CLIMACTERIC 2015;18:372–375
Working women and the menopause T. Kopenhager and F. Guidozzi* Parklane Clinic, Parktown, Johannesburg; *Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa Key words: WORKING WOMEN, MENOPAUSE EMPLOYMENT, MENOPAUSE SYMPTOMS
ABSTRACT Women are living longer, working more and retiring later. About 45% of the over 50-year-old workforce in virtually all forms of employment are women, all of whom will experience the menopause and its symptoms, which in some women will be mild to moderate, whilst in others they may be severe and debilitating. About half of these women will find it somewhat, or fairly difficult, to cope with their work, about half will not be affected and only about 5% will be severely compromised. Poor concentration, tiredness, poor memory, depression, feeling low, lowered confidence, sleepiness and particularly hot flushes are all cited as contributing factors. As with any longstanding health-related condition, the need for support and understanding from line management is crucial and can make a major difference to how a woman will deal with the adverse impact the menopausal symptoms may have on her productivity, her job satisfaction and her efficiency. A number of plausible strategies have been proposed that can be realistically implemented in the workplace and which could certainly make a significant difference. Careful thought, planning, consideration and effort may be required but, if instituted, they will, in the final analysis, benefit both employer and employee.
INTRODUCTION Women today are living longer, a great many are part of the workforce, and a significant number continue working through their forties, fifties and sixties, thus retiring much later. A number of older women return to work when family commitments allow, or economic factors dictate that they contribute to the family income. All women who reach the fifth decade will experience the menopause and its symptoms which may be mild to debilitating, so that there is potential for significant impact on their performance in the workplace. Yet, despite this, the effects of the menopause on working women have received scant attention in the medical literature. In the United Kingdom, women comprise 47% of the workforce. More than 3.5 million of these women exceed 50 years of age and constitute about 45% of the over 50-yearold workforce, a percentage that is steadily increasing. In the USA, the number of women in the workforce has increased by 44% in the last 25 years. In 2010, the US Congress Joint Committee declared that the USA economy is dependent on working women. Women play a very diverse role in the workplace and are found in virtually any type of employment, including heavy manual labor, particularly in Africa and Asia. In the UK, Europe and the USA, statistics on women in the workplace pertain to those in professional occupations,
scientific and technical activities, education, information and communication, finances, administration, business, wholesale and retail trade, industry, agriculture and the defence forces1,2.
METHOD A systematic search of English-language publications was undertaken using Medline, Index Medicus, Pubmed, Embase and Google Scholar, using the terms ‘Menopause and the workplace’, ‘Working menopausal women’, ‘Menopausal women who are working’, ‘Working women and the menopause’. Any article that addressed or had any relevance to the topic was used in this review.
THE EFFECT OF MENOPAUSE ON WORKING WOMEN The most recognizable effects of declining ovarian hormone levels are associated with the menopause transition and result in irregular menses and eventual amenorrhea. Initially, there may be ‘hormonal chaos’, followed by the well-known menopausal symptoms, hot flushes, night sweats, urogenital
Correspondence: Dr F. Guidozzi, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; E-mail: [email protected] REVIEW © 2015 International Menopause Society DOI: 10.3109/13697137.2015.1020483
Received 11-01-2015 Accepted 14-02-2015
Working women and the menopause atrophy, sleep disturbances, fatigue, mood changes, difficulty with concentration and impaired short-term memory. These are associated with decreased quality of life3,4. In the postmenopause, the risk of breast cancer, coronary heart disease, large bowel cancer, macular degeneration and falls with osteoporotic fracture increase and will impact the performance of menopausal woman in the workplace. Sleep disorders and daytime sleepiness, tiredness and fatigue are additional challenges for menopausal women during their working day5. The postmenopausal years tend to occur at a challenging time in the life of most women. Chronic personal health issues become more common and their risk increases with age. Women at this age may have other significant stresses in their lives, especially economic hardships and therefore the need to work. In addition they may have the responsibility for the care of chronically ill or disabled parents or partners. Care of children, either one’s own, or one’s grandchildren, may be a stress factor, especially if these children are socially problematic. Divorce, children leaving home, or death of a partner will add to the stresses at this time in a woman’s life. A significant number of women bear the greater burden of domestic responsibility and may indeed need to work at the same time. As previously stated, there are a very limited number of studies that have explored the impact of the menopause on working women. The management of gender-specific health issues in the workplace, other than pregnancy, is rarely discussed, even though women aged between 50 and 65 years constitute a sizeable part of the workforce. The prevailing data support the fact that the menopause has negative effects on work. A significant number of women find it difficult to cope with work during this time of their life. Poor