Menopause and work: An electronic survey of employees' attitudes in the UK

Abstract

This study explored women's experiences of working through menopausal transition in the UK. It aimed to identify the perceived effects of menopausal symptoms on working life, to outline the perceived effects of work on menopausal symptoms, and to provide recommendations for women, healthcare practitioners and employers.
An electronic questionnaire was distributed to women aged 45-55 in professional, managerial and administrative (non-manual) occupations in 10 organisations. Items included: age, age and gender of line manager, educational level, job satisfaction; menopausal status; symptoms that were problematic for work; hot flushes; working conditions; work performance, disclosure to line managers; individual coping strategies; and, effective workplace adjustments and employer support.
The final sample comprised 896 women. Menopausal transition caused difficulties for some women at work. The most problematic symptoms were: poor concentration, tiredness, poor memory, feeling low/depressed and lowered confidence. Hot flushes were particularly difficult. Some women felt work performance had been negatively affected. The majority of women were unwilling to disclose menopause-related health problems to line managers, most of whom were men or younger than them. Individual coping strategies were described. Four major areas for organisational-level support emerged: (i) greater awareness among managers about menopause as a possible occupational health issue, (ii) flexible working hours, (iii) access to information and sources of support at work, and (iv) attention to workplace temperature and ventilation.
Employers and healthcare practitioners should be aware that menopausal transition causes difficulty for some women at work, and that much can be done to support them.

Full text

Maturitas
76 (2013) 155–
159
Contents
lists
available
at
ScienceDirect
Maturitas
journa
l
h
om
epa
ge:
www.elsevier.com/locate/maturitas
Menopause
and
work:
An
electronic
survey
of
employees’
attitudes
in
the
UK
Amanda
Griffiths
∗,3
,
Sara
Jane
MacLennan
1,3
,
Juliet
Hassard
2,3
Division
of
Psychiatry
and
Applied
Psychology,
School
of
Medicine,
University
of
Nottingham,
Yang
Fujia
Building,
Jubilee
Campus,
Wollaton
Road,
Nottingham
NG8
1BB,
UK
a
r
t
i
c
l
e
i
n
f
o
Article
history:
Received
10
June
2013
Received
in
revised
form
5
July
2013
Accepted
6
July
2013
Keywords:
Menopause
Women
Work
Employers
a
b
s
t
r
a
c
t
Objectives:
This
study
explored
women’s
experiences
of
working
through
menopausal
transition
in
the
UK.
It
aimed
to
identify
the
perceived
effects
of
menopausal
symptoms
on
working
life,
to
outline
the
perceived
effects
of
work
on
menopausal
symptoms,
and
to
provide
recommendations
for
women,
healthcare
practitioners
and
employers.
Methods:
An
electronic
questionnaire
was
distributed
to
women
aged
45–55
in
professional,
managerial
and
administrative
(non-manual)
occupations
in
10
organisations.
Items
included:
age,
age
and
gender
of
line
manager,
educational
level,
job
satisfaction;
menopausal
status;
symptoms
that
were
problematic
for
work;
hot
flushes;
working
conditions;
work
performance,
disclosure
to
line
managers;
individual
coping
strategies;
and,
effective
workplace
adjustments
and
employer
support.
Results:
The
final
sample
comprised
896
women.
Menopausal
transition
caused
difficulties
for
some
women
at
work.
The
most
problematic
symptoms
were:
poor
concentration,
tiredness,
poor
memory,
feeling
low/depressed
and
lowered
confidence.
Hot
flushes
were
particularly
difficult.
Some
women
felt
work
performance
had
been
negatively
affected.
The
majority
of
women
were
unwilling
to
disclose
menopause-related
health
problems
to
line
managers,
most
of
whom
were
men
or
younger
than
them.
Individual
coping
strategies
were
described.
Four
major
areas
for
organisational-level
support
emerged:
(i)
greater
awareness
among
managers
about
menopause
as
a
possible
occupational
health
issue,
(ii)
flexible
working
hours,
(iii)
access
to
information
and
sources
of
support
at
work,
and
(iv)
attention
to
workplace
temperature
and
ventilation.
