Hello, and welcome to this edition
of the ILO's Future of Work Podcast.
I'm Sophy Fisher.
Is the menopause a workplace issue?
Should it be?
Traditionally, it's been regarded
as a medical or personal issue
affecting women and their families only,
but a growing amount of research
shows that the menopause
is driving women out of the workforce,
creating losses in talent, skills,
Is it time for the actors in the world of work
to get more engaged with this issue?
With me today are Dr. Louise Newson,
who is a leading menopause specialist
and founder of the Balance Menopause app,
and Professor Jo Brewis of the UK's
Open University Business School.
Professor Brewis is the lead author
of a report commissioned
by the UK government on the effects
of menopause transition on women's
economic participation in the UK.
Ladies, welcome to you both,
and thank you very much for joining us.
Thanks for inviting us.
Louise, can I start with you
since you are the doctor,
everybody knows about the menopause
and we know about symptoms
like hot flashes,
but I think your research has shown
that it goes much further than that.
There are far more symptoms.
Estrogen, the main hormone,
we have receptors in cells
all over our bodies,
so it can affect anywhere
in our bodies actually.
I realize more that I speak to people,
the symptoms that affect people the worst,
if you like, at work,
are symptoms such as fatigue,
memory problems, anxiety, brain fog,
just reduced stamina, reduced motivation,
and those symptoms actually mean often
that women are not pushing themselves
forward for promotion.
They're leaving their jobs,
they're changing their jobs,
they're reducing their hours
and it's really sad for me as a physician,
knowing that we have
an evidence-based treatment
and we have also nice guidance
showing us that the majority of women
benefit from that treatment
yet only the minority of women are taking it.
It's no surprise that as you say,
it's not just family
and friends and relatives
that are affected by the menopause,
but people in the workplace
because women are really struggling
out there to hold their jobs
and I completely understand
why when they've got menopause
and perimenopausal symptoms.
Okay. Let's just nail down exactly
what are we talking about here
and what age ranges is it affecting?
The average age,
not that any women's average,
but the average age of the menopause
in the UK is 51.
The menopause is when our periods stop.
It's actually a year after our period stop.
A lot of women have a hormonal decline
in their 40s
because they can be perimenopausal.
That's when they start to experience
but their periods are changing
either in nature or frequency.
If most women go through the menopause
or start going through the menopause
when they're in their early 50s,
that means a lot of women in their 40s
We also know that one in a hundred women
under the age of 40 are menopausal
so they have an early menopause.
There's lots of women out there
in their 20s and 30s
who are experiencing menopausal
or perimenopausal symptoms.
The menopause doesn't just mean that
our period stop and our symptoms stop.
A lot of women in their 50s, 60s,
70s, 80s, and 90s actually are experiencing
A lot of people find that symptoms
such as hot flashes and sweats
actually improve with time
but other symptoms such as low mood,
anxiety, memory problems,
muscle and joint pains,
they often start or then start to worsen
when women are a bit older.
Is this just affecting women,
because men have changes
in their hormone levels
at about the same time?
They can do so if some men
have testosterone deficiency,
but it's not 100% of men.
This is talking.
We're talking about 100% of women
will become menopausal
and for men it's different.
They can have their hormone levels
checked to see whether they have
low testosterone or not.
With women, it's a diagnosis based on symptoms.
You can't do a blood test or saliva test
or a urine test to check for the menopause.
When I was researching this podcast,
one of the things that surprised me
was the fact that the symptoms
extended into areas such as anxiety,
and one of the things that was constantly
mentioned by women
were things like brain fog.
There was one woman who made
a program about this who said,
"I thought I was getting early-onset dementia."
Now, when you deal with people,
when people come into your surgery,
how common is it to report symptoms
of that level of severity?
The majority of women I see
have really bad psychological symptoms
and you are absolutely right.
A lot of them are very worried that
they think they're going to have dementia
or the early stages of dementia.