concentration, tiredness, poor memory, depression or feeling low, lowered confidence and sleepiness are frequently cited as contributing factors. Coping with hot flushes may be particularly stressful, especially for women who work in a hot or poorly ventilated environment, attend formal meetings or give formal presentations, and may lead to a significant amount of embarrassment, which in turn adds further to the stress. About half of menopausal women are likely to find it somewhat, or fairly difficult, to cope with work during the menopausal transition. About the same number will not find it difficult and about 5% will find it very or extremely difficult to cope with work6–8. Women are more likely to report stress, are more prepared to attribute it to work and have different reactions to stress than men. The menopause is an occupational health issue. Employers have been slow to recognize that menopausal women may need special support and consideration in order to remain as productive as they could be9. In 2003, the Trades Union Congress in the UK surveyed 500 safety representatives on the question of menopause in the workplace5. This study found that 45% of company managers did not know of the existence of menopause-related problems; 35% of workers reported embarrassment in discussing their menopause problems with managers, especially if the
Climacteric
Kopenhager and Guidozzi managers were younger than they, or if they were male; 30% of managers were critical of menopause-related sick leave; 20% of workers reported criticism, ridicule and even harassment when these problems were broached. Menopausal subjects stated that symptoms most likely to be made worse by work were hot flushes (53%), headaches (46%), tiredness and lack of energy (45%), sweating (39%), anxiety (33%), aches and pains (30%), dry eyes and skin (29%)10. Menopausal subjects claimed that symptoms were exacerbated by certain working conditions including high temperatures in the workplace (66%), poor ventilation (50%), work-related stress (49%), poor or non-existent toilet and rest facilities, lack of access to drinking water and inconvenient working hours10. In 2010, the British Occupational Health Research Foundation (BOHRF) presented a report of ‘Women’s experience of working through the menopause’3. They found that most women were ill prepared for the consequences of the menopause and even more poorly equipped to manage menopause symptoms at work. The majority of women felt in need of advice, support and information regarding the menopause, and how to cope with symptoms at work. These women felt that this information should be provided by their employers. Five percent of women found it very or extremely difficult to work as a result of their menopause symptoms. Almost half of the remaining women found it somewhat or fairly difficult to cope, while the other half did not find it difficult at all. Seventy-five percent of women in the study reported using hormone therapy to alleviate their symptoms and thus allow them to manage their work load. Just over 90% of these women reported that hormone therapy was effective. Many women felt that work places and work practices were not designed to accommodate menopausal women and that hot flushes at work were a major source of distress. Almost half of the women reported that menopause symptoms negatively affected their work performance. Women were not comfortable discussing their health problems with their managers, especially if these were younger than they or male. Many of these women worked extremely hard to hide their self-perceived shortcomings resulting from their menopausal symptoms. Only half of the women who took time off to deal with their menopause symptoms revealed the real reasons in their sick-leave applications. Over half of the respondents felt that flexible working hours would facilitate their ability to handle the discomfort of their symptoms but were unable to negotiate these. Many women contemplated resigning or applying for part-time employment but were concerned about the effect of this on their careers. Almost half of the sample reported no form of temperature control in their workplaces. Some could not open windows, or, if they could, this often caused interpersonal differences with colleagues. Many women described strategies to cope with hot flushes such as change in diet, exercise, more sleep at weekends, the use of personal fans, layers of clothing or bringing a change of clothing to work11,12. In 2012, a cross-sectional study looked at the impact of menopausal symptoms on the ability to perform effectively at the workplace. The premise was that, if the menopausal
373
Working women and the menopause symptoms interfere with quality of life of women, would they also interfere with quality and consistency of work output? A total of 208 women aged 44–60 years who worked for a hospital and home-care organization in the Netherlands were recruited. Each subject completed a questionnaire that included the Work Ability Index (which reflects selfreported ability relative to past performance, job demands, current diseases and recent illness related absences) and the Greene Climacteric Scale (a 21-item survey of menopausal symptoms and their severity, including psychological symptoms, such as difficulty in concentrating, mood changes and depression, and somatic symptoms, such as headaches, dizziness, joint pains and vasomotor symptoms). A significant negative correlation between the total Greene Climacteric Scale and the Work Ability Index was found which clearly indicated that the more severe the menopausal symptoms were, the poorer the general work ability. Contrary to expectation and what had been found in other studies, this study showed that psychological and somatic symptoms, but not vasomotor symptoms, correlated with a low Work Ability Index score, indicating