Menopause support resource

Menopause is simply the time that periods stop, usually around the age of 45 to 55, although this can occur sooner for some women. The average age of the menopause in the UK is 51.

It’s common for symptoms to start before periods actually stop. The months or years either side of periods stopping when some menopausal symptoms are experienced is called ‘peri-menopause’. Around one in 100 women will experience peri-menopause before the age of 40 and face menopausal symptoms sooner, which can cause some health implications if left untreated.

When symptoms start before the onset of any change in periods, it can be confusing and difficult to understand the cause, often leaving women concerned they have a more serious health condition. Even when periods have finally stopped, symptoms may persist for many months or years.

While predominantly experienced by women, it’s important to note that experiences and perceptions of the menopause may differ in relation to other protected characteristics such as:

• age
• disability
• gender reassignment
• race
• religion
• sexual orientation
• marriage and civil partnership status

We must recognise that, for many reasons, people's individual experiences of the menopause can differ greatly.

Transgender men, non-binary and intersex people may also experience the menopause. Additionally, transgender women can experience menopausal symptoms when they commence HRT treatment and hormones are adjusted, introduced or stopped, particularly before and after surgeries and procedures throughout the transition process.

Many who experience the menopause will have mild symptoms, but for others, symptoms can be severe and impact their home life, social life and most commonly, their working life. Around three-quarters of women will experience flushes and sweats – a sudden feeling of intense heat, often accompanied by sweating.

Some symptoms are hardly noticeable, but others can stop a woman in her tracks: intense sweating, a tomato red face and heart palpitations. When this occurs, a woman will often need to stop what she’s doing, take some deep breaths and wait for it to pass. Hot flushes frequently lead to a feeling of anxiety, particularly in public settings, and it could happen once or twice, or many times a day and at night.

"It made me very anxious; inside, I felt I had to work harder than ever to achieve normal."

"It’s embarrassing; you’re in a meeting and it just comes on you as a wave of heat; you go red and visibly sweat."

Other symptoms include:

• mood swings
• brain fog
• difficulty concentrating
• increased anxiety
• poor sleep
• fatigue
• issues with self esteem
• memory problems

These symptoms can have a strong adverse impact on both physical and mental health when paired with long hours and high demands on time and output, which are so common in law firms.

Women describe feeling that they are ‘just hanging in’, or ‘pushing through’ in order to work effectively while experiencing symptoms. For some, this makes work a challenge and affects wellbeing. This is often perpetuated by feeling as though they are not able to discuss this openly within their teams or to their managers. The stigma associated with the menopause encourages suffering in silence.

Routine work becomes a major challenge. Women start to wonder if they can do their jobs and their confidence is threatened. They also often feel anxious about being seen as less competent, so they carry on, not mentioning their menopause to anyone and never really resolving or easing the symptoms.

Usually it passes, although for some women, it can drag on for many years which in some cases, leads to women leaving their job as the only viable way to cope.

• Menopausal age women are the fastest growing demographic in the workplace
• Nearly eight out of ten menopausal women are in work
• Three out of four women get symptoms; one in four troublesome enough to affect everyday life

Increasingly employers, including law firms and in-house teams, are recognising the important role they can play in supporting women.

According to figures shared in the House of Commons in 2018, 50% of working women found doing their job challenging due to menopausal symptoms and 10% left the workplace altogether. It’s clear from these statistics that educating both employers and employees is paramount alongside improving working environments.

There are a vast number of positives that come from being proactive in your approach to your workforce and considering the needs and adjustments diverse groups of people may require.

Developing clear processes or guidelines is to everyone’s benefit. It supports an inclusive culture and reaps short- and long-term benefits.

Managers do not need to be menopause experts

Managers simply need an understanding of how menopause might affect some women and a willingness to have an open conversation particularly in regard to the practical needs of the employee.

Influencing culture in this way, where further learning and open dialogue is encouraged, comes with a wealth of benefits. Championing employees to feel comfortable to be completely themselves and speak freely can have a huge positive effect on productivity, wellbeing, motivation and morale.

Create an open culture

Cultivate and maintain environments where the topic of menopause can be discussed as openly as any other, normalising it for everyone.

Starting an internal networking group to share insights and experiences is an easy way to start the conversation and give it opportunity to continue. Employees who will not directly experience the menopause, like some men for example, may experience it to some degree alongside family members and partners. Ensuring all staff are welcome to join this group, and the discussion, will prove particularly helpful in lifting the stigma associated with the menopause.

An internal support network is also a great resource for people who may have a personalised experience of the menopause due to a protected characteristic.

Share resources and guidance

Documents which detail the symptoms of the menopause, how women and their lives can be affected and the types of support available are invaluable for both helping individuals and breaking down the stigma.