Conclusion:
Employers
and
healthcare
practitioners
should
be
aware
that
menopausal
transition
causes
difficulty
for
some
women
at
work,
and
that
much
can
be
done
to
support
them.
© 2013 Elsevier Ireland Ltd. All rights reserved.
1.
Introduction
In
the
UK
there
are
over
3.5
million
women
in
employment
who
are
aged
50–65
[1].
There
is
little
evidence
about
their
work-related
health
[2].
In
the
workplace,
the
management
of
gender-specific
health
issues
other
than
pregnancy
are
rarely
discussed.
However,
as
menopause
occurs
on
average
between
the
ages
of
50–51
[3]
and
menopausal
transition
typically
lasts
for
four
to
eight
years,
at
any
one
time
a
significant
proportion
of
older
women
workers
∗
Corresponding
author.
Tel.:
+44
0115
8466637;
fax:
+44
0115
8466625.
E-mail
addresses:
amanda.griffiths@nottingham.ac.uk
(A.
Griffiths),
s.maclennan@abdn.ac.uk
(S.J.
MacLennan),
j.hassard@bbk.ac.uk
(J.
Hassard).
1
Permanent
address:
Academic
Urology
Unit,
University
of
Aberdeen,
Health
Sciences
Building,
Foresterhill,
Aberdeen
AB25
2ZD,
UK.
2
Permanent
address:
Centre
for
Sustainable
Working
Life,
Birkbeck
College,
Uni-
versity
of
London,
Department
of
Organizational
Psychology,
Clore
Management
Centre,
Malet
Street,
Bloomsbury,
London
WC1E
7HX,
UK.
3
All
authors
were
employed
at
the
former
Institute
of
Work,
Health
and
Organi-
sations,
University
of
Nottingham,
at
the
time
the
work
was
conducted.
will
be
experiencing
menopausal
transition.
Symptoms
commonly
reported
by
perimenopausal
and
postmenopausal
women
–
which
include
menstrual
irregularities,
hot
flushes,
sleep
disruption,
fatigue,
mood
disturbance,
bladder
irritability
and
general
malaise
–
might
feasibly
impact
on
working
life.
There
are
a
limited
number
of
studies
that
have
explored
the
impact
of
menopausal
symptoms
on
working
life.
They
suggest
that
some
women
find
menopause
has
negative
effects
at
work
[4–10]
and
that
certain
work
situations
and
physical
working
environ-
ments
increase
the
intensity
of
menopausal
symptoms
[8,11,12].
Situational
factors,
including
work,
may
precipitate
or
exacerbate
hot
flushes,
and
affect
women’s
perceptions
of
the
severity
of
symp-
toms
[3].
The
experience
of
hot
flushes
at
work
has
been
reported
as
stressful,
particularly
for
those
who
report
embarrassment
[12].
Women
are
generally
reluctant
to
divulge
menopausal
status
[13]
but
particularly
so
at
work,
where
fear
of
stigmatisation
and
ridicule
is
common,
and
where
poise
and
control
are
highly
valued
[12].
Dis-
cussion
about
the
menopause
at
work
is
widely
perceived
as
taboo
[8]
and
there
has
been
little
consideration
of
what
employers
could
do
to
provide
support.
0378-5122/$
–
see
front
matter ©
2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.maturitas.2013.07.005

156 A.
Griffiths
et
al.
/
Maturitas
76 (2013) 155–
159
This
study
represents
the
first
large-scale
survey
of
women’s
experience
of,
and
attitudes
to,
working
through
menopausal
tran-
sition
in
the
UK.
Its
objectives
are
to
identify
the
perceived
effects
of
menopausal
symptoms
on
working
life,
to
outline
the
perceived
effects
of
working
conditions
on
menopausal
symptoms,
and
to
produce
recommendations
for
women,
healthcare
practitioners
and
employers.
2.
Methods
2.1.
Study
setting,
sample
and
procedure
Women
employed
in
10
UK-based
organisations
participated
in
the
survey.
According
to
the
UK
Standard
Industrial
Classification
of
Economic
Activities
[14],
the
organisations
represented:
profes-
sional,
scientific
and
technical;
information
and
communication;
education;
transportation
and
storage;
wholesale
and
retail;
and,
public
administration
and
defence.
