Discussing menopause at work

Chau Doan: Welcome to the Acas podcast. I'm Chau Doan and in this episode we will be discussing the menopause at work and how organisations and employers can support their staff through the menopause. Joining me today is Haitham Hamoda, clinical lead for the menopause service at King's College Hospital and also the immediate past chair from the British Menopause Society. And also joining us is Kate Nowicki, Acas director of Dispute Resolution. Thank you both for joining me today.

Kate Nowicki: You're welcome.

Haitham Hamoda: Hello.

Chau: So what I'd like to start with is I know with the menopause there can be quite a few misconceptions about it. So can I firstly ask you Haitham from a medical perspective, what is the menopause? And when and how can it affect people as well?

Haitham: So the menopause marks the end of the reproductive life cycle. And so women are born with a finite set number of eggs and in the course of the reproductive life cycle that gradually drops, falls. And as that number reaches a stage where there isn't a sufficient number to maintain ovulation, the menstrual cycle ceases, stops. And that's by definition, the menopause. Now, the impact of it can vary. So some women can go through the menopause and have little change, many can have a number of symptoms and there are a number of symptoms that can be associated with the menopause. So it can have a different effect. It can affect women in a variety of ways.

Chau: Can I also ask about you mentioned women but does the menopause also affect other people as well? So for example, trans people or other people who are variation of sex development.

Haitham: Yes, so I think it's important to highlight that because often, it's not referred to often enough that you can experience the symptoms of hormone deficiency in all categories. So it's relevant to say that people in that category in that situation who are exposed to oestrogen deficiency can experience these symptoms. And of course, going back to how it can affect people, what it can do, what you see the majority of people going through the menopause will experience symptoms. And to be more precise, studies suggest about 75% of people will experience symptoms, 25% don't experience symptoms and 25% can experience severe symptoms. So it is a really varied presentation, so individualisation is important.

It’s important that we don't turn it into something that's too negative, that people will be thinking 'dreading going through the menopause'. But equally it's important to highlight that it can have an impact because if you're not aware of it, and you're thinking I'm struggling with my day-to-day life, I'm struggling to function. So it's important that both aspects are addressed. So awareness is key in the process as people understand where they are, what's going on and what their choices are.

I mean when we talk about symptoms, most people will attribute hot flushes and night sweats to the menopause. And you could say many people can self-diagnose their menopause transition if they're saying that I'm 50/50 on, my periods are beginning to space out, getting hot flushes and night sweats. But there are other symptoms and of course, hot flushes and night sweats are the commonest symptoms and a majority of women going through menopause who have symptoms will have them. 

But there are other symptoms. That can be sleep disturbances, there can be changes in mood, anxiety, changes in memory concentration – people often refer to it as 'brain fog'. The changes in energy levels, although that bit again can overlap with many other factors, changes in sexual drive and libido. Again, some women may not feel comfortable talking about it. And again, that's not at all a common symptom, joint aches, muscle aches and vaginal dryness. All of these are symptoms that are common and are associated with the menopause.

Chau: So then can I refer to you Kate? So in regards to the menopause within the workplace, how can employers actually help and support their staff who are actually going through the menopause or potentially have gone through that process as well? So, for example would it be advisable to have any menopause policies in place? Or perhaps if they have any ED&I policies, to include that onto that as well?

Kate: That's a great question Chau, thank you. And yes to both of those things. And I think the important thing about that is to put that into the context of being a supportive employer who cares about the wellbeing of all of their employees, and has got a good approach to that more generally, and who has got managers and enables managers to have great conversations with their staff so that those tricky subjects if you like, can be picked up. But as for policies, yes, an organisation that's got a policy in place which tells people where to go, tells people what support is available, perhaps outlines what the key symptoms are, is a great starting point for an organisation. And I always think that an organisation that's got, you know equality and diversity policies or menopause policies says something about the nature of the organisation and it sets out their positive intent to help. And then with great line managers, trained and able to have those conversations, you're well on the way to supporting women and anyone else affected by menopause through their working life.

Chau: And I was just wondering as well, if there are policies in place but for example, if certain staff might feel uncomfortable talking about their condition with the employer or if they feel slightly embarrassed about that. Are there things that either the employer could do or approach the subject with them, if they notice any concerns?

