Menopause in the workplace - a complete guide

The natural process of the menopause is triggered when a woman's ovaries either run out of eggs or stop producing them. The ovaries are also responsible for producing the hormone oestrogen, so when the ovaries stop functioning, the oestrogen levels in the blood drop. It is this hormonal shift which causes periods to be disrupted and also triggers many of the other symptoms associated with the menopause.

There are a few symptoms which are closely and widely associated with the menopause, over and above periods becoming irregular and then stopping, the most well-known of which is the onset of hot flushes and night sweats. The critical point to understand about the menopause, however, particularly concerning its impact on working life, is that the list of possible symptoms is long and varied and that every woman experiences these symptoms in different ways and to differing degrees. The onset of these symptoms can start as early as four or five years before periods stop and go on for as long as four or more years afterwards.

Perimenopause is a name for the period before the menopause itself, during which the hormones in the body are unbalanced, and many of the symptoms of the menopause may begin to manifest themselves. In most cases, the perimenopause starts five or six years before the date of the actual menopause, so for some women, the whole process can impact their physical and mental wellbeing for as long as ten years.

Time and again, women express a sense of relief at discovering that something they were going through, beyond the well-reported symptoms, could be attributed to menopause or perimenopause. Some of the most commonly reported ailments are:

• Irregular periods – any change in a woman's cycle could signify the start of the perimenopause. However, as with all symptoms, women should seek medical advice if they are concerned or unsure of the cause.
• Hot flushes – sudden feelings of heat, often around the face, neck and chest, which can last for several minutes. During a hot flush, some women also experience palpitations and (not unexpectedly) feelings of anxiety.
• Night sweats – this is the name given to hot flushes which occur at night, probably caused by the fact that changing hormonal levels impact the body's ability to regulate temperature.
• Insomnia – in many cases, the insomnia experienced by women during the menopause and perimenopause is caused by night sweats. 81% of menopausal and perimenopausal women report difficulty sleeping to some degree.
• Fatigue – the levels of fatigue experienced during the menopause could be caused by changes in the levels of hormones such as oestrogen, progesterone, thyroid hormones, and adrenal hormones, all of which help regulate energy.
• Lower sex drive – the drop in oestrogen levels is often linked to reduced libido.
• Memory problems – many women report finding it more difficult to remember things during the menopause. These memory problems are thought to be caused by the drop in oestrogen and compounded by fatigue and a lack of sleep.
• Problems with concentrating – similar to how powers of recall are impacted, many women find focusing challenging due to the drop in oestrogen and fatigue.
• Vaginal dryness – the drop in oestrogen levels can trigger a lack of natural vaginal lubrication. This, in turn, can cause itching and dryness and pain during sexual activity.
• Headaches – women who suffer from headaches during their periods are more likely to experience them as a symptom of the menopause. During the perimenopause, periods may come more often, making the headaches worse, as will the disruption of the usual hormonal cycle within the body.
• Mood changes – some women experience mood swings, depression and anxiety, similar to those sometimes experienced during a period but more extreme.
• Palpitations – the heart beating irregularly or at an increased rate could be triggered by changing hormone levels.
• Anxiety – anxiety can be caused by two things; the fluctuating levels of oestrogen and progesterone can directly trigger anxiety, while a degree of anxiety might also be felt as a natural response to the range of other symptoms being experienced.
• Joint problems – the drop in oestrogen levels and a degree of inflammation could lead to joint stiffness. This includes stiffness, aches and pains in the joints caused by decreasing oestrogen levels and inflammation.
• Reduced muscle mass – the reduction in muscle mass experienced by some women during the menopause is often accompanied by weight gain.
• Weight gain – hormonal changes trigger weight gain during the menopause. It is particularly common for women to gain weight around the abdomen.
• Urinary Tract Infections (UTIs) – the hormone changes that occur during menopause leave women more vulnerable to UTIs.
• Incontinence – oestrogen is the hormone that helps keep the bladder and urethra healthy. As oestrogen levels drop, the pelvic floor weakens, leading to an increased likelihood of urinary incontinence.
• Bloating – alongside irregular periods, a degree of bloating is one of the earliest signs of the menopause.
• Digestive problems – while levels of oestrogen drop during the menopause, levels of the hormone cortisol increase. This can trigger digestive problems such as constipation, diarrhoea, stomach cramps and nausea.
• Hair loss – the drop in levels of oestrogen and progesterone causes the hair to grow more slowly and become thinner, which is exacerbated by the wider ageing process.
• Itchy skin – the drop in oestrogen levels can impact the production of collagen, the naturally occurring substance which keeps the skin looking fuller. This, in turn, can cause dryness and itching.
• Tingling – tingling sensations in fingers and toes can be triggered by the central nervous system responding to the drop in oestrogen levels.
• Sore breasts - the soreness in the breasts that some women feel during the menopause is similar to that experienced during pregnancy.
• Burning mouth – when the levels of oestrogen drop, it can decrease the amount of saliva in the mouth. This dryness can then trigger the sensation of burning in the tongue, lips and roof of the mouth.
• Dizzy spells – the feelings of dizziness which some women experience during the menopause have been linked to the drop in oestrogen levels.
• Brittle nails – the lower levels of oestrogen in the body are likely to weaken the nails' keratin layer, causing them to become brittle and break more easily.
• Depression – the fluctuations in hormone levels at the heart of the menopause increase the risk of women suffering from depression.
• Allergies – the close link between the immune system and the body's hormones means that some women notice the onset of intolerances or allergies during and after the menopause.
• Osteoporosis – the fact that bone density can drop by as much as 20% during the menopause means that women are at greater risk of developing osteoporosis, which causes the bones to become more brittle and fragile.

