Timing is everything. Just when I started having menopausal symptoms, I was asked to design a menopause awareness workshop for a large government organisation. Due to health concerns, I had a total hysterectomy, becoming one of many women with extreme symptoms – an unfortunate side effect of a ‘medical menopause’. If you haven’t heard of this term before and thought that there was only one kind of menopause, you’d be forgiven. In fact, there’s the female menopause, the medical menopause, the male menopause, more accurately known as the andropause, and the transgender menopause. It’s a natural part of the ageing process and it impacts an estimated 13 million women in the UK1 who are currently peri-, post- and menopausal, many of whom are working.
The menopause typically attracts jokes about hot flushes and can be hard to talk about openly, particularly at work. Recent research2 reveals that women remain silent about their problems despite reporting on average seven different symptoms of menopause including hot flushes and sweats, musculoskeletal symptoms, effects on mood/mental health, increased abdominal fat, urogenital symptoms, and sexual difficulties including low desire. Forty-two per cent of women report that their symptoms were worse or much worse than they expected.2
In my role (as a consultant) working with organisations, I believe there is too much silence around the topic of menopause within the workplace. We have an ageing workforce and 30 per cent of people in employment in the UK are over the age of 50: it’s worrying therefore that there isn’t more recognition of this life phase.3 Mental health campaigns (such as Time to Change)4 have been successful at holding Time to Talk events and opening up conversations about how we are feeling. I believe it’s now time we started to talk more openly about the menopause in the workplace, which can affect both our mental and physical health. My interest is in how employers and workplace therapists can better support individuals and organisations, and I outline some of my thoughts here.
The perimenopause
We know that only 50 per cent of women reach out for support during menopause, though there are no real figures on women seeking support during the perimenopause.2 The latter term means the start of the transition towards menopause and begins some years before the menopause itself, usually when a woman is in her 40s or sometimes 30s. The average length of the perimenopause is four years, but for some women this stage may last only a few months or may continue for as long as 10 years.
In my experience of working with women, the perimenopause can be a time when some women feel as if they are being controlled by their hormones, including feelings of losing control and periods of low mood. It is worth considering whether this is taking place for our clients and guiding them towards strategies for overcoming menopausal symptoms. If individuals have these strategies in place leading up to menopause, it can help when menopause actually occurs.
The male menopause
The male menopause tends to be a term that is used rather unhelpfully in the media to explain symptoms such as depression, loss of sex drive, erectile dysfunction and other physical and emotional symptoms which might be experienced by men reaching their late 40s to early 50s. This label is misleading because it suggests the symptoms are the result of a sudden drop in testosterone in middle age, which isn’t true. Although testosterone levels fall as men age, the decline is steady – less than two per cent a year from around the age of 30–40.5
The US is way ahead of us in terms of dealing with male and transgender menopause and being open about discussing it as a natural part of the ageing process. Testosterone patches can help men to regulate the symptoms associated with a loss of testosterone that is more than the norm.
It’s my view that many men need emotional support at this stage in their lives and could also benefit from some temporary workplace adjustments. The decrease in testosterone can be linked with low mood and difficulty sleeping and high levels of stress can also be linked with a reduction in testosterone. Good nutrition, sleep and exercise can all help to improve these symptoms.
Menopause in the transsexual man
This can happen when a transsexual man – a female-to-male (FTM), is experiencing the same menopausal symptoms as if they had not undergone a hysterectomy. It can be an incredibly complex area where questions of identity may reappear after many years of living as a man. This can totally change the equilibrium of a person’s life, and individuals may need psychological support to help understand the different aspects of who they are. Equally, for a younger individual who has had a hysterectomy, there will be symptoms of a medical menopause along with all the other physical and psychological changes occurring. Support is often required to explore a sense of identity and sexuality, alongside coping strategies.6
Loss and culture
The menopause has the capacity to impact on us at so many levels, and often involves layers of loss, including the loss of the ability to reproduce, youthfulness, cognitive function, quality of sleep, memory, sense of self as a woman/man, self-esteem, a sense of sexuality, energy, control, and a loss of knowing what else is going to happen to one’s body. Occurring at around 50 years, it is interlinked with the passing of time and brings to mind the concept of our mortality, another last taboo in the UK. The menopause can be a wake-up call to many, that nature is just gently (or not so gently) letting us know we are getting older and that we need to take more control of our lives and our wellbeing.
As therapists, we are aware of the impact of loss and the complexity this can bring into the counselling room and the links to depression. As 60 becomes the new 50, and 50 the new 40, and so on, it seems that as a society we are keen to distance ourselves from consciously thinking about ageing, even though each decade will bring with it additional knowledge, skills and wisdom. In Western cultures, there can be an implicit message for menopausal women: ‘You have served your purpose. Now please step aside’; while in other cultures, there is respect for a woman approaching and experiencing menopause, and gratitude for her wise mind and knowledge.7
Removing stigma
There is a long history of stigma associated with women’s bodies, menstruation and the menopause, but perhaps the baby boom generation are influencing a cultural shift around some of these last taboos. As women have more power and influence in organisations, there is a greater openness about women’s health, and the generation going through the menopause now may not be as prepared ‘to put up and shut up’ as their predecessors.