that vasomotor symptoms were not bothersome to most of the women. This finding is very confusing and may well have arisen because only 24% of the women enlisted responded to the questionnaires which may have been because of the fear that participation would bring intimidation or negative repercussions if discovered13. Nevertheless, although this finding is difficult to substantiate, the study does indicate that psychological and somatic menopausal symptoms had deleterious effects on work ability and increased absenteeism. Sarrel, in an editorial, remarks that the confusion following the publication of the WHI study in 2002 caused many women to discontinue their hormone therapy, thus increasing the severity of menopausal symptoms and decreasing the capacity to function effectively in the workplace14. In April 2012, in a BHRT blog concerned with ‘Coping with the menopause in the workplace’, Zachos opines that we live longer, work harder and retire later because today success requires longer work hours, shorter breaks and less vacation time. Zachos asked the question ‘How are women with menopause coping in the ever competitive workplace?‘. Zachos, however, does not answer the question15. A study from Australia in 2014 looked at the health, wellbeing, menopausal status, symptoms and work outcomes of 583 women aged 40–70 years who worked mainly in executive, administrative and academic positions in tertiary education. Women reported that their headaches, sleep disturbances, weakness, fatigue and anxiety caused less job satisfaction, greater intention to leave, less engagement with work and less commitment to their task. Less than 1% had on-job training in menopause awareness and there was a lack of planning for the issues that the menopause may precipitate. A significant number of the women in the study stated that they were not keen to raise the issue of menopause, especially those women with high-image professional positions16.
374
Kopenhager and Guidozzi
PROPOSED STRATEGIES TO OVERCOME THE PROBLEM Can anything be done to alleviate, or at least accommodate, menopause and its resulting impact on women in the workplace? First, menopause should be regarded as an occupational health issue, so that it is recognized that menopausal women need special support and consideration, in order to remain as productive as they once were. As with any longstanding health-related condition, the need for support and understanding from line management is crucial and can make a major difference to how a woman will deal with the issues arising from the menopause. Obviously, there are a variety of strategies that need to be considered as every workplace has different conditions. The time has come for employers to accept responsibility and take into account all the difficulties that women may experience during the menopause. The Trade Union Council of the UK has produced a booklet to educate employers and to clarify their role in the workplace so that women can expect and receive support and assistance to overcome their deficiencies at work brought about by the menopause. Recommendations include: • Managers, risk managers and safety officers must be aware of the effects of the menopause on work. They should be trained to make the necessary adjustments to support struggling women. • Employers must display a positive attitude to the menopause by incorporating it into a wider health awareness campaign. This should help to prevent embarrassment in menopausal workers. • Issues arising at work as a result of the menopause should be appropriately handled. These should preferably be handled by older female human resources, welfare or safety managers so as to avoid embarrassment to the workers. There should be an adequate number of these managers with whom the female workers can interact. • Sickness absence procedures must be flexible to cater for menopause-related illness. Women should experience no detriment as a result of this. • Flexible working times should be introduced to allow menopausal women breaks when needed.
• Work environments should not exacerbate menopausal symptoms, such as ambient temperature control, ventilation, access to cool water and clean toilet facilities.
CONCLUSION In conclusion, many women enter menopause at the prime of their productive lives. It would be of advantage to employers to retain these women for their skills, knowledge, experience and loyalty. The economic impact of menopause and the work place has recently been addressed by Fenton and Panay17. It is surprising that the subject has not been more researched
Climacteric
Working women and the menopause and that there is an obvious dearth of literature addressing the problem. Although there are some variations in some of the findings published in the literature, the consensus is that about half of the working menopausal women will be compromised to some extent by the menopausal symptoms, about half the women will not obviously be affected, and only about 5% will be severely affected. Women may work extremely hard to overcome their perceived shortcomings resulting from menopause symptoms. When women take time off work to deal with these symptoms, only half disclose the real reason for their absence to their managers. Other women have even considered resignation because of the embarrassment they felt caused by the menopausal symptoms. The strategies that
Kopenhager and Guidozzi have been proposed to overcome the possible adverse impact of these menopausal symptoms are plausible, realistic and could make a significant difference. Careful thought, planning, consideration and effort may be required, but, if instituted, will in the final analysis benefit both employers and employees. Conflict of interest The authors report no confl ict of interest. The authors alone are responsible for the content and writing of this paper. Source of funding
Nil.