Publish these types of content on your internal intranet pages or make sure that employees are aware they exist and how to access them. It’s valuable to share resources which touch on wellbeing, as menopause and wellbeing are often so intertwined.

Resources and guidance should be diverse and inclusive offering support and information to all who can experience the menopause and menopausal symptoms. People with varying characteristics and, for a variety of additional factors, will have differing experiences and so information should be relevant and available to anyone who could benefit from it.

Guidance of this nature could be implemented for other topics that are also often considered taboo, like fertility and infertility, for example.

Workplace training

The Faculty of Occupational Medicine’s 2016 guidelines on menopause and the workplace recommend training that raises awareness of menopause at work and introduces an array of workable solutions.

Henpicked’s How menopause friendly is your organisation? is a helpful yet simple way to identify the variety of areas which should be looked at when creating a more inclusive workplace.

Using dates focused on the menopause within the diversity calendar can present opportunities to offer training and educational sessions for internal staff. Examples include:

• Menopause Awareness Month (September)
• World Menopause Day (18 October)
• International Women’s Day (8 March)

These dates could also be used as an opportunity to begin organically facilitating the conversation within your organisation.

Offer staff personalised support with experienced menopause practitioners

Peppy offers employers a way to give staff one to one personalised support with verified and experienced practitioners.

Using chat and telephone advice, women can:

• discuss their symptoms
• find out about treatment options if needed
• discuss privately and confidentially any work issues relating to menopause
• make a plan to move seamlessly through the menopause transition

See appendix for Peppy details.

Reasonable adjustments and discrimination

Employers owe a duty of trust and confidence to their staff and how they’re supported in the workplace when facing these issues.

Some menopausal women may also be protected under the Equality Act 2010, if their symptoms are severe enough to amount to a disability. A disabled person is someone with a mental or physical condition, which has a substantial and long-term effect on their ability to carry out normal ‘day-to-day’ activities. Day-to-day tasks are not limited to workplace tasks and can include an inability to sleep or concentrate. Substantial is something that is more than trivial, and long-term means that it has affected, or is likely to, affect an individual for over 12 months.

If a woman’s menopausal symptoms meet this definition, which many do, their employer must make any reasonable adjustments to help her return to or stay in work.

There has been some litigation about the menopause and the issue of reasonable adjustments, and it’s likely the number of cases will increase as women remain working.

The requirement to make reasonable adjustments applies where a “provision, criterion or practice” (such as a workplace policy) or physical feature (such as working in a hot environment) puts a disabled person at a substantial disadvantage. Introducing a range of simple and effective reasonable adjustments, which staff are aware of and know how to access, is an easy way to begin developing an accommodating and inclusive work environment.

Dress code

Three in four women will experience hot flushes, frequently accompanied by sweating. Implementing a more relaxed and flexible dress code can help manage this and allow women to feel more comfortable at work.

Accessibility to cooling

Employees should have access to a fan or air conditioning where possible. If this is infeasible, allowing employees to sit near a window or step outside is necessary to minimise discomfort.

Access to drinking water and toilet/ changing facilities

With bladder symptoms commonly present at menopause, the need for the toilet may be urgent and privacy extra important, especially if periods are heavy or irregular and when flushes and sweats lead to a need to change during the day.

Flexible working

Managing the symptoms of the menopause can be especially difficult, even in modern offices. Trouble sleeping and sleeping issues generally are one of the top cited symptoms of menopausal women and this can affect work performance and wellbeing. Working from home can help, which most law firms are now equipped to do, as can giving women flexibility around when they start and finish work.

It’s key that all managers and senior leaders develop an understanding of this topic to drive inclusivity within their organisation and avoid disability discrimination claims. Women are more likely to confide in managers who treat them respectfully and make time to discuss issues properly. If they’re able to have open conversations about their menopausal symptoms, it’s much more likely that their managers will be able to put in place practical measures to help them continue to work and perform to the best of their abilities.

Generally, employers are only liable for disability discrimination if they know their employee is disabled or could reasonably be expected to know.

Even if women do not expressly tell their manager they are menopausal as they may not know they are, employers should sensitively and tactfully ask questions rather than jump to conclusions and instigate performance management or disciplinary proceedings to deal with perceived shortcomings or changes in attitude or performance.

Information should be accessible to all employees and visibly signposted, especially as many women acknowledge that they themselves do not fully understand the menopause and the impact it can have on them.

• Menopausal symptoms are generally short lasting, but not always
• Most women get only some, not all, of typical symptoms
• Menopausal symptoms sometimes go on for much longer than you might expect and can be more troublesome than you might imagine

Staying healthy through menopause

For many, menopause occurs around mid-life, just when other life pressures often build up too. Work is often at its busiest; you may have teenage children at home, leaving home and elderly family that you are looking after.