• One in ten women who worked during the menopause left a job due to their symptoms.
• Eight out of ten women say their employer hasn't shared information, trained staff, or implemented a menopause absence policy.
• Almost half of women haven't approached their GPs, and three in ten have seen delays in diagnosis.
• Only four in ten women were offered HRT in a timely fashion.

This isn't the only survey highlighting the difficulties faced by perimenopausal and menopausal women at work. In February 2022, the House of Commons Women and Equalities Committee published the results of a survey into how women experienced menopause in the workplace. It found that 31% of women had taken time off work due to symptoms of the menopause and that their ability to work had been impacted in the following ways:

• 72% felt less able to concentrate
• 70% felt more stressed
• 67% felt less confident in their abilities
• 48% felt less patient with others
• 34% felt less physically able to carry out their duties

More than 900,000 women in the UK have quit their jobs due to the menopause, which is a tragedy for the individuals and a huge waste of resources, talent and skills for the UK as a whole. Equipping women with the information they need should help to cut this number in the future drastically.

Positively, those who did confide in their peers were more likely to feel supported as a consequence. In total, only 11% of people surveyed requested adjustments be made to their workplace or job role to help manage their symptoms.

Of those who requested an adjustment, the majority received it in some form, with 30% not receiving any concession. Of those who did see the adjustments made, 55% found them 'helpful or very helpful'.

Speaking up if you are struggling may be difficult, but it is essential. An employer cannot help you or put any necessary support in place for you if they do not understand the context of any issues you may be having.

Some businesses have specific menopause policies that provide a framework for raising concerns or seeking assistance, but many do not. Employers do, however, have a duty of care to protect their employee's health and safety whilst at work, so if menopausal symptoms are putting someone at risk, they will need to listen and respond accordingly. As such, it is important to formally raise the matter with HR or a trusted line manager to explore how your employer can support you and implement reasonable adjustments.

Employers should train key employees, such as line managers, to offer the kind of help that employees may need. This would involve them understanding menopause and its effects, knowledge of the support available within the workplace, how employment law relates to the menopause and how to talk about these matters in a sensitive and engaging manner.

Remaining agile when it comes to solutions is a must, as symptoms can come and go. Taking time to discuss specific symptoms and their impact on someone's job role is crucial, as only then can the necessary concessions be decided. The adjustments that best ease someone's ailments are often practical and could include introducing flexible or hybrid working patterns, for example. It is also crucial to ensure that symptoms of the menopause are exacerbated by the workplace or working practices. Undertaking a risk assessment built around the menopause would include items over and above the standard risk assessment and could cover elements such as:

• The temperature of the workplace and any ventilation in place
• The material used for any uniforms worn and the design and fit of that uniform
• The provision of a space such as a quiet room for staff to rest in if needed
• Easily accessible toilet facilities
• The availability or otherwise of cold drinking water
• Whether managers had received training specifically relating to the menopause and health and safety

Absences from work caused by the menopause should also be recorded in isolation from other absences. This will prevent the menopause-related absences from being measured as part of an employee's overall attendance record in a discriminatory manner.

Such a policy is used to outline best practice in tackling absenteeism or ill health due to the menopause in a sympathetic and supportive manner, setting the boundaries for communication between all parties, and providing an overview of reasonable workplace adjustments which could be made.

Significantly it advises that training and awareness-raising sessions are undertaken amongst all staff, along with the introduction of a named point of contact who will provide confidential support for any issues that arise.