It's very, very frightening
when your brain doesn't work,
but we have receptors for cells
in our brains that respond to estrogen
and testosterone and both these hormones,
we don't realize how important
they are until they're missing.
They're very common these symptoms,
yet often women are being told
that they're depressed
or they've got mood changes
because of another reason
and it's not until you balance their hormones
back you know it's related to their hormones
because their symptoms improve
with the right dose and type of HRT.
That means we can rule out the fact that
it's simply other midlife issues,
like additional responsibility, declining,
physical abilities, and so on?
Obviously, the menopause often occurs
at a time when we are busy with our jobs,
family, whether they're children
or elderly relatives.
We're pulled in lots of directions.
I think for too long people have thought,
well, that's because that's a reason
I'm feeling like this,
but actually we have to think about hormones.
The other thing for me as a physician,
I'm very interested in the long-term health
risks of having low hormone levels.
We are talking about symptoms
which are very important,
but we also need to remember that women
who have low hormone levels
have an increased risk of osteoporosis,
heart disease, diabetes, and dementia.
As we're staying in the workforce for longer,
that means that we'll have
more women who are older,
who will then be exposed and increase
their risk of these diseases
unless they have their hormones back
Let me bring in Professor Brewis
at this point because, Jo,
you've been looking at the issue
of the menopause from the aspect
of economic participation
and as Louise Newson has just said,
we have an ageing workforce,
not just in the UK,
but generally in the developed world.
We have an ageing workforce,
we will have more women
of this age participating.
What sort of economic and professional
consequences did you find
when you were doing your report?
Thank you, Sophy.
Not just the report,
but the stuff that we've done subsequently
and all the other excellent research,
which is really beginning to grow now
into menopause in terms
of how it affects the workplace
and how workplace in fact can exacerbate
Everything that Louise has said,
I completely agree with.
I think one of the things
that she said very clearly,
which is so important is that the commonest
symptoms that we about
in terms of menopause
are things like hot flushes
and there's certainly evidence that
they cause a lot of problems in the workplace
because sometimes they're visible,
they can affect women's concentration.
Women can find them stressful in terms of,
they think it's affecting
their professional demeanor
and their ability
to present themselves at work
but more than that, it's the brain fog,
it's the memory loss, it's the fatigue.
What we're saying,
or what we're seeing rather
is some really quite startling statistics
that were published earlier this year,
which suggests that if a woman has only one,
and most of us have more than one
problematic menopausal symptom
at the age of 50,
what these researchers discovered
by using UK government data
was that five years later at the age of 55,
they are 43% more likely to have left
their jobs altogether
and 23% more likely to have
reduced their hours.
What you're seeing there is exactly
as Louise and you have discussed, Sophy,
effectively a brain drain
from the workplace.
Women reducing their hours, leaving work,
that affects employers
in terms of all the skills
and talent and experience
that's walking out the door
and the cost of recruiting and replacing
or putting in new staff
to replace those women.
It also has a real impact
on women themselves, of course,
because work involves financial security,
but it also involves self-esteem
and social support.
We get those very important
psychological boosters from work.
It's almost like a vicious cycle if you like.
We hear a lot of talk about concern
on getting women into what are often called
the C-suite jobs, in other words,
senior management, running companies,
senior white-collar professions.
Is there a link between these two things,
do you think, or is that going too far?
I think it's a really interesting question,
It's not something that I can comment on
in terms of the research that exists,
but if you ask me anecdotally
and in terms of my own instincts,
if you like, certainly it's the case
that menopause comes along.
I think it's also important to say that
not every woman has a problematic menopause.
There are people
who quite literally sail through it,
but best estimates suggest probably
about three-quarters of us have symptoms
and at least a quarter of those
have really problematic
and debilitating symptoms.
I don't think it's any coincidence
actually that menopause is coming along
just at the time when many of us
are really looking to or have already
succeeded in attaining senior positions.
