Treating women as equal to men does not mean treating the two sexes the same. Women are different biologically and this may need to be taken into account at work. Gordon Tranter investigates how the menopause can affect women’s health in the workplace and suggests how employers can provide support to enable women to continue to work comfortably and productively during this time.
Millions of women workers
The menopause is a natural stage of life that millions of women workers are either experiencing now or will go through in the future. There are around 4.3 million women over the age of 50 currently working in Britain and consequently an increasing number of women of menopausal age are working in the UK. Many women workers leave their jobs through lack of support during this difficult period in their lives. Positively managing the menopause at work can help employers to retain valued staff.
The menopause is marked by changes in hormones and the end of menstruation (when a woman’s periods stop for 12 consecutive months). For most women the menopause occurs between the ages of 45 and 55, although a minority of women can experience it in their 30s or earlier. The symptoms (perimenopause) can last from four to eight years.
While some women experience almost no symptoms, the majority do experience significant changes, such as hot flushes, palpitations, night sweats and sleep disturbance, fatigue, concentration loss, memory loss, irritability, skin irritation, depression and loss of confidence. Urinary problems may also occur during the menopause, and many women have recurrent lower urinary tract infections, such as cystitis. It is common for the need to pass urine to arise urgently or more often.
As such, menopausal symptoms can prove embarrassing for some women, making them reluctant to discuss the issue openly. Working with male colleagues can increase the level of embarrassment and discomfort, eg during hot flushes.
Hot flushes are a major source of distress for many women at work. The symptoms can be exacerbated by working in hot and poorly ventilated environments. Hot flushes can cause embarrassment or other difficulties in relationships with colleagues or clients and can make it more difficult to cope with formal meetings, and high visibility work such as formal presentations.
Women affected by menopausal symptoms are reported to feel less confident. Some women suspect the menopause has a negative impact on their managers’ and colleagues’ perceptions of their competence at work and feel anxious about these perceived performance deficits. Their performance can suffer and situations which would normally have been dealt with easily become more difficult.
Increasing national focus
There has been an increase in interest in the effects of the menopause at work. In a debate on health services and the menopause in the House of Commons, the then Minister for Care (Caroline Dinenage) said: “We need to ensure that workplaces provide the necessary and appropriate support for women. A recent study found that 41% of women aged 50–60 said that the menopause had affected their job, but that 70% did not tell their employer about their symptoms. This demonstrates the work that needs to be done to move beyond shame and silence to an open conversation about the menopause, because half the population will go through it. Giving better support to those women in work is not only right, but fundamentally good for the economy. Women over 50 are now one of the fastest growing groups of employees. They have invaluable skills and experience, which means that they are incredibly difficult to replace. We should be looking to support them to stay in work whenever we can.”
An enquiry by the Women and Equalities Committee, open between July and September 2021, was tasked with scrutinising the current legal protection and workplace practices available to women going through the menopause against discrimination. This is part of a government commitment to conduct research into “what works to improve women’s reproductive health, across their life…” and “develop indicators relating to women’s health experience and impact on their work”.
The first ever Women's Health Strategy is also being developed, and it has recently announced that a new cross-government Menopause Taskforce will be established. This taskforce will look at the role education and training, workplace policies and peer groups for menopausal women can play in supporting women though this challenging time. The Civil Service is also developing its first workplace menopause policy to enable women to continue to fulfil their full potential.
The Wellbeing of Women charity group has also created a “Menopause Workplace Pledge” campaign which was launched on 4 October 2021. This asks employers to take positive steps in offering employee’s support, and commit themselves to:
recognise that the menopause can be an issue in the workplace and women need support
talk openly, positively, and respectfully about the menopause
actively support and inform employees affected by the menopause.
The major impact
The report Women’s Experience of Working through the Menopause, from the Institute of Work, Health & Organisations at Nottingham University, found that many women going through the menopause felt that their job performance had been negatively affected by their symptoms. Some reported that they worked extremely hard to overcome their perceived shortcomings.
