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 Right. 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? Yes. 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? Well, 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. Goodbye [music]
