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The Future of Work Podcast

Episode 13
Gender equality

Is the menopause a workplace issue?

7 January 2022

Traditionally the menopause has been an almost invisible issue, regarded as a medical or personal matter for women and their families only.

But women of menopausal age now account for 11% of the G7 workforce alone, and the number affected will rise globally, as populations age. Recent research has shown that the effects of the menopause are far more extensive than previously understood, including anxiety, depression, ‘brain fog’, insomnia, exhaustion and heart palpitations.

In the UK alone, more than 900,000 women are estimated to have left the workforce early because of the menopause - at an age when their talent, skills and experience are most valuable - with knock-on consequences for gender pay and pensions gaps and workplace productivity. One study has estimated global menopause-related productivity losses at more than US$150 billion a year.

A growing cohort of companies, trade unions and policymakers are re-evaluating the menopause as a business, economic and even legislative issue, one that is an integral part of the world of work. So, how should the menopause be handled in the workplace?


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,

and productivity.

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.

Yes, absolutely.

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

menopausal symptoms,

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

they're experiencing

perimenopausal symptoms.

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

menopausal symptoms.

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,

sometimes headaches,

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,

confidence, memory,

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?

Very common.

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?

Yes, absolutely.

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

menopausal symptoms.

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,

Sophy, actually.

It's not something that I can comment on

with confidence

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

evidence-based treatment.

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,

memory problems,

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,

and hopefully,

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,

shouldn't we?

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

between menopause

and work is done in the global north

and the vast majority is also done

on women in the white-collar

professional-managerial research.

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,

and goodbye.

I hope you will join us again soon

for another edition of the ILO's

Future of Work Podcast.