Kate: It's a really tricky area that Chau. I think it has to be so guided by the individual and for many people it still feels very taboo and uncomfortable. And many people anyway, wouldn't discuss any personal health matters, actually, with a line manager. Now, I suppose it depends on the sort of individual that you are and the sort of relationship you have with your line manager. So I think the very best thing is for managers and supervisors to be skilled, and thoughtful and supportive, very broadly anyway. There's a phrase I use a lot which I really think is helpful: "You know that the conversation is the relationship, to have that relationship you've got to speak with your colleagues, talk to them". And it's more likely then, that if you're observing something in them that you think is a concern, that you'll personally as a manager feel better able to have that conversation with them, and to do it in a way that's sensitive and respectful for them too.

Chau: So do you also think that it might also be best to actually let the member of staff lead on the conversation as well? So rather than make assumptions around anything that the member staff is potentially having difficulties with, would it be the case to let them lead in that process?

Kate: I certainly would advocate that process, approach Chau, yes for sure. It's such a sensitive thing you know, it would be really uncomfortable wouldn't it for some well-intentioned person who's just been on menopause training to notice somebody looking a bit hot and to leap in with two feet and say the wrong thing when perhaps they're just being a bit hot that day. So yes, you'd want to be super, super careful and be led by the individual. Having created all the right environment and space and as I say the right environment for them to do so.

Chau: When we talk about the support of people at work in regards to the menopause, can I then refer back to you Haitham, so you mentioned about training and support. So what is the training that's available out there? So would you think that for example, would it be good to have mental health support or advisers or any leads, or menopause leads in the workplace that could help?

Haitham: I think the key, what you're hoping to see in a manager or a line manager or supervisor, is to be aware of what's involved. We're not expecting them to give advice so it's for them to be aware of what is likely that the individual may experience. As Kate referred to it's when we talk about anxiety and low mood, there could be some lack of, you know, some drop in self-confidence, you know, all of that. So you have to be careful how you address it. 

And I totally agree with Kate, it's having that information available to leave it to the individual to choose how they're progressing. So you could say from a work environment, what we'd like to see is that openness about it, so you could say maybe on your website in the wellbeing or any health area on your website, that you've got a link on menopause information. So if an individual goes and has a look at it, they may go into it and look and find support information that they could get further information from.

Maybe you could have within mandatory training or within any kind of annual update meetings, you can have someone to come and talk about the menopause. So all of this will bring it into awareness for people to know what they can do if they're in that situation. And then of course, the role of the manager in that situation is to guide them to what the next steps will be. So that might be the occupational health or access to the information that you've got. So they're really kind of almost like a gatekeeping awareness and direction is what you're hoping to see. 

And of course, one area I would add to that, I mean, it's really great that we are talking about it in a workplace capacity. I mean, you know, it's very welcome how many organisations are wanting to have these policies and developing these policies. But one important thing one would like to see at this stage, especially when it's very much in its infancy, is to say that you want to have a uniform base policy across, or platform, across the country because you don't want to have this postcode variation, where, you know, you could have this policy and your next door neighbour who's across the road has got a very different policy. So the core aspects of policies, one would like to see them the same across the board. But of course, there's going to be adaptations and variations to what your individual organisation needs. But I think that would be relevant to consider that as well.

Chau: You mentioned there about occupational health, so maybe referring staff for further advice for that. But would you also think that, for example the employer could use things like risk assessments or be aware of health and safety checks or potentially any reasonable adjustments? Could that also help the employer in regards to handling menopause in the workplace as well if they find that certain staff might be having difficulties in relation to the work that they're doing?

Haitham: You could say the role of occupational health is also going to be probably more of a direct medical assessment but also they're going to refer on to, let's say, someone who is able to offer specific advice. Now management, if we kind of take a step back and say, what's going to happen as the next step. And you could say, of course, we were talking earlier on about awareness, understanding where you are, what's going on – to many that's the key point. 

But then if you move on a step to saying what can I do about it? It's not just all about HRT so menopause shouldn't be seen as equaling HRT. Yes, HRT is the most effective intervention and a very common intervention but lifestyle changes are very common and very effective. So if you look at them, you could say, changing diet, exercise, optimising weight, reducing caffeine, reducing alcohol – all of these can help control symptoms. Cognitive Behavioural Therapy (CBT), you could do it at home, you could do it online, there's lots of information on the British Menopause Society and other places where you could look to get that information, so guiding people to where they could get information, let's say, like I said the British Menopause Society, the Royal College of General Practitioners who are College of Obstetricians and Gynaecologists. And you could get this information in this day and age, as helpful as the web is and social media are, you've got so much information and you often think what is correct, what is not? 