Throw in hormonal disruption and you can begin to see why some women struggle with life and work at this time. There are specific ways you can look after your physical health as you go through the changes of menopause.

Eat a balanced diet

Ensure a balanced diet rich in calcium, for bone health. You need around 700 to 1000mg a day.

Calculate your calcium intake

Consider taking a vitamin D supplement (400iu) in the winter months from November to March. Some groups are recommended to take vitamin D all year round. This includes if you:

• have dark skin
• cover your arms most of the day for religious or other reasons
• have been proven to be deficient in vitamin D before
• know your bones are thinner than average (osteopenia or osteoporosis)

Reduce your intake of saturated fats such as butter, biscuits, cakes, to maintain a healthy weight. Eat a variety of foods to achieve nutritional balance. This will help to prevent Type 2 diabetes and heart disease, and contribute to a healthy cholesterol level.

Stop smoking

Do not smoke. If you do, seek help to quit. Smoking can worsen menopausal flushes and is not good for bone health. Heavy smoking may bring forward your menopause a little.

Limit alcohol intake

Limit alcohol to a minimum to reduce flushes. It may also help your sleep if you cut down on alcohol. Government recommendations are that women have no more than 14 units a week.

Exercise regularly

Take regular exercise, ideally five times a week for at least twenty minutes. This promotes both bone and heart health as well as helping with weight management. Women often gain weight as they get older, usually because of changes in both diet and metabolism, and the menopause may worsen weight gain as your metabolism changes.

Exercise is good for both the mind and body and for some, can reduce symptoms. It can take a while to get into an exercise habit and it’s worth finding something you actually enjoy, perhaps joining a class if you prefer social activity. Online exercise classes can be a useful tool and sometimes more convenient.

Seek professional advice

If you go through menopause under the age of 40 years, seek the advice of a health professional who will guide you through the treatment options. It’s important that you get hormonal support as well as emotional support at, what can frequently be, an anxious time.

Managing symptoms

There are a variety of options to consider when looking for ways to manage your menopause.

Lifestyle changes

Use relaxation methods such as mindfulness, yoga, and exercise and make adjustments to daily activities, including work, to accommodate symptoms. You may not be able to eliminate your symptoms, but they may reduce in severity and scope.

Identifying triggers

Some women know that certain things worsen symptoms. Feeling time pressures, work or family stress, caffeine, lack of fresh air, some foods, such as spicy food and alcohol, can all make menopausal symptoms worse. Take note of what makes your symptoms worse and try to avoid or reduce them where possible.

Non-medical approaches

Supplements (for example, red clover), herbal therapies (for example, black cohosh) may help reduce hot flushes. Therapeutic approaches such as cognitive behavioural therapy, relaxation, mindfulness and acupuncture may improve general wellbeing and help you cope with symptoms.

Hormone replacement therapy (HRT)

For most women, hormone replacement therapy (HRT) offers the most effective relief of symptoms and is low risk for most. HRT usually comprises of two hormones, oestrogen and progestogen. If you have a hysterectomy (removal of womb), you generally only need oestrogen HRT.

For some women, testosterone may also be added especially if you are younger or had a surgical menopause (removal of ovaries).

Your GP will be the first point of contact to receive HRT: speak to them for further information. See the resources below for more on HRT.

Other medical treatments

If HRT is unsuitable, or if you choose not to use it, there are other alternatives to managing your symptoms through medical treatment. These can be prescribed and advised by a medical professional, and include:

• various low dose antidepressants (which can help flushes)
• clonidine (for flushes)
• vaginal treatments (for bladder and intimate dryness)

The menopause is not a uniform experience and it’s normal to experience many, some or none of the commonly cited symptoms.

It’s important to be informed of these symptoms and the treatment options available and explore these further with a medical professional if necessary.

When looking for information and advice, always think about the following:

Is it accurate?

Look at the ‘about us’ section of web pages. Look for sites that are open about working within UK NICE Guidance. Whilst the Scottish equivalent of NICE is SIGN we note that the NHS Scotland website cites NICE guidance on menopause as best practice. Is the author a health care professional or if not, what are their credentials?

Is it biased?

Are they selling a product or a service? Although not overtly an issue, it should be transparent. Many sites will separate advice from adverts, with clear distinction between sections.

Is it recent?

Medical information changes fast. Is there reference to recent research? Make sure to look at dates on the site and try to find information produced in the last five years.