Of course, the last thing that you want,
particularly if you're moving into
or wanting to move into those c-suite jobs,
is a set of symptoms which really
can knock you off balance.
Now, there have been a number of articles
in the papers about this issue
and reading the comments at the bottom,
one that comes up quite regularly
is basically along the lines of, well,
if women aren't up to the job
for whatever reason,
they should just step aside.
Why should employers make concessions?
I'd like to ask both of you
what your response is to that?
Whose problem is it?
Louise, do you want to go first, or shall I?
I think this is a very interesting question
and it's one that I think about a lot actually.
I've often said I think it's a real shame
that it's led to almost thinking about it
as a workplace problem because,
in an ideal world,
women would be receiving the treatment
that they deserve and ask for,
and then that would result
in far less women suffering
and far less women having a problem
in the workplace,
so this wouldn't even be a conversation.
This goes back to the fact that
the minority of women are receiving
If you had something like
a broken arm at work,
you wouldn't have a broken arm policy,
because I'm hoping if I've broken my arm
and it looked very painful and a bit deformed,
one of my managers or one of the team
would say to me, "Louise, that is really painful.
I know where the local A&E department is.
Go down there, sort out your arm,
come back when it's fixed,"
and that would be job done.
If I had menopausal brain fog,
I was an emotional wreck at work,
the last thing I would want
my employer to do is say, "Louise,
you're really performing badly at work.
You're menopausal, go home,
reduce your hours, reduce your pay,
don't go for promotion."
What I would love my employer to do is say,
"Louise, if you thought about the menopause,
perhaps you know
there's this fantastic clinic
or you can go to your GP and get the treatment.
When you're better, you can come back,
you'll go for that promotion that you want."
This is where we should be talking over
the next few years as treatment
of the menopause improves
because we've got safe treatment.
We're talking about hormone deficiency.
We don't have this for hypothyroidism
because people have thyroxine,
this is no different.
I feel sorry for workplaces
because there's a lot of pressure on them
to change their policies.
It's very important we've got a really
robust menopause policy here
where I work where I employ
dozens of menopausal women,
but we have to be thinking about
helping them get the right treatment.
Yes, I agree with Louise to some extent
but not completely.
I fully support the appropriate
hormone replacement therapy
can work wonders
for the vast majority of women,
and I'm one of those women.
That said, I think actually that to suggest
that the natural way that
the female body is constructed,
its biological composition,
and the things that it goes through
because of the way that it's constructed
should be ignored and overlooked
in the workplace as is suggested
by some of the below the line commentary
as you've said, Sophy, and in the newspapers.
I actually find that really quite frustrating
and not to say annoying.
Are we then going back
to the very good policies
that most workplaces have now
around pregnancy and maternity leave
and suggesting that they should be removed?
If a woman decides that she's going
to fall pregnant and have children,
that she just needs to leave her job
because that's just something that
the employer can't be expected to cope with.
I think it's also really important to say that
a lot of the things that
menopausal policies actually enshrine,
if you like, in the workplace,
are things that good employers
should be doing anyway.
One of the key examples here is flexible work.
In the UK, anybody who has worked
for the same employer for more than 26 weeks,
yes, I think that's right,
six months basically, has the legal right
to request flexible working.
This is something that's already enshrined
in employment legislation.
Flexible work is often something
that can really help menopausal women
if they're having particularly
symptomatic days, for example.
We've also learned that through the pandemic,
those of us who do
office-based work like myself,
although it's not ideal to be working
at home all the time,
it's actually reasonably straightforward
once you've sorted out
some of the technological issues.
I feel as if there's actually
quite a lot of things
that employers could be doing
that actually should be open to anybody
who would benefit from them.
I also believe that in a lot of organizations,
the only way to make sure
that menopausal women can access
those things is by having
a menopausal policy.