Although it has been firmly established that HRT is effective at alleviating many of the symptoms of the menopause, the decision to take it has to be made individually, weighing the risks and benefits in light of advice from experts in the field.

A large part of the drive for what might be called 'menopause awareness' is focused on making advice much more freely available because, according to the Fawcett Society survey, only 14% of menopausal women are currently taking HRT. It's to be hoped that next time such a survey is taken, the boost in awareness of the menopause and its impact will have pushed this percentage up considerably. Of those taking HRT, 54% said it had given them their life back.

Putting medication to one side, there are plenty of things which women can do to help alleviate some of the dramatic effects of the menopause. There are no quick fixes, of course, but the advice given below can lessen the impact of the symptoms which women sometimes feel are taking over their life, and the simple fact of acting positively to deal with the menopause, to whatever degree, can boost feelings of wellbeing and control.

Foods rich in calcium include dairy products, leafy green vegetables like kale and spinach as well as tofu, beans, fish such as sardines where the bones are eaten, bread and products made with fortified flour.

The primary source of vitamin D is sunlight, which is a bit of a problem when you live in the UK, as is the fact that your skin is less efficient at using sunlight to produce vitamin D as you age. The foods which are rich in vitamin D include oily fish, eggs and cod liver oil, and vitamin D supplements can also be taken.

Exercise

The benefits of exercise during the menopause and perimenopause are multiple. Regular exercise can play a part in dealing with stress by converting anxiety into positive energy, at the same time as reducing the risk of heart disease, controlling weight increase and helping to build bone mass.

It also helps to promote better sleeping patterns and gives you more energy in general. To keep the idea of exercise interesting, it's best to put together a varied programme, taking in activities such as swimming, cycling, running and aerobics.

Stop smoking

Anyone who still smokes should attempt to stop for the good of their health, but this is particularly important for women going through the perimenopause and menopause. Some studies have shown that smoking can trigger earlier menopause. At the same time, it also increases the risk of women developing heart disease and osteoporosis, two conditions which are more likely to impact women going through the menopause.

Keeping cool

Hot flushes can affect some women going through the perimenopause and menopause more than any other symptom, causing problems in daily life and interfering with sleep patterns. Steps you can take to help alleviate the problem include wearing clothing made of breathable fabrics such as cotton and dressing in layers that can quickly be adjusted when you feel too hot.

The same tip can apply to your bedding and keeping any bedroom well ventilated.

Many women have commented on using portable fans in the workplace or public spaces where they don't control the ambient temperature. Drinking plenty of water is another way of keeping cooler, as hydrating also aids the body in regulating temperature. Symptoms of the menopause such as bloating or dryness can also be alleviated by taking hydration on board.

Another practical step to take when dealing with hot flushes is to avoid those things that trigger them. This can mean spicy foods, smoking, alcohol, caffeine or stressful situations – the specifics will vary from woman to woman, but once you know the things which trigger your hot flushes, you can take steps to avoid them.

Pelvic floor exercises

Regular pelvic floor exercises can help strengthen the pelvic muscles and help deal with the kind of stress or urge incontinence which is sometimes a symptom of the perimenopause or menopause. The NHS provides a guide to pelvic floor exercises, which, in simple terms, involve tightening and relaxing the muscles which support the bowel, bladder and vagina.

Seeking professional help

Despite the importance of self-care, no woman should have to go through the perimenopause or menopause alone. The first person to speak to should be your GP, but research has shown that this is sadly not always a complete solution. According to the Fawcett Society report, 31% of women had to speak to their GP multiple times before the GP realised they were experiencing the menopause or perimenopause. This figure rose to 45% among women of colour and 42% among those experiencing five or more severe symptoms.

Of those women who did speak to their GP, only 39% were offered HRT upon being diagnosed with the menopause, even though NICE guidelines on the perimenopause and menopause recommend HRT as the first treatment offered, following discussions of the risks and benefits.

An alternative to your GP could be a private or NHS menopause clinic. The British Menopause Society website has a page which enables women to find their nearest specialists, filtering for NHS or private clinics. It is possible to self-refer to an NHS clinic, where you can be guaranteed a consultation with an expert in the field, although waiting times will vary across the UK.

Seeking supportive help

There are many charities and support groups across the UK for women going through the perimenopause and menopause. The British Menopause Society is primarily a site for health care professionals, but it does feature the tool for locating a menopause clinic referred to above. Other sources of support include The Menopause Charity, Menopause Matters, and Menopause Support, while the NHS web page on the menopause is a reliable and trusted source of information.