Each
organisation
identified
a
contact
person
to
liaise
with
researchers
and
publicise
the
study.
They
arranged
distribution
of
a
link
to
an
on-line
questionnaire
to
women
aged
45–55
in
professional,
managerial
and
administrative
(non-manual)
occupations,
who
had
access
to
personal
computers
and
the
web
at
work.
No
incentives
were
offered.
The
question-
naire
was
administered
using
Snap
Survey
Software,
Version
9
(
http://www.snapsurveys.com
),
a
Windows-based
programme
for
web-based
survey
design
and
management.
Ethical
approval
was
obtained
from
the
host
research
institute’s
Ethical
Committee,
and
permissions
gained
from
Human
Resources
or
Occupational
Health
managers
in
each
of
the
10
participating
organisations.
Informed
consent
was
gained
from
all
women
who
participated.
Anonymity,
confidentiality
and
the
voluntary
nature
of
participation
were
emphasised.
2.2.
Measures
The
content
of
the
questionnaire
was
informed
by
the
literature
review,
an
earlier
study
of
women
police
officers
using
a
similar
methodology
to
the
present
study
[15]
and
by
semi-structured,
workplace
interviews
with
61
women
volunteers,
aged
45–55,
from
four
organisations.
One-to-one
interviews
were
carried
out
by
the
research
team
and
consisted
of
a
standard
set
of
questions
relating
to
menopausal
symptoms,
coping
techniques,
disclosure,
support
mechanisms,
work
organisation
and
the
psychosocial
environment,
the
impact
of
menopause
on
health
and
work
performance;
the
impact
of
work
on
menopausal
symptoms;
and
women’s
sugges-
tions
about
helpful
sources
of
support.
Interviews
were
recorded,
transcribed
and
reviewed
to
generate
items
for
the
question-
naire
that
related
specifically
to
the
work
context.
They
informed
the
adaptation
or
extension
of
measures
used
in
earlier
studies
[11,12,16]
and
the
development
of
new
items.
Successive
drafts
of
the
questionnaire
were
reviewed
and
piloted
with
experts
in
epidemiology,
gynaecology,
health
promotion,
human
resources,
occupational
medicine,
occupational
health
nursing,
organisational
psychology,
mental
health
policy,
statistics,
corporate
planning
and
development,
members
of
trade
unions
and
women
with
recent
or
current
experience
of
menopausal
transition.
Questionnaire
items
included:
age,
age
and
gender
of
line
man-
ager,
educational
level,
job
satisfaction
(single
item);
menopausal
status
[17];
menopause
symptoms
that
were
potentially
prob-
lematic
for
work
and
for
‘life
in
general’;
hot
flushes
at
work;
working
conditions;
work
performance,
disclosure
to
line
man-
agers;
individual
coping
strategies;
and
effective
and
desirable
workplace
adjustments
and
employer
support.
The
questionnaire
took
approximately
15–20
mins
to
complete.
Table
1
Symptoms
viewed
by
women
as
problematic
for
work
and
for
life
in
general.
Symptom
Work
(%)
Life
in
general
(%)
Poor
concentration
50.9
34.9
Tiredness
50.7 53.4
Poor
memory
50.5
42.1
Feeling
low/depressed
41.9
39.7
Lowered
confidence
38.9
21.9
Sleep
disturbances
37.3
56.5
Irritability
35.6
37.8
Hot
flushes
35.1
40.4
Joint
and
muscular
aches
and
discomfort 31.3 41.5
Mood
swings
29.0
35.5
Anxiety/panic
attacks
25.3
21.2
Tearfulness
23.7
25.4
Frequent
visits
to
the
toilet
23.3
32.8
Heavy
periods/flooding
22.4
24.0
Clumsiness
17.4
24.4
Palpitations/irregular
or
racing
heart
15.0
19.9
Weight
gain
10.6
38.3
Night
sweats 8.3 43.1
Changes
in
skin/dryness
6.4
27.0
Overall,
when
asked
how
difficult
it
was
to
manage
work
during
menopausal
tran-
sition,
5%
stated
it
was
‘very
or
extremely
difficult’,
48%
reported
it
was
‘somewhat
or
fairly
difficult’,
and
47%
found
it
‘not
at
all
difficult’.
