterone ultimately decline 100-fold post menopause and at one year after the last menstrual period, both oestrogen and progesterone are barely detectable in a routine blood test.
Perimenopause usually starts when periods are still fairly regular, perhaps with only slight changes to the menstrual cycle and longer and shorter cycles alternating. It also comes with a heavy burden of emotional symptoms such as irritability, new onset anxiety or a worsening of previous mood problems. Moreover, insomnia, but also hot flashes, night sweats and lack of concentration are also common. Mood symptoms are often described as “not feeling myself”.
Other symptoms such as vaginal dryness, frequent urinary tract infections, low libido and low energy may also occur. Some women may also experience very heavy menstrual flow in peri-menopause, sometimes described as “flooding” when they may not feel able to leave the house and often need the opinion of an expert gynaecologist. There is also increased menstrual fatigue.
Although menopause is a natural process, our increased lifespan may now bring the potential of spending almost half of our lifetime post menopause.
Every woman’s experience of menopause is very individual. However, low levels of hormones post menopause and the wide fluctuating levels prior to this change have been associated with an increase in cardiovascular disease post-menopause. The rate of bone loss also increases significantly, potentially leading to osteoporosis.
There are two women diagnosed with Alzheimer’s for every man and the role of sex hormones in maintaining brain health is increasingly recognised; moreover, Covid-19 added specific risks to women’s health and menopause, and although women overall had better outcomes from the acute Covid 19 infection they were far more likely to develop long covid. Higher perceived stress during the pandemic increased menstrual problems and menopause symptoms.
Women’s health research has been historically underfunded and poorly organised. Findings from the largest trial on menopause treatment “The Women Health Initiative Study” did not even consider studying perimenopausal women and focused entirely on post menopause.
Moreover, the types of hormone therapies available used in that study – equine estrogen in tablet form and synthetic progestogens, which were later linked to increased breast cancer risk and other risks such as clots and stroke, have left many women fearful of HRT. But medical care of menopause is finally moving away from the synthetic hormones previously used on a very large scale and in favour of safer bio/body identical hormones.
The wider availability of hormones with the same structure to human hormones with a much-improved safety profile in the form of transdermal oestrogen and oral micronized progesterone – both identical to the human hormones 17 beta estradiol and progesterone are now more widely available and studies now show that there is no increase breast cancer risk at eight years of follow-up using these hormones.
The use and potential benefits of adding testosterone replacement to estrogen replacement in women is also becoming more widely acceptable.
The Marion Gluck clinic has championed the use of bio-identical transdermal estrogen, progesterone and testosterone using hormone preparations tailored to each women at every stage of peri and post menopause for more than 20 years.
HOW CAN WOMEN BE BEST SUPPORTED DURING THE MENOPAUSE TRANSITION
Currently, CIPD and ACAS have guidance on Menopause and the law and policies that should be available in every business. Although menopause is not a protected characteristic under the Equality Act 2010, it is covered under the Discrimination Act for age and sex and also by the Health and Safety at work act 1974.
There is now a growing commitment at government level to encourage support of educational activities for both healthcare providers and the public on the symptoms of menopause and available strategies that include lifestyle changes and medical treatments that may be helpful in this transition.
Employers have a responsibility to create safer workspaces where menopause conversations can take place; tackling the stigma surrounding menopause is an essential first step. Creating a climate of openness and organising educational events at work may be helpful.
Employers must consider offering work adjustments when needed. ACAS and CIPD recommend considering flexible working, later start times, more frequent comfort breaks as needed and other adjustments like a desk fan or other environmental adjustments (ventilation, drinking water etc).
IS THERE ANY EVIDENCE?
A recent systematic review of literature looking at the effectiveness of workplace interventions for menopause found a series of interventions that improved both menopausal symptoms and work outcomes. These included both awareness programs, and health promotion events in the workplace.
Both employers and employees reported that their knowledge and attitudes towards the menopause had improved as a result of these measures. Moreover, facilitating access to specialist menopause consultations and easier access to expert advice, work-life coaching, certain forms of physical exercise and training, yoga and self-help CBT made a statistically significant difference in the data.
In a number of clinical trials, Cognitive Behaviour Therapy (CBT) was shown to have a statistically significant impact in improving a range of menopausal symptoms.
The large majority of evidence on best interventions for menopause in the workplace is so far based on a number of small studies and more data is needed.
An approach that is rooted in a commitment to being honest and open in conversations about menopause is important. There should be an aim to break the taboo and stigma surrounding it, alongside facilitating access to a choice of timely expert advice, coaching or psychological support. Menopause-specific fitness and relaxation strategies (yoga, mindfulness) are also likely to be beneficial.
Any intervention should be evaluated and reshaped to meet the needs of today’s overburdened women.
As women will likely continue to juggle work/life balance challenges, conflicting demands, and too little time, access to expert care and safe therapies is also essential. Care must be holistic and encompass access to science based lifestyle changes, self-care strategies and hormone therapies where required.
Menopause remains a transitional phase in a woman’s life. Much non-menopause related research has shown that women are happiest in their 30s and also after the age of 55, with the lowest period in their lives occurring in their late 40s to early 50’s.
Many symptoms such as hot flashes, low mood, insomnia and lack of concentration may improve post menopause even in the absence of hormone therapy, with lifestyle changes alone. However, some women continue to have long term symptoms long past the last menstrual period.
Many women post menopause find themselves with newfound wisdom, courage, and creativity, able to live very productive and fulfilling lives, which benefits society as a whole. Employers who may wish to seize the opportunity to support women in this transitional phase of their lives with interventions that fully meet their needs may well reap the benefits of a committed and creative female workforce.
Dr. Monica Lascar, functional medicine and hormone expert
Dr. Monica Lascar trained in Sexual Health and HIV at University College Hospital; she went on to achieve a research degree from UCL in Viral Immunology. Throughout her career, Dr. Lascar developed an interest in functional medicine, bioidentical hormones and a more holistic approach to patient care.
Dr. Lascar employs a functional medicine approach where appropriate, which looks at food as medicine alongside targeted supplements and to balance the body’s hormones, the use of bioidentical hormones. She has experience treating patients with a range of complex symptoms, including perimenopause, menopause, fatigue and immune dysfunction conditions.
Dr. Lascar has seen her expert advice published in GP Online, along with other medical blogs and journals. She has been a guest on the Happy Hormones podcast.