References 1. United Kingdom Office of National Statistics, 2010. www. statistics.gov.uk/ 2. United States Joint Economic Congress, 2010. www.jec.senate. gov/public/ 3. Guidozzi F, Alperstein A, Bagratee J, et al. for the South African Menopause Society. South African Menopause Society revised consensus position statement on menopausal hormone therapy, 2014. South African Med J 2014;104:537–43 4. Utian W, Woods NF. Impact of hormone therapy on quality of life after the menopause. Menopause 2013;20:109–10 5. Guidozzi F. Sleep and sleep disorders in the menopause. Climacteric 2013;16:214–19 6. Whiteley J, Wagner A, Kopenhafer L, Dibonaventura M. The impact of the severity of vasomotor symptoms on health status, resource use and productivity. Menopause 2013;20:518–24 7. High RV, Marcellino PA. Menopausal women and the work environment. Social behaviour & Personality 1994;22:347–54 8. Reynolds F. Distress and coping with hot flushes at work: implications for counsellors in occupational settings. Counselling Psychology Q 1999;12:353–61 9. UNISON’S Health and safety guide to the menopause. www. unison.org.uk/acrobat/Healthand Safety June 2011.pdf
Climacteric
10. Working through the change: health and safety and the menopause. TUC survey of safety representatives. March 2003. www. tuc.org.uk/workplace/tuc-6316-10.cfm 11. Griffiths A, MacLennan A, Hassard J. Menopause and work; an electronic survey of employee’s attitude in the UK. Maturitas 2013;76:155–9 12. http://www.bohrf.org.uk/downloads/Womens_Experience_of_ Working_through_the _Menopause-Dec_2010.pdf 13. Geukes M, van Aalst MP, Nauta MCE, Oosterhof H. The impact of menopausal symptoms on work ability. Menopause 2012;19: 278–82 14. Sarrel PM. Women, work and menopause. Menopause 2012;19: 250–2 15. Zachos G. Coping with the menopause in the workplace. BHTR Blog Menopause. http://bsc5.com/bhrt/coping-with-menopausein-the-workplace/2012 16. Jack G, Bariola E, Riach K, Schnapper J, Pitts M. Work, women and the menopause: an Australian Exploratory Study. Climacteric 2014;17(Suppl 2):34 17. Fenton A, Panay N. Menopause and the workplace. Climacteric 2014;17:317–18
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Working women and the menopause T. Kopenhager and F. Guidozzi* Parklane Clinic, Parktown, Johannesburg; *Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa Key words: WORKING WOMEN, MENOPAUSE EMPLOYMENT, MENOPAUSE SYMPTOMS
ABSTRACT Women are living longer, working more and retiring later. About 45% of the over 50-year-old workforce in virtually all forms of employment are women, all of whom will experience the menopause and its symptoms, which in some women will be mild to moderate, whilst in others they may be severe and debilitating. About half of these women will find it somewhat, or fairly difficult, to cope with their work, about half will not be affected and only about 5% will be severely compromised. Poor concentration, tiredness, poor memory, depression, feeling low, lowered confidence, sleepiness and particularly hot flushes are all cited as contributing factors. As with any longstanding health-related condition, the need for support and understanding from line management is crucial and can make a major difference to how a woman will deal with the adverse impact the menopausal symptoms may have on her productivity, her job satisfaction and her efficiency. A number of plausible strategies have been proposed that can be realistically implemented in the workplace and which could certainly make a significant difference. Careful thought, planning, consideration and effort may be required but, if instituted, they will, in the final analysis, benefit both employer and employee.