Books

• Menopause: The One Stop Guide, Kathy Abernethy, 2019
• Menopause: The Change for the better, Henpicked and Deborah Garlick 2018
• Managing hot flushes, a cognitive behavioural self help guide to the menopause, Myra Hunter 2013
• Men…let’s talk menopause, Ruth Devlin 2019

Websites

Information on the menopause:

• www.menopausematters.co.uk
• www.womens-health-concern.org
• www.henpicked.net
• www.daisynetwork.org
• www.menopausecafe.net/

For workplaces:

• www.peppy.health/menopause
• www.menopauseintheworkplace.co.uk
• www.fom.ac.uk/health-at-work-2/information-for-employers/ dealing-with-health-problems-in-the-workplace/advice-on-the-menopause
• https://www.cipd.co.uk/knowledge/culture/well-being/ menopause

Support when you need it the most

• Six-week programme of education and support around menopause topics to enable confidence and understanding of the changes that occur
• One-to-one chat with menopause practitioner
• Group support in small moderated chat groups, anonymous if preferred
• Personal telephone consultation with specialist nurse
• Access to resources, tips, webinars and more

Imagine you’re experiencing symptoms as a result of menopause: a normal life transition and one you thought you were prepared for.

The symptoms start gradually, then creep up on you. “Is this normal? Is there something wrong with me? How long will this last? I need to sort these symptoms out but, where do I go? What can I use, and will it help anyway? Should I use HRT, is it safe, will it work? Is there anything I can use?”

These questions and others start to come into your mind and soon you may be thinking “my job has got harder because of these symptoms, I am having to change my ways of working, how can I discuss this with colleagues or managers? Should I go sick, not tell anyone, hide my symptoms or have the discussion that might leave me, and my manager embarrassed? What if they think I can’t do my job?”

Now imagine, you have access to a personal menopause practitioner, at the end of your phone, through confidential chat, at a time that suits you. The opportunity to ask anything you like about menopause related topics, to have personalised support and to learn all about the changes that may occur, how you can deal with them and what your options are at this time. Imagine learning what is happening to your body, how you cope with symptoms and look after your health in the best way possible.

Add a personal 45-minute telephone consultation with a specialist nurse, someone who is experienced in menopause practice, fully vetted and indemnified to give accurate evidence-based advice, specific to you. Tell her your story, your medical background and know that the advice she gives will be in line with UK clinical guidelines and recommendations. Ask her your personal questions, share your thoughts and anxieties, discuss your options in confidence and work through solutions that are right for you, both at home and at work.

More questions? Go back to your chat nurse, keep asking questions, and receiving tips and advice. Link to online exercise classes, mental health support and access a directory of resources as you journey through the menopause transition.

Peppy works with employers to offer this service directly to staff. To find out more about how Peppy can support your employees get in touch at hello@peppy.health.

Kathy Abernethy

Kathy Abernethy is the director of menopause services at Peppy Health and former chair of the British Menopause Society. A British Menopause Society Registered Menopause Specialist with over 25 years of clinical experience, she co-leads an NHS Menopause Service in North London and has a private clinic in South West London.

She has written numerous articles for women, which have appeared in Woman’s Weekly, Now, Essentials, Saga and Yours magazines. Kathy raises awareness of the impact of menopause at work by delivering workplace sessions to staff and managers and has a programme of menopause education for health care professionals.

Her book for women Menopause: The One Stop Guide is available in shops and online.

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Jenny Arrowsmith

Jenny Arrowsmith is a partner at national law firm Irwin Mitchell and is a specialist in employment law. She has extensive experience of advising employers in all areas of employment law and has a particular interest in discrimination issues.

She’s spoken at numerous events on the legal implications of wellbeing issues, such as menopause and mental health in the workplace, leading discussions on how employers should proactively support employees and mitigate the rising risk of claims.

She led on the Court of Appeal case, Ali v Capita, confirming that maternity leave has a distinct purpose to shared parental leave and that it is not discriminatory to pay maternity leave at enhanced rates of pay. She was nominated as the Lawyer of the Week by the Times for her work in this case in June 2020.

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Sarah Gilzean

Sarah Gilzean is a senior associate at Morton Fraser. She is the Convener of the Law Society of Scotland’s Equalities Law Reform Committee and Secretary of the Scottish Discrimination Law Association. She is an accredited specialist in both employment law and discrimination law, one of only eight in Scotland.

Sarah is ranked as an ‘Associate to Watch’ by Chambers, with expertise in high-value discrimination and equal pay cases. She acted for the claimant group in the largest equal pay litigation in Scotland against Glasgow City Council.

She regularly advises organisations in relation to discrimination issues outside of the field of employment e.g. in relation to issues such as gender recognition, disability discrimination and education.

During her career, Sarah has worked both in private practice and in-house at the Equality and Human Rights Commission, where she was involved in taking test cases to the Supreme Court and European Court of Justice.

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