A more recent research report, The Effects of Menopause Transition on Women’s Economic Participation in the UK, from the University of Leicester, lists the negative effects on menopausal women’s quality of working life and performance at work as including:
reduced engagement with work
reduced job satisfaction
reduced commitment to the organisation
higher sickness absence
an increased desire to leave work altogether.
The research found evidence to suggest that these outcomes have negative effects on time management, emotional resilience and the ability to complete tasks effectively.
Support at work: the problem
Often employers have very little understanding of the difficulties surrounding the menopause and see them as a private matter. Consequently, it is very rarely discussed and organisations are slow to recognise that women of menopausal age may need special consideration. Many women feel that their managers would be embarrassed if they disclosed their problems and consequently do not ask for the adjustments that may help them.
The legal requirements
Employers are required under the Health and Safety at Work, etc Act 1974 to ensure the health, safety and welfare of their employees and, under the Workplace (Health, Safety and Welfare) Regulations 1992, to make workplaces suitable for the individuals who work in them. The duty under Management of Health and Safety at Work Regulations 1999 to carry out risk assessments should include any specific risks to menopausal women.
It is not clear that a woman going through the menopause is covered by the Equality Act 2010’s duty to make adjustments. Under the Equality Act 2010, in order for a condition to be classed as a disability in England and Wales, the condition must have a physical or mental impairment which has a substantial and long-term adverse effect on someone’s ability to carry out day-to-day activities. Michael Rubenstein in Equal Opportunities Review, issue 267, states: “It is well known that the menopause can lead to substantial changes to the health of some women and that this can affect their job performance and/or their attendance at work. Yet until now no legal obligation on employers to make adjustments for this has been clearly established.”
Michael Rubenstein does point out that, as a result of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), there has been a change on the effect of the impairment on professional life. Discrimination on grounds of “disability” is prohibited by the EU Employment Equality Directive 2000/78, but the directive contains no definition of “disability”. However, CRPD was applied by the Court of Justice of the European Union (CJEU) in the Ring case (HK Danmark, acting on behalf of Ring v Dansk almennyttigt Boligselskab, see EOR 236) to hold that the directive’s prohibition covers a limitation which results in particular from physical, mental or psychological impairments which, in interaction with various barriers, may hinder the full and effective participation of the person concerned in professional life on an equal basis with other workers, and the limitation is a long-term one.
In the Kaltoft case (Fag og Arbejde (on behalf of Kaltoft) v Kommunernes Landsforening (on behalf of the Municipality of Billund), see EOR 255), the CJEU added that it was sufficient to meet the definition of disability, that there is a hindrance to the exercise of a professional activity. It is also well established that the particular cause of an impairment is not relevant to whether it is to be regarded as disabling. The CJEU’s interpretation has been regarded as binding on UK courts and tribunals. Consequently female employees in the UK may bring cases under the Equality Act 2010.
In the case Merchant v BT plc, considered by an employment tribunal, Ms Merchant alleged that she had been discriminated against on the grounds of her gender because her employer failed to deal with her menopause symptoms in the same way that it would have dealt with other medical conditions.
Ms Merchant was under-performing in her role and had been subject to the capability or performance management process a number of times. She reached a final written warning and her employers were to decide whether to offer her alternative employment or dismiss her. Ms Merchant provided her employers with a letter from her GP. This said that she was going through the menopause, which could affect her level of concentration at times, and also that she was suffering stress from being a carer for two members of her family.
Although the performance management report said that there must be investigation into whether her under-performance was due to health factors, the manager carrying out the process decided to not investigate the possible impact of the employee’s menopause. Ms Merchant was dismissed, and subsequently brought claims for unfair dismissal and direct sex discrimination under the Equality Act 2010. The tribunal upheld Ms Merchant’s claims.
The case of Rooney v Leicestershire City Council recently considered this point (in 2021). In this case, Rooney started her role as a childcare social worker in August 2006. In 2017, she started to experience menopausal symptoms so had several periods of sickness absence because of this and due to work-related stress. Rooney felt that the management of her absences by her employer, Leicester City Council, was insensitive and heavy-handed, which led to her resignation in 2018.