2.3.
Analysis
Data
were
coded
using
and
statically
analysed
using
SPSS
ver-
sion
18.0.
The
primary
aim
of
this
study
was
to
examine
the
landscape
of
collected
data
and
range
of
women’s
experience.
Therefore,
a
series
of
descriptive
analyses
was
conducted.
Missing
data
was
addressed
using
a
pairwise
deletion
strategy.
3.
Results
3.1.
Sample
characteristics
Of
the
1247
responses
received,
351
were
excluded
as:
not
in
the
target
age
range
(3);
working
outside
the
UK
(18);
menopausal
status
classified
as
premenopausal
(100),
undefined
(223),
or
premature
menopause
(7).
A
sample
of
896
remained.
Each
orga-
nisation’s
contact
person
estimated
the
number
of
women
in
the
target
group
who
received
the
invitation.
The
response
rate
was
calculated
for
each
organisation,
and
varied
between
5%
and
43%.
In
all,
43.1%
of
the
sample
was
classified
as
perimenopausal,
30.6%
as
natural
menopause,
18.5%
as
hormone
use,
and
7.8%
as
surgical
menopause.
The
highest
level
of
education
achieved
was
undergraduate
or
postgraduate
(33%),
school
(62%),
with
5%
repor-
ting
no
formal
educational
qualifications.
3.2.
Menopause
symptoms
affecting
work
Women
indicated
from
a
list
of
19
symptoms
typically
associ-
ated
with
the
menopause,
which
were
problematic
for
them
for
work
and
problematic
for
‘life
in
general’
(Table
1).
The
symp-
toms
most
commonly
reported
as
problematic
for
work
were:
poor
concentration,
tiredness,
poor
memory,
feeling
low/depressed
and
lowered
confidence.
Three
symptoms
appeared
to
be
particularly
more
problematic
for
women
at
work
than
for
‘life
in
general’:
lowered
confidence,
poor
concentration
and
poor
memory.
3.3.
Hot
flushes
at
work
Women
who
were
experiencing
hot
flushes
at
the
time
of
com-
pleting
the
questionnaire
reported
experiencing
hot
flushes,
on
average,
for
3.45
years.
The
average
number
of
hot
flushes
expe-
rienced
at
work
was
3.43
and
over
a
24
h
period
was
6.32.

A.
Griffiths
et
al.
/
Maturitas
76 (2013) 155–
159 157
Table
2
Work
situations
that
made
coping
with
hot
flushes
more
difficult.
Work
situations
More
difficult
(%)
Hot/unventilated
offices/workspaces
71.3
Formal
meetings 62.8
High
visibility
work
(e.g.,
presentations)
45.2
Learning
new
things/procedures
42.8
Tasks
requiring
attention
to
detail
36.4
Shared
offices/workspaces
34.9
The
majority
of
women
(see
Table
2)
reported
that
hot
flushes
were
more
difficult
to
cope
with
when
working
in
hot
or
unventilated
workspaces
or
in
formal
meetings
(71.3%
and
62.8%
respectively).
3.4.
Working
conditions
Just
over
half
of
the
women
(53.2%)
in
this
sample
indicated
they
were
not
able
control
the
temperature
in
their
usual
working
envi-
ronment.
Many
either
worked
in
environments
where
it
was
not
possible
to
open
windows
for
fresh
air,
or
where
doing
so
created
interpersonal
difficulties,
as
the
majority
(62.7%)
worked
in
shared
offices
or
workspaces.
Most
women
reported
there
were
adequate
toilets
in
their
workplaces
(85.3%)
and
half
reported
access
to
rest
areas
(53.5%).
Nearly
a
third
of
respondents
(29.6%)
indicated
they
could
nego-
tiate
their
working
hours
or
working
practices
as
much
as
they
needed
to
help
them
deal
with
the
menopause
and
40.4%
indicated
they
could
not.
The
remaining
30%
indicated
that
this
was
not
appli-
cable
to
them.
In
terms
of
job
satisfaction,
the
majority
(65.4%)
were
satisfied/very
satisfied/extremely
satisfied,
15.7%
neither
dissatis-
fied
nor
satisfied,
and
18.9%
extremely
dissatisfied,
very
dissatisfied
or
dissatisfied.