This was something that became very apparent to me when I was called in to produce some health-related material for employees in a large government organisation. Each month, I design and deliver a broadcast on a range of mental health and wellbeing topics. Typically, up to 300 callers will dial in to listen to a broadcast, which is recorded and available for one month for staff to listen to. I suggested that I cover the topic of the menopause, as I thought this would attract interest – however, I hadn’t anticipated quite how much. We had the highest numbers of calls into the broadcast to discuss the menopause – over 1,000 lines – from all genders and ages, and on some of those lines were
groups of staff calling in from conference rooms. It became clear that there was an enormous appetite for knowledge and that staff were actively seeking better support to cope with the menopause at work.
Interestingly, there were many male line managers who wanted to learn more so they could make sure that they were able to support their female colleagues and team members. We covered the topic of female, male and transgender menopause and the session was focused around menopause awareness and coping strategies. I delivered 30 minutes of content followed by questions and answers from the audience for another 30 minutes, and to say we ran out of time is an understatement.
One of the most common queries, came from women who were struggling with hot flushes, especially during meetings or if they had to give a presentation, and who wanted some support in this area. My advice is to recognise that hot flushes can worsen with increased emotion, so if you feel anxious about a presentation or frustrated in a meeting, then your hot flush will increase. The key is to be aware of your emotional responses and to keep your breathing under control, taking deep breaths to reduce your emotion, before and during an event. There are also practical aspects, such as wearing comfortable, breathable clothing and thin layers.
We then trialled a follow-up conversation, called Ask the Expert, which was via confidential email and, again, the response was overwhelming. Emails were answered by our Chief Medical Officer, Dr Lucy Wright, if they were of a medical nature, and the other 50 per cent, which were about psychological/lifestyle aspects, I answered myself. Interestingly, all the medical questions had some aspect of psychological distress and so required a joint response, covering both areas. As a result, the organisation now has an area on its intranet devoted to wellbeing and the menopause, and has also started a menopause action group, which meets regularly to create initiatives to help menopausal individuals to come together as a group and share their experience.
Another government organisation asked for a menopause awareness workshop to be delivered on site, and due to the high demand, we went on to deliver a further 10 workshops. This resulted in the organisation requesting a workshop specifically tailored for managers, to explore what strategies and tools they could learn to support their teams. Ultimately, it’s about developing open communication and trying to ensure that the needs of the individual and the needs of the organisation can dovetail together.
Disclosure and coping strategies
The issue of disclosure, from a menopausal person’s perspective, is not always straightforward. While some are happy to disclose their menopausal status to colleagues and their line managers, others are more private and would not wish to. This could be related to the quality of the relationship, age, gender, perceived trustworthiness, personal embarrassment, fears that the other person might become embarrassed, and concerns about whether performance at work may be questioned as being affected by the menopause.2
In my experience, many women feel that no consideration at all is given to the fact that they are menopausal and this is probably because of the silence and the stigma which have kept it so hidden. I’ve been asked if the menopause comes under the Disability Act (which it doesn’t), but the fact that this question is being asked, shows the extent to which it can leave people feeling debilitated. However, the menopause is an occupational health issue and so it’s important for the individual to be listened to by their line manager and helped to identify any temporary reasonable adjustments to ensure the individual feels comfortable to stay in work. Supportive conversations can prevent someone from going off sick, due to feeling unable to cope with work, as well as the menopause.
Practical adjustments to the physical environment, for example, using fans or opening windows, can help. Sleep disturbance can be helped by adjustments to work routines including changing working hours, taking more breaks, not overworking voluntarily, taking leave, and adopting flexible working practices. Some compensatory strategies can also help individuals with memory loss, such as writing notes, lists, making greater use of technology than previously, and withdrawing from challenging situations or tasks to lessen the load.2
Conclusion
As we spend more of our lives at work, we need a wider understanding and acceptance that menopause and perimenopause are a natural part of the ageing process. We need to be able to talk more about our symptoms and gain support both inside and outside of the workplace. An action-based approach, focusing on exercise, nutrition and sleep, as well as asking for support from employers during this time and making any temporary reasonable adjustments, can help support individuals to stay well in work during and beyond the menopause.
Columba Sodhi-Urey is experienced at facilitating groups and individuals in a range of organisational settings. She is interested in wellbeing, mental health, building resilience and stress management. MBACP (Accred), BSc, CIPD
References
1 Short H. Let’s talk menopause because we are failing 13 million women. The Guardian 2015; 1 April. https://www.theguardian.com/healthcare-network/2015/apr/01/lets-talk-menopause-because-we-are-failing-13-million-women.
2 The British Occupational Health Research Foundation. 2010. [Online.] http://www.bohrf.org.uk/downloads/Womens_Experience_of_Working_through_the_Menopause-Dec_2010.pdf (accessed 26 February, 2018).
3 CIPD. Labour supply and the ageing workforce. [Online.] https://www.cipd.co.uk/knowledge/work/trends/ageing-workforce-report (accessed 26 February, 2018).
4 Time to Change. [Online.] www.time-to-change.org.uk (accessed 2 March 2018).
5 NHS. The male menopause. [Online.] http://www.nhs.uk/conditions/male-menopause/Pages/Introduction.aspx (accessed 26 February, 2018).
6 Royal College of Nursing. Fair care for trans patients. [Online.] http://nursing.advanceweb.com/Menopause-Symptoms-in-a-Transsexual-Man/#. Wa7n_aBp5Lo.email (accessed 26 February 2018).
7 Women’s Health Network. [Online.] https://www.womenshealthnetwork.com/menopause-and-perimenopause/menopause-in-different-cultures.aspx (accessed 26 February, 2018).