So also when it comes to the menopause, I will say there's a lot of well-intended misinformation out there. So it's really important that you look at where you're getting this information to help people get accurate information, accurate advice that's unbiased evidence based. 

But of course, when you look at it, going back to your point about what would you do in the workplace, of course, there's a place for workplace adjustments. So you could, say, look at cooling air conditioning fans, etc. You could look at adapting working times, flexibility with work but I would often say that would suggest the symptoms are going to be ongoing for many and hopefully with the intervention, they will get on top of the symptoms. But of course if these are an ongoing issue these adaptations will help but I think I would say guiding people to what they can do and to the active interventions is the key in this.

Chau: I think it is a very interesting point that you mentioned that there's a lot of information out there and I think it can be quite confusing for people in relation to that. But you also mentioned about the awareness and the importance of making the awareness of menopause in the workplace. So can I then refer back to you Kate. So when we talk about awareness, I know that in the past, menopause has potentially been seen as a bit of a joke subject from a lot of people and obviously, there's been a lot more awareness been made recently around it. But can I ask then if a member of staff in the workplace felt that they were, for example being bullied, harassed or even potentially been discriminated because of their menopause symptoms, what can they then do about it? But also, more importantly, what can the employer do to help in that situation as well then?

Kate: Oh, that's a really good question isn't it Chau, and you're quite right. I think it has been a sort of a bit of a 'women of a certain age' type joke historically, hasn't it?

Bullying and harassment, harassment is unlawful in the workplace and we're now starting to see some cases coming through. In fact, apparently last year, there was quite a notable increase in employment tribunal cases where menopause was the main factor that had gone up by over 40% actually. They're still very, very small numbers but it's going up so I think that speaks for itself. 

But yes, if it's happening, from a woman's point of view, well I would always say to any individual, any employees experiencing bullying and harassment in the first place, they need to tell somebody about it, depending on who's doing it of course. You would look to your line manager, your wellbeing contact, there'll be formal channels through which people can raise complaints. 

It's really uncomfortable even to think about people being subject to harassment in that way actually, on account of experiencing menopause symptoms. That's an uncomfortable thought but I know that kind of thing certainly does happen. So from an employer's point of view if there's a complaint around that, I mean, they really have to take it very, very seriously. It's potentially you know, from a litigation point of view, that could be potentially very costly.

There was a case in Scotland not so long ago which cost the employer £14,000 which was around their treatment of a woman who's undergoing menopause symptoms and has medical issues. So it can be quite costly. So employers need to take it seriously, they should make sure that they've got the right policies and practices in place to minimise the chance of that happening in the first place. But to handle it with proper sensitivity, care and do investigation if it does arise.

Chau: If that person felt slightly uncomfortable approaching their line manager to talk about their menopause symptoms or any difficulties about that, are there other people that they could potentially get into contact with? Or for example, if there are any networks within their organisation that they could refer to for support?

Kate: Yes, I mean I think that's where having the policy is really helpful in the first place. Because in your policy you identify fair treatment contacts, perhaps a menopause champion. So it's my privilege to be the executive board menopause champion in Acas and I'm really delighted that I am. And I often have conversations with colleagues actually, around that subject. They're just informal chats but yes, it's important that the policy identifies contacts that are there to support the individual.

So as I say, fair treatment contacts, networks, perhaps a women's network would be most commonly used. And the trade union as well, so if there's a trade union in the workplace, they can be a really terrific source of support and help for somebody who's really having a tough time of it in the workplace.

Chau: Then can ask Haitham, in regards to the staff talking to their employer. If it's say, for example, if it's a workforce that is a majority of women working, and I'm playing devil's advocate a bit here because you're a male Haitham, would you think it would be appropriate for a male line manager to speak to a female colleague if they had any concerns about their menopause symptoms either affecting their work or affecting their mood? Or as we mentioned before, would it be maybe best to signpost them to further support instead?