INTRODUCTION Women today are living longer, a great many are part of the workforce, and a significant number continue working through their forties, fifties and sixties, thus retiring much later. A number of older women return to work when family commitments allow, or economic factors dictate that they contribute to the family income. All women who reach the fifth decade will experience the menopause and its symptoms which may be mild to debilitating, so that there is potential for significant impact on their performance in the workplace. Yet, despite this, the effects of the menopause on working women have received scant attention in the medical literature. In the United Kingdom, women comprise 47% of the workforce. More than 3.5 million of these women exceed 50 years of age and constitute about 45% of the over 50-yearold workforce, a percentage that is steadily increasing. In the USA, the number of women in the workforce has increased by 44% in the last 25 years. In 2010, the US Congress Joint Committee declared that the USA economy is dependent on working women. Women play a very diverse role in the workplace and are found in virtually any type of employment, including heavy manual labor, particularly in Africa and Asia. In the UK, Europe and the USA, statistics on women in the workplace pertain to those in professional occupations,
scientific and technical activities, education, information and communication, finances, administration, business, wholesale and retail trade, industry, agriculture and the defence forces1,2.
METHOD A systematic search of English-language publications was undertaken using Medline, Index Medicus, Pubmed, Embase and Google Scholar, using the terms ‘Menopause and the workplace’, ‘Working menopausal women’, ‘Menopausal women who are working’, ‘Working women and the menopause’. Any article that addressed or had any relevance to the topic was used in this review.
THE EFFECT OF MENOPAUSE ON WORKING WOMEN The most recognizable effects of declining ovarian hormone levels are associated with the menopause transition and result in irregular menses and eventual amenorrhea. Initially, there may be ‘hormonal chaos’, followed by the well-known menopausal symptoms, hot flushes, night sweats, urogenital
Correspondence: Dr F. Guidozzi, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; E-mail: [email protected] REVIEW © 2015 International Menopause Society DOI: 10.3109/13697137.2015.1020483
Received 11-01-2015 Accepted 14-02-2015
Working women and the menopause atrophy, sleep disturbances, fatigue, mood changes, difficulty with concentration and impaired short-term memory. These are associated with decreased quality of life3,4. In the postmenopause, the risk of breast cancer, coronary heart disease, large bowel cancer, macular degeneration and falls with osteoporotic fracture increase and will impact the performance of menopausal woman in the workplace. Sleep disorders and daytime sleepiness, tiredness and fatigue are additional challenges for menopausal women during their working day5. The postmenopausal years tend to occur at a challenging time in the life of most women. Chronic personal health issues become more common and their risk increases with age. Women at this age may have other significant stresses in their lives, especially economic hardships and therefore the need to work. In addition they may have the responsibility for the care of chronically ill or disabled parents or partners. Care of children, either one’s own, or one’s grandchildren, may be a stress factor, especially if these children are socially problematic. Divorce, children leaving home, or death of a partner will add to the stresses at this time in a woman’s life. A significant number of women bear the greater burden of domestic responsibility and may indeed need to work at the same time. As previously stated, there are a very limited number of studies that have explored the impact of the menopause on working women. The management of gender-specific health issues in the workplace, other than pregnancy, is rarely discussed, even though women aged between 50 and 65 years constitute a sizeable part of the workforce. The prevailing data support the fact that the menopause has negative effects on work. A significant number of women find it difficult to cope with work during this time of their life. Poor concentration, tiredness, poor memory, depression or feeling low, lowered confidence and sleepiness are frequently cited as contributing factors. Coping with hot flushes may be particularly stressful, especially for women who work in a hot or poorly ventilated environment, attend formal meetings or give formal presentations, and may lead to a significant amount of embarrassment, which in turn adds further to the stress. About half of menopausal women are likely to find it somewhat, or fairly difficult, to cope with work during the menopausal transition. About the same number will not find it difficult and about 5% will find it very or extremely difficult to cope with work6–8. Women are more likely to report stress, are more prepared to attribute it to work and have different reactions to stress than men. The menopause is an occupational health issue. Employers have been slow to recognize that menopausal women may need special support and consideration in order to remain as productive as they could be9. In 2003, the Trades Union Congress in the UK surveyed 500 safety representatives on the question of menopause in the workplace5. This study found that 45% of company managers did not know of the existence of menopause-related problems; 35% of workers reported embarrassment in discussing their menopause problems with managers, especially if the
Climacteric