3.5.
Work
performance
When
asked
whether
they
felt
their
performance
at
work
had
been
negatively
affected
by
menopausal
symptoms,
approximately
equal
proportions
of
women
agreed/strongly
agreed
(39.6%),
and
disagreed/strongly
disagreed
(37.2%).
The
remaining
23.2%
of
respondents
neither
agreed
or
disagreed
or
reported
this
as
not
applicable.
Of
those
who
felt
that
their
work
performance
was
not
affected,
a
third
(35.5%)
agreed/strongly
agreed
that
“I
feel
my
menopausal
symptoms
could
negatively
affect
my
performance
at
work,
but
I
work
very
hard
to
overcome
the
difficulties
so
that
it
is
not
actually
affected.”
Only
a
small
proportion
of
the
sample
(16.5%)
felt
that
the
menopause
had
negatively
affected
their
managers’
and
co-
workers’
views
of
their
competence.
3.6.
Disclosure
to
line
managers
A
quarter
of
the
sample
(24.9%)
had
discussed
their
menopausal
symptoms
with
their
line
manager.
Those
women
who
had
not
discussed
their
symptoms
with
their
line
managers
(n
=
496)
were
presented
a
list
of
possible
reasons
for
non-disclosure
and
asked
to
select
all
that
were
applicable.
The
most
frequently
reported
reasons
for
non-disclosure
were
because:
‘it’s
private/personal’
(62.1%);
‘it
has
no
effect
on
work’
(42.7%);
‘my
line
manager
is
a
man’
(41.9%);
‘it’s
embarrassing’
(31.7%);
‘I
don’t
know
my
line
manager
well
enough’
(28.6%),
and;
‘my
line
manager
is
younger’
(15.3%).
Most
women
(62.1%)
had
a
male
line
manager,
and
84%
had
a
line
manager
whom
they
reported
to
be
younger
than
them.
In
total,
11.9%
of
the
sample
indicated
that
they
had
taken
a
day
off
work
because
of
their
menopausal
symptoms.
Of
those
that
had
Table
3
Individual
coping
strategies
for
dealing
with
menopause
symptoms
and
work.
Strategies
Helpful
(%)
Actions
to
cool
down
(e.g.,
put
fan
on,
open
window,
go
outside)
95.5
Talking
to
other
women
going
through/who
have
gone
through
menopause
93.5
Wearing
appropriate
clothing
(layers)
93.4
Joking
about
it/trying
to
look
on
the
bright
side
92.3
Getting
more
information
about
menopause
91.2
Talking
to
someone
about
how
I
am
feeling 89.7
Double
checking
my
work 88.4
Writing
notes/making
lists
87.6
Exercise
86.8
Choosing
tasks
according
to
my
tiredness/concentration
levels
85.8
Getting
more
sleep
85.5
Immersing
myself
in
non-work
activities/interests
78.7
Changing
diet
78.3
Ignoring
it/distracting
myself
74.3
Avoiding
interactions
with
others
65.7
Changing
working
hours
(e.g.,
flexible/fewer
hours) 56.3
Taking
time
off
work
54.4
done
so,
the
majority
(58.5%)
had
not
told
their
line
manager
the
real
reason
for
their
absence.
3.7.
Individual
coping
strategies
Women
reported
a
wide
range
of
coping
strategies
to
be
helpful
in
trying
to
manage
menopausal
symptoms
and
working
life.
They
were
psychological
(distraction,
making
light
of
matters),
social
(talking
with
other
women
who
had
gone
through
the
menopause);
informational
(increasing
knowledge
about
menopause);
practical
(double
checking
work,
making
notes/lists);
organisational
(chang-
ing
working
hours,
flexible
approach
to
tasks);
and
changing
health
behaviours
(exercise,
sleep,
diet).
These
and
others
are
summarised
in
Table
3
alongside
the
percentage
of
women
who
found
each
strategy
helpful.
Of
women
who
reported
using
hormone
replacement
therapy
(HRT)
in
the
previous
12
months
(n
=
127),
11.8%
reported
that
cop-
ing
with
work
was
the
only
reason
they
decided
to
use
HRT,
and
57.5%
indicated
that
work
was
among
the
reasons
they
did
so.