See the bottom of this guide for a more comprehensive list of supportive organisations and charities.

Of those women who took time off work due to the menopause or perimenopause, three-quarters felt unable to give the real reason for their absence because of the taboo still surrounding the menopause. That taboo is slowly shifting, but either way, it is important to be honest with your employer about the reasons for your absence to avoid any claim that you have misled them.

In addition, explaining that it is the menopause that has led to your absence will help if you ever wish to establish a pattern of ill-health related to the menopause, which could explain any perceived 'underperformance' in your role.  

As of 4th April 2021, any woman taking sick leave as a result of the menopause or perimenopause will be entitled to statutory sick pay (SSP) at the rate set by the government each year, provided they meet certain qualifying conditions. In some cases, an employer may also have agreed to a contractual entitlement to additional pay on top of SSP, which could boost sick pay to a percentage of normal pay or even to full pay. Your employer's sickness policy will explain whether this is the case.

In most cases, this will mean treating the absence – since it is disability-related – differently from normal sickness absence, particularly in regard to any disciplinary action taken. Your employer may need to keep your job open for longer than would be the case for non-disability sickness leave and support your rehabilitation.

Similarly, if your symptoms lead to your being absent from work on a long-term basis, your employer would need to fulfil certain obligations before being able to dismiss you fairly. These obligations would include seeking medical advice, maintaining contact with you, and warning you of the possible consequences of ongoing sickness leave.

In most cases, being dismissed on the basis of disability-related absence would be regarded as discriminatory unless your employer could justify the genuine business necessity and the lack of a less discriminatory alternative.

The most important thing you can do if you feel you are being discriminated against is to keep a record of everything. From conversations to emails, it can help you build a case.

There are, of course, steps you should look to take first to ensure that you can prove that you have tried every action possible to rectify the situation. These should be well documented too.

Firstly, try to talk to someone who can help internally. If this is not your line manager or HR, look for another trusted source or a trade union representative who can actively help you seek change.

If this doesn't work, you can make a formal complaint or submit a grievance, as this will ensure that your concerns are officially acknowledged. A qualified and experienced employment law solicitor can help if you need guidance on this process.

If you still don't get the desired results, your situation hasn't changed, you fear that the discrimination is getting worse, or you have left your role due to the ongoing situation, then you should seek legal support and could look to take the matter to an employment tribunal.

An employment tribunal would undoubtedly help determine any claims of unfair or constructive unfair dismissal; ‘Unfair’ being when an employer has dismissed an employee on unreasonable grounds, and ‘constructive’ being when an employee feels that they have been mistreated to the point where they had no other option but to resign as a result of the mistreatment. Both require an employee to have been employed by their employer for a continuous period of two years. For claims of discrimination, there is no requirement for an employee to have been continuously employed for a set period of time.

It should be noted that an employment tribunal can be stressful, deeply personal, and expensive. Plus, considering how inconsistent the rulings in tribunals centred around menopause have been to date, you will almost certainly want to ensure that you have exhausted all other viable options first. But with that said, you do not need to suffer in silence, and if you are concerned about the treatment you have received from an employer in response to your menopausal symptoms, you should seek legal advice.

Even though the menopause and perimenopause aren't protected under the Equality Act 2010, an employee who feels they are being treated unfairly with regard to sick leave caused by the menopause or any other less favorable treatment may be able to claim they are being discriminated against because of their sex, age or a disability.

Will my workplace have a company policy on menopause?

A menopause workplace policy is similar to policies regarding health and safety, equality and a general code of conduct - the kind that most workplaces already have in place. However, not all businesses have a specific menopause policy, and whilst ACAS advises it, it is not a legal requirement.

Having a menopause policy in place sends a clear signal to all employees that this is a subject taken seriously and one that can and should be discussed openly within the workplace.

Policies should be distributed across the organisation and form the basis of any menopause training given to managers. It should also be reviewed regularly to ensure that it is still fit for purpose. The policy should demonstrate a clear understanding of what menopause is and how it affects people, as well as understanding that each individual will be affected differently. It will also set out in detail the support on offer for employees affected by the menopause.

Other information included in the policy should be details of the menopause-related training offered to managers, team leaders and supervisors, the specific point of contact – or multiple points of contact – for questions about the menopause and a commitment to talking and listening about the effects of the menopause in a supportive and sensitive manner.

What can employers do to support menopause?