The employee raised two separate tribunal claims; first for constructive dismissal, non-payment of holiday and overtime, and reimbursement for expenses. She then appointed a new solicitor and submitted a second claim form asserting disability and sex discrimination on the grounds of her disability due to the menopause.
The employment tribunal summarised the claimant’s evidence that her symptoms resulted in her “forgetting to attend events, meetings and appointments, losing personal possessions, forgetting to put the handbrake on in her car and forgetting to lock it, leaving the cooker and iron on and leaving the house without locking doors and windows. She also spent prolonged periods in bed due to fatigue/exhaustion. She further referred to dizziness, incontinence and joint pain”. However, the tribunal dismissed Rooney’s claim of disability discrimination saying that her medical conditions did not amount to a disability. It also stated that any impairment was not long-standing but this was unsupported by any reasoning.
The employment tribunal struck out Rooney’s sex discrimination claim saying that it had no reasonable prospect of success. It came to the conclusion that Rooney relied on her embarrassment about discussing her menopausal symptoms with men, but that no comparator (real or hypothetical) was suggested. The tribunal said that the claim appeared to be an “add-on” without any substance.
In the evaluation of her disability discrimination claim, the Employment Appeals Tribunal found that there was no explanation as to how the tribunal concluded that Rooney’s evidence, which it did not reject, did not demonstrate an effect on day-to-day activities that was more than minor or trivial. The Employment Appeals Tribunal also stated that the employment tribunal erred in focusing on the things that Rooney could do and did not weigh this against what she could not do.
The Employment Appeals Tribunal also found that the employment tribunal ‘s decision to dismiss the sex discrimination claim failed to comply with the fundamental requirement to explain to the claimant why her appeals were struck out and did not take into consideration the employee’s claims as clarified in the Scott Schedule.
Support at work
Employers should have clear processes to support women coping with menopausal symptoms. As the symptoms of menopause can fluctuate, a flexible approach involving checking with the individual should be taken.
Some businesses have branded themselves as “menopause friendly” as a means of helping recruitment.
Approaches that should be considered include the following.
Improving organisational culture. It should be made clear that the organisation supports menopausal women. Women in the workplace should be made aware that the organisation takes the condition seriously and it is acknowledged that it is a normal stage of life; it is something women of child-bearing age should not be ashamed of and that adjustments can easily be made.
The culture should be one in which the menopause can be talked about openly. Informal conversations between manager and employee can enable discussion of changes in health, which can include issues relating to the menopause. Occupational health campaigns in workplaces can be used to increase staff awareness of the difficulties women might face during transition and to challenge any negative stereotypes.
Providing women in a workplace with information. Guidance on how to deal with the menopause should be freely available in the workplace. Information should include how they can get support for any issues that arise as a result of the menopause. Any literature should encourage women employees to discuss any relevant health concerns with their GP.
Supporting women in the workplace. Management and all line managers should be trained to understand how the menopause can affect work and what adjustments may be necessary to support women who are experiencing it. Women may feel uncomfortable going to their line manager, especially if he is a man. Employers should therefore offer other options, such as someone in HR or an occupational health professional.
Support can also be provided by allowing the provision of informal support for mid-life women during menopause transition. This can include women's workplace networks, online discussion forums and helpline numbers.
Occupational health units could provide medical check-ups and advice for women of a certain age.
Institution of Occupational Safety and Health recommendations
The Institution, which represents more than 47,000 health and safety professionals around the world, recommends a number of measures, which include:
considering whether existing policies and procedures cater for the psychosocial needs of menopause-related issues, for example whether they can introduce flexible working patterns
ensuring risk assessments consider specific risks to menopausal women and identify reasonable adjustments for individuals
developing awareness, training and education strategies that raise understanding of the menopause and associated symptoms, their impact on work and potential solutions
following the advice of health and safety professionals based on the outcomes of age and gender-sensitive health risk assessments, including potential changes in functional capacities
developing more inclusive and supportive workplace cultures and managerial styles that make women feel comfortable disclosing symptoms or requesting adjustments to support them with symptoms.