Kopenhager and Guidozzi managers were younger than they, or if they were male; 30% of managers were critical of menopause-related sick leave; 20% of workers reported criticism, ridicule and even harassment when these problems were broached. Menopausal subjects stated that symptoms most likely to be made worse by work were hot flushes (53%), headaches (46%), tiredness and lack of energy (45%), sweating (39%), anxiety (33%), aches and pains (30%), dry eyes and skin (29%)10. Menopausal subjects claimed that symptoms were exacerbated by certain working conditions including high temperatures in the workplace (66%), poor ventilation (50%), work-related stress (49%), poor or non-existent toilet and rest facilities, lack of access to drinking water and inconvenient working hours10. In 2010, the British Occupational Health Research Foundation (BOHRF) presented a report of ‘Women’s experience of working through the menopause’3. They found that most women were ill prepared for the consequences of the menopause and even more poorly equipped to manage menopause symptoms at work. The majority of women felt in need of advice, support and information regarding the menopause, and how to cope with symptoms at work. These women felt that this information should be provided by their employers. Five percent of women found it very or extremely difficult to work as a result of their menopause symptoms. Almost half of the remaining women found it somewhat or fairly difficult to cope, while the other half did not find it difficult at all. Seventy-five percent of women in the study reported using hormone therapy to alleviate their symptoms and thus allow them to manage their work load. Just over 90% of these women reported that hormone therapy was effective. Many women felt that work places and work practices were not designed to accommodate menopausal women and that hot flushes at work were a major source of distress. Almost half of the women reported that menopause symptoms negatively affected their work performance. Women were not comfortable discussing their health problems with their managers, especially if these were younger than they or male. Many of these women worked extremely hard to hide their self-perceived shortcomings resulting from their menopausal symptoms. Only half of the women who took time off to deal with their menopause symptoms revealed the real reasons in their sick-leave applications. Over half of the respondents felt that flexible working hours would facilitate their ability to handle the discomfort of their symptoms but were unable to negotiate these. Many women contemplated resigning or applying for part-time employment but were concerned about the effect of this on their careers. Almost half of the sample reported no form of temperature control in their workplaces. Some could not open windows, or, if they could, this often caused interpersonal differences with colleagues. Many women described strategies to cope with hot flushes such as change in diet, exercise, more sleep at weekends, the use of personal fans, layers of clothing or bringing a change of clothing to work11,12. In 2012, a cross-sectional study looked at the impact of menopausal symptoms on the ability to perform effectively at the workplace. The premise was that, if the menopausal
373
Working women and the menopause symptoms interfere with quality of life of women, would they also interfere with quality and consistency of work output? A total of 208 women aged 44–60 years who worked for a hospital and home-care organization in the Netherlands were recruited. Each subject completed a questionnaire that included the Work Ability Index (which reflects selfreported ability relative to past performance, job demands, current diseases and recent illness related absences) and the Greene Climacteric Scale (a 21-item survey of menopausal symptoms and their severity, including psychological symptoms, such as difficulty in concentrating, mood changes and depression, and somatic symptoms, such as headaches, dizziness, joint pains and vasomotor symptoms). A significant negative correlation between the total Greene Climacteric Scale and the Work Ability Index was found which clearly indicated that the more severe the menopausal symptoms were, the poorer the general work ability. Contrary to expectation and what had been found in other studies, this study showed that psychological and somatic symptoms, but not vasomotor symptoms, correlated with a low Work Ability Index score, indicating that vasomotor symptoms were not bothersome to most of the women. This finding is very confusing and may well have arisen because only 24% of the women enlisted responded to the questionnaires which may have been because of the fear that participation would bring intimidation or negative repercussions if discovered13. Nevertheless, although this finding is difficult to substantiate, the study does indicate that psychological and somatic menopausal symptoms had deleterious effects on work ability and increased absenteeism. Sarrel, in an editorial, remarks that the confusion following the publication of the WHI study in 2002 caused many women to discontinue their hormone therapy, thus increasing the severity of menopausal symptoms and decreasing the capacity to function effectively in the workplace14. In April 2012, in a BHRT blog concerned with ‘Coping with the menopause in the workplace’, Zachos opines that we live longer, work harder and retire later because today success requires longer work hours, shorter breaks and less vacation time. Zachos asked the question ‘How are women with menopause coping in the ever competitive workplace?‘. Zachos, however, does not answer the question15. A study from Australia in 2014 looked at the health, wellbeing, menopausal status, symptoms and work outcomes of 583 women aged 40–70 years who worked mainly in executive, administrative and academic positions in tertiary education. Women reported that their headaches, sleep disturbances, weakness, fatigue and anxiety caused less job satisfaction, greater intention to leave, less engagement with work and less commitment to their task. Less than 1% had on-job training in menopause awareness and there was a lack of planning for the issues that the menopause may precipitate. A significant number of the women in the study stated that they were not keen to raise the issue of menopause, especially those women with high-image professional positions16.