Haitham: I mean of course you have to, I would say, respect the wishes of the individual and who they feel comfortable talking to. But I genuinely would often say, with all these things, I think we should all be aware and I don't think it really makes a difference who's talking. I mean, as you said, many, many of us work in the field and, you know, we explain to patients what's going on and we get the feedback that, you know, people are happy with it. And so I think it's about the individual and about the message, and I think doesn't necessarily have to be a certain, you know, looking at it in a certain way. But of course, you have to take into consideration the wishes of the individual.

I just have one slight variation in my comment in relation to what was mentioned about perceptions. One of the interesting things with the talks about menopause in the workplace is, you find you give a talk to a group and men attend, younger woman attend. Often people will say men aren't interested, younger women are less interested because it doesn’t affect them. And you'd be surprised how many younger women or men ask questions at the end and say: "Oh, I didn't know about any of that. That was really good to know". And I think a lot of that aspect is almost like unawareness, a lack of awareness. That's the issue rather than someone thinking they're trying to undermine someone in doing that. So I think, again, you could say, awareness is for all, it's for the individual affected but also I think it'd be very helpful. It's also helpful for people around them.

Kate: Yes, I couldn't agree more with what Haitham said there Chau, that wider awareness just gradually taking down the taboo, having the conversation and who would have thought that I as a woman would be having a conversation with two men about this. I think that's fantastic, a really great thing. 

And it puts me in mind of a close friend of mine actually who took an early retirement from her very high powered job because she was experiencing mood swings, a loss of confidence, anxiety, some sort of cognitive concerns that she had. And she was convinced there was something, you know, appallingly wrong with her. And there was nobody, there was no outlet in the workplace, she didn't discuss that in the workplace, There was no narrative around her in the workplace that would enable her to recognise for herself what was happening to her or for even to have had any sort of conversation with colleagues about that. And she left her employment and then subsequently had conversations and it dawned on her, and she got help and she's, you know, in a much better place now.

And so it's not an urban myth about women losing their position in the workplace because of menopause. It's real and that broader awareness for everyone to be aware of it, young women, men of all ages and I think that's a very powerful point and one really for us to take away.

Chau: I think just coming from that - I think, yes, you both mentioned that awareness is an important thing. And when I also think about it now, actually in the case of the menopause, it is actually a collective responsibility for everyone because technically, you probably might have experience with someone who is going through the menopause, so for example, family members, friends, colleagues. I think that educational piece is a really important thing. So finally then, can I ask from you both is there one main piece of advice that you would like our listeners to take from this podcast episode?

Haitham: Thank you, Chau. I would like to see that access to information. And I would stress this point, I've said it repeatedly because I do think what's key is access to accurate information to help women make informed choices. That to me is the key. It's not about what you do, it's about understanding where you are.

As Kate referred to when we see people going through the symptoms and struggling with them, the common theme is this whole, what do I do? what's going on? As much as the effect of these symptoms and understanding what you can do, what's happening and what your choices are is the main thing. 

I think this whole positive change that we've seen over the last few years is very welcomed because it's taken away that negativity, that taboo about talking about the menopause. We're talking about it, and that will filter down and people will feel more comfortable thinking right I'm getting this, is something that you know what is going on and it will make people more comfortable talking about it, getting help and seeking advice.

Kate: Yes absolutely, I would totally endorse that, it's so central for myself personally as well. And in the workplace for me the key thing is for employers to look at having that menopause policy because if you've got the policy it reflects the content of the policy, if you like, around informing and enabling managers and the wider workforce to understand and have awareness which in turn provides that backdrop against which women can themselves find support and enable them to get the information to which Haitham refers.

Chau: Thank you both for your contribution to the podcast today. I think our listeners would find it very insightful, informative but also very helpful and supportive. And I think that if they can take these key points that we've mentioned. So we mentioned we talked about awareness, the importance of access to information but at the same time creating that open environment so that we break down the barriers and the taboos around menopause in the workplace. But thank you once again to both of you for taking part in the podcast today.

Kate: You're welcome. Thank you very much, Chau.

Haitham: Thank you, Chau.

Chau: This has been the Acas podcast. You can find out more information and support on menopause at work including advice, guidance, training, and resources on our website at acas.org.uk. Further information is available in the episode notes. Thank you for listening.