It is apparent that the experience of the menopause varies considerably from woman to woman. Workplaces should provide a variety of workable mechanisms so that the menopausal female workers can be provided with appropriate adjustments. Reasonable adjustments to take account of the menopause include:
taking account of menopause in performance and sickness reviews
making it clear that no negative consequences should follow from sick days a woman takes due to menopausal change
reducing workloads and ensuring employees are not working excessively long hours
giving relevant employees the capacity to rearrange formal meetings or presentations if needed
allowing them to switch to different tasks on bad days
allowing employees to take breaks where needed
allowing those struggling with the change to work flexible hours and/or at home, especially on bad days or when they have slept particularly poorly
allowing them to take days off if required or to leave early, perhaps to resume work later in the day or evening
allowing relevant employees time off during the working day to attend medical appointments
some women may suffer with heavy or irregular periods so you could consider making sanitary products available in toilet facilities and making it easy to request extra uniforms if needed.
Stress at work can make some menopausal symptoms worse. The effects of this can be increased by having to make decisions on how to cope with the menopause and taking extra time off work to consult a doctor. It is important that workplace stress is also considered and addressed using the Health and Safety Executive Stress Management Standards. Employers could also refer employees to their Employee Assistance Programme, if they have one.
The physical working environment
There are changes to the workplace facilities that can be taken to ensure the working environment does not exacerbate menopausal symptoms. Difficulties caused by hot flushes can be alleviated by access to fans, good ventilation including windows which open and blinds that can be drawn, and by giving menopausal women the ability to control temperature through air conditioning or heating. The provision of cold drinking water, showers and washing facilities also allows better management of hot flushes. Being able to move if an office is small and confined can help in the case of hot flushes.
Clean, well-equipped and comfortable toilet facilities near workstations should be provided for women experiencing urinary incontinence, with showers and washing facilities.
Other changes that can help menopausal women include:
quiet workplace rest areas for menopausal women experiencing headaches or fatigue to relax
access to natural light, which has been identified as having a positive effect on mood and the absorption of calcium during menopause transition (PCS), or light boxes if natural light is not easily available
a reduction of exposure to noise to help reduce fatigue.
Employers should provide menopausal women with lighter, non-synthetic workplace clothing, uniforms or corporate clothing to accommodate hot flushes. Apart from causing discomfort, the uniform may reveal sweat patches easily or become transparent which can be embarrassing and very upsetting for the affected employee.
Heat stress is a known risk associated with the use of personal protective equipment (PPE). It can be heightened for women and the risk can become even more acute during the menopause. Employers should consider the design of the PPE they provide to mid-life women; and perhaps the time wearing the PPE should be restricted.
Risk assessments of the specific risks to menopausal women should be carried out to ensure that the working environment will not make their symptoms worse. The assessment can review the arrangements to support the needs of menopausal women including:
workstations and the arrangements for work breaks
manual handling arrangements
temperature, humidity and ventilation systems
welfare issues such as toilet facilities, rest rooms and access to cold water
the suitability of any uniform or corporate clothing provided to women workers
management arrangements including reporting sickness, access to information on the menopause, flexible working arrangements, working hours, the sickness absence policy and the arrangements for switching to lighter or different duties
whether any PPE used reflects the needs of menopausal women.
One risk that should not be overlooked is stress, which can worsen menopausal symptoms, and in some cases has been shown to bring on an earlier menopause.
A policy for menopausal women
As women are physically different to men, they face different risks at work and there is a strong case for this to be reflected by including women’s health and safety separately in the organisation’s health and safety policy. This should include the menopause, to ensure that working conditions do not worsen a woman’s symptoms and to retain their skills in the workplace.
Better support needed for menopause at work
Effects of Menopause Transition on Women’s Economic Participation in the UK, University of Leicester, 2017.
Women’s Experience of Working through the Menopause, Institute of Work, Health & Organisations at Nottingham University, 2010.