Louise, what measures can you suggest
for workplaces and employers
to accommodate people
suffering from the menopause,
women suffering from the menopause?
I think the most important thing
is talking about it actually.
Like we've done, as Jo said, for pregnancy,
it's really important that it's acknowledged.
It's the same for mental health,
this great work
with mental health awareness.
I think that should be
really top of people's policies,
it's making awareness something.
I'm not saying that menopausal women
should walk around with a badge saying,
"I'm menopausal, give me some space."
It's about having that conversation.
I really struggled with symptoms
five years ago,
and I'm really embarrassed
because I'm a menopause specialist,
so I was creating
my menopause doctor website
and I still didn't recognize my symptoms.
I couldn't remember the name of drugs.
I was running late the whole time.
I was very emotional at work.
I had very low self-esteem
and I was worried about my memory.
If someone had come into my room then
and said, "Louise, I've got this leaflet.
Do you think you're 45?"
If somebody could just maybe point me
into the right direction of getting
some more information,
that would have saved me four or five months
thinking I'm going to have to give up
working as a doctor.
This is really scary.
It is this awareness piece
is really important.
What women do about their treatment
for their menopause
is entirely individualized
and it's up to them,
but it's about having that conversation
because there are a lot of women out there
who are not going for promotion.
We found that just it was just a survey
that we did,
that 50 of those surveyed
and there were 3,800 women,
50% of them had resigned
or took early retirement
due to their symptoms.
That's a real shame.
As Jo said, we are losing some great people
and it's costing the economy a lot of money.
Women should have a choice,
but sadly we know a lot of women
are signed off with anxiety or stress
when they are menopausal.
We need to make it
more of an open conversation,
is really important.
Do you think workers' organizations
and unions have a role to play here as well?
I see that the UK's Trade Union Congress
has already produced a guide on this.
Yes, I think it's really important.
I think if you look at what a disability means,
the menopause is a disability
for a lot of women.
It really has very disastrous effects
for a lot of women.
Most women I speak to in my clinic
have given up their job,
many of them their partners have left them,
they are in a real crisis
and no one has helped them at all.
I'm not saying that they should get their help
100% from their employee,
but these women
don't want to give up their work,
they really don't.
It should be a pincher movement
almost that people at home are helping,
people in the workplace are helping
and above all, health care professionals
should be helping giving women
individualized advice and treatment,
and the treatment that they want
is really important.
I think we should we should stress here,
That this is not just something
that affects women
in the developed world
and who work in white-collar jobs in offices.
I think it affects all women,
those who work in blue-collar jobs
in the developing world too,
but do we know that much about them?
No, we don't.
The vast majority of the research
that exists around the connections
and work is done in the global north
and the vast majority is also done
on women in the white-collar
We badly need research
elsewhere in the world
and we also badly need research
that covers the jobs
that the vast majority of women do,
which are not necessarily
white-collar professional or managerial.
I would say also that the trade unions
actually in the UK at least,
have been at the forefront of pushing
menopause in the workplace
as an agenda, and they've done
some absolutely sterling work.
We've worked closely with TUC Education,
the TUC in general has issued
guidance long since, and TUC Wales
have produced one of the best toolkits
I've ever seen,
which advises both women
and their employers about
how the menopause can be tackled,
if you like, at work.
I would just like to say
one other thing as well,
which is that menopause isn't something
that always happens to people
who identify as women.
Some transgender men
and people who identify
as gender non-binary or gender fluid
and so on will also go through menopause.
I think that's something that we know
almost nothing about.
Professor Jo Brewis and Dr. Louise Newson,
thank you very much for your time
and for talking about this complex subject.
I hope you, our listeners,
have found this of interest.
If you want to find out more about
their work or about this subject,
more generally, you can find links
on the web page of this podcast,
which is on the ILO website.
For now, thank you for listening,
I hope you will join us again soon
for another edition of the ILO's
Future of Work Podcast.