374
Kopenhager and Guidozzi
PROPOSED STRATEGIES TO OVERCOME THE PROBLEM Can anything be done to alleviate, or at least accommodate, menopause and its resulting impact on women in the workplace? First, menopause should be regarded as an occupational health issue, so that it is recognized that menopausal women need special support and consideration, in order to remain as productive as they once were. As with any longstanding health-related condition, the need for support and understanding from line management is crucial and can make a major difference to how a woman will deal with the issues arising from the menopause. Obviously, there are a variety of strategies that need to be considered as every workplace has different conditions. The time has come for employers to accept responsibility and take into account all the difficulties that women may experience during the menopause. The Trade Union Council of the UK has produced a booklet to educate employers and to clarify their role in the workplace so that women can expect and receive support and assistance to overcome their deficiencies at work brought about by the menopause. Recommendations include: • Managers, risk managers and safety officers must be aware of the effects of the menopause on work. They should be trained to make the necessary adjustments to support struggling women. • Employers must display a positive attitude to the menopause by incorporating it into a wider health awareness campaign. This should help to prevent embarrassment in menopausal workers. • Issues arising at work as a result of the menopause should be appropriately handled. These should preferably be handled by older female human resources, welfare or safety managers so as to avoid embarrassment to the workers. There should be an adequate number of these managers with whom the female workers can interact. • Sickness absence procedures must be flexible to cater for menopause-related illness. Women should experience no detriment as a result of this. • Flexible working times should be introduced to allow menopausal women breaks when needed.
• Work environments should not exacerbate menopausal symptoms, such as ambient temperature control, ventilation, access to cool water and clean toilet facilities.
CONCLUSION In conclusion, many women enter menopause at the prime of their productive lives. It would be of advantage to employers to retain these women for their skills, knowledge, experience and loyalty. The economic impact of menopause and the work place has recently been addressed by Fenton and Panay17. It is surprising that the subject has not been more researched
Climacteric
Working women and the menopause and that there is an obvious dearth of literature addressing the problem. Although there are some variations in some of the findings published in the literature, the consensus is that about half of the working menopausal women will be compromised to some extent by the menopausal symptoms, about half the women will not obviously be affected, and only about 5% will be severely affected. Women may work extremely hard to overcome their perceived shortcomings resulting from menopause symptoms. When women take time off work to deal with these symptoms, only half disclose the real reason for their absence to their managers. Other women have even considered resignation because of the embarrassment they felt caused by the menopausal symptoms. The strategies that
Kopenhager and Guidozzi have been proposed to overcome the possible adverse impact of these menopausal symptoms are plausible, realistic and could make a significant difference. Careful thought, planning, consideration and effort may be required, but, if instituted, will in the final analysis benefit both employers and employees. Conflict of interest The authors report no confl ict of interest. The authors alone are responsible for the content and writing of this paper. Source of funding
Nil.
References 1. United Kingdom Office of National Statistics, 2010. www. statistics.gov.uk/ 2. United States Joint Economic Congress, 2010. www.jec.senate. gov/public/ 3. Guidozzi F, Alperstein A, Bagratee J, et al. for the South African Menopause Society. South African Menopause Society revised consensus position statement on menopausal hormone therapy, 2014. South African Med J 2014;104:537–43 4. Utian W, Woods NF. Impact of hormone therapy on quality of life after the menopause. Menopause 2013;20:109–10 5. Guidozzi F. Sleep and sleep disorders in the menopause. Climacteric 2013;16:214–19 6. Whiteley J, Wagner A, Kopenhafer L, Dibonaventura M. The impact of the severity of vasomotor symptoms on health status, resource use and productivity. Menopause 2013;20:518–24 7. High RV, Marcellino PA. Menopausal women and the work environment. Social behaviour & Personality 1994;22:347–54 8. Reynolds F. Distress and coping with hot flushes at work: implications for counsellors in occupational settings. Counselling Psychology Q 1999;12:353–61 9. UNISON’S Health and safety guide to the menopause. www. unison.org.uk/acrobat/Healthand Safety June 2011.pdf
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