The steps an employer can take to support employees going through the menopause have been set out in some detail above. To summarise, the employers need to:

• Demonstrate awareness of the impact of the menopause and perimenopause.
• Nominate specific individuals to act as 'menopause champions' across the workforce, offering support and a clear point of contact for employees wishing to ask questions or raise points.
• Create a detailed menopause policy to offer an overview of the support on offer and formalise the creation of a menopause-friendly culture within the organisation.
• Undertake risk assessment which refers specifically to symptoms experienced as part of the menopause, such as hot flushes.

Does employment law cover the menopause?

Whilst employment law doesn't cover the menopause directly, the findings of the House of Commons Women and Equalities Committee inquiry did suggest that businesses generally lacked clarity regarding their obligations towards employees going through the menopause. The inquiry's participants also expressed a belief that those going through the menopause should be legally protected, possibly as one of the protected characteristics listed under the Equality Act 2010. The Equalities Committee has not yet published any recommendations, however upon doing so these could have an impact upon employment law and how menopause is addressed within it.

Upon releasing the results of the survey undertaken by the committee, chair Caroline Nokes MP stated that:

"If companies want to retain talent and experience, they need to wake up to the reality of menopause. Our survey shows us just how common symptoms have an obvious impact in the workplace and how ashamed those experiencing them feel. Yet the survey tells us that the solutions are in easy reach for most organisations. Much of this is about practical adjustments for employees and stamping out boorish 'banter' that menopause is a 'women's problem' or a joke. There's a legal, social and economic imperative to support working women through a normal life transition, so we can hold on to role models for the next generation."

Whether this translates into a change in employment law is something that will only become clear when the committee publishes its recommendations.

How do you tell your employer you're going through the menopause?

The hope would be that your employer has taken the necessary steps to create a menopause-friendly workplace as part of their health and safety obligation to the workforce. This gives you a clear idea of who to approach and the kind of support you'll be offered.

However, despite the progress made in recent years, this is sadly still not the case in many UK workplaces, so the onus remains on the individual to be forthright in communicating exactly in what way the perimenopause or menopause is impacting them. It can be difficult to talk to a manager about something so personal when your interactions to date have always been professional, but there are some things you can do to make the process easier to handle and more effective:

• Prepare in advance by finding out if your organisation has a policy and support system in place.
• Keep a diary noting the symptoms you're experiencing and how they are impacting your work. Having things written down will help you to explain clearly what you are experiencing and make it easier for your employer to suggest ways of supporting you. Noting that you suffer hot flushes at work, for example, could prompt an offer of a desk fan, a shift to a new location within the premises or a change in any uniform worn.
• Book the meeting with your manager or HR department in advance, so they have time to prepare.
• Agree to an action plan which will help you and can be practically supported by the organisation. Accept that they may need to seek advice from their line managers to find out exactly what the organisation can offer. If this is the case, book a follow-up meeting to review the situation at the earliest convenient date.

Having drawn up an agreed action plan, you should arrange regular follow-up meetings to review its effectiveness and make any changes needed to reflect changes in the symptoms being experienced.

Is there any legal protection for women at work who have menopause?

Currently, there is no specific legislation that protects women going through menopause. However, claims can still be made under the Equality Act 2010, which largely includes three key characteristics: age, sex and disability discrimination, or the Health and Safety at Work Act 1974, which covers working conditions and can be extended to reflect women whose health concerns are not being appropriately managed by the employer.

Confusingly, for employees and employers alike, the  tribunals  are often inconsistent with their rulings around the matter, with seemingly similar cases having very different results, especially when there is a claim of disability discrimination.

Technically, Menopause symptoms could be considered to be a Disability, providing the ailments have had (or are likely to have) a long-term, substantially detrimental impact on a person's ability to undertake normal day-to-day activities. But, whilst symptoms can impact a person's mental and physical wellbeing for a lengthy period, medically speaking, menopause is classed as a phase of life. So, although there have been a small number of notable successful disability claims made, more often than not, menopausal tribunal claims will fall under sex discrimination. This is because the claim often specifically concerns the unfair treatment of a person because of their gender. For example, an employer may be seen to be treating the menopause far less seriously than any long-standing health issues in male colleagues.

What should be noted, however, is that as it stands, caps for successful discrimination claims are unlimited.

• British Menopause Society
• The Menopause Charity
• Menopause Matters
• Menopause Support
• The NHS web page on the menopause
• Henpicked Menopause in the Workplace
• NICE page on the menopause – diagnosis and management
• Women's Health Concern
• Faculty of Occupational Medicine
• Menopause Café
• Talking Menopause
• The Menopause Exchange
• Menopause Matters
• Menopause Support
• Meg's Menopause
• My Menopause Centre
• International Menopause Society
• Royal College of Obstetricians and Gynaecologists
• Acas working for everyone