Of
these
88
women,
the
majority
(65.9%)
felt
HRT
helped
them
cope
better
with
work.
A
further
25%
felt
HRT
helped
them
cope
better
with
work,
but
that
side
effects
were
problematic
and
9.1%
felt
that
HRT
did
not
help
them
cope
better
with
work.
Previous
HRT
users
(n
=
96)
were
asked
for
their
reasons
for
HRT
discontinuation.
The
most
frequently
reported
reason
was
‘experience
of
side
effects’
(46.9%).
3.8.
Effective
and
desirable
workplace
adjustments
and
employer
support
Those
women
who
indicated
that
menopausal
transition
made
it
difficult
for
them
to
manage
work
were
asked
to
indicate
which
of
10
employer
actions
they
found
helpful
or
which
would
be
helpful.
They
are
listed
in
Table
4
alongside
the
percentage
of
women
who
considered
each
helpful.
4.
Discussion
This
is
the
first
large
scale
exploration
of
women’s
experiences
of
menopausal
transition
and
work
in
the
UK.
Symptoms
attributed
by
women
to
menopausal
transition
that
were
most
commonly
viewed
as
problematic
for
work
were:
poor
concentration,
tired-
ness,
poor
memory,
feeling
low/depressed
and
lowered
confidence.
There
is
debate
as
to
whether
or
not
symptoms
women
typically
associate
with
menopause
such
as
poor
memory
or
depression

158 A.
Griffiths
et
al.
/
Maturitas
76 (2013) 155–
159
Table
4
Workplace
adjustments
and
employer
support.
Adjustments
and
support
Helpful
(%)
Management
awareness
of
menopause
as
a
possible
health
problem
74.3
Flexible
working
hours
63.5
Information/advice
from
employer
about
menopause
and
coping
at
work
57.4
Better
ventilation,
air
conditioning
and
temperature
control
55.3
Access
to
informal
support
at
work
(women’s
network/advice
line/contact
number)
52.7
Working
from
home 47.9
Provision
of
a
rest
area
39.5
Readily
available
cold
drinking
water
38.8
Adequate
access
to
toilets
33.1
Facilitating
a
change
from
full-time
to
part-time
work
19.0
are
menopause
related,
age-related
or
attributable
to
other
factors
[3].
Nonetheless,
they
are
attributed
by
women
to
the
menopause,
present
them
with
problems,
and
can
be
addressed
both
by
indi-
vidual
and
organisational
level
strategies.
Generally,
results
of
this
study
support
and
extend
those
of
earlier
and
smaller
scale
studies
[12],
suggesting
menopausal
symptoms,
particularly
hot
flushes,
can
pose
problems
for
women
at
work,
leaving
them
feeling
less
confident
and
at
odds
with
their
desired
professional
image.
A
third
of
women
in
this
sample
perceived
their
work
perfor-
mance
to
be
impaired
by
menopausal
symptoms.
A
much
smaller
proportion
felt
that
their
managers
and
colleagues
were
aware
of
any
drop-off
in
performance.
At
interview
women
commented
that
they
believed
they
managed
to
conceal
performance
deficits
from
their
co-workers
and
managers.
Of
those
who
felt
their
perfor-
mance
was
not
negatively
affected,
a
third
agreed
that
it
would
be
if
they
did
not
work
hard
to
compensate
for
the
difficulties
their
symptoms
presented.
However,
no
objectives
measures
of
perfor-
mance
were
included
in
this
study.
In
an
earlier
study,
line
manager
reports
of
menopausal
women’s
performance
revealed
most
con-
tinued
to
do
their
job
well
[18].
It
was
clear
that
many
women
found
coping
with
the
menopause
at
work
was
difficult,
and
that
coping
with
hot
flushes
in
particu-
lar
was
stressful.
Stress
may
also
lower
the
threshold
for
triggering
hot
flushes
[3].
Data
from
successive
British
Labour
Force
surveys
reveal
that
the
group
most
commonly
reporting
work-related
stress
is
women
aged
45–54
[19].
Many
factors
may
combine
to
explain
this.
Women
may
be
more
prepared
to
report
stress,
be
more
pre-
pared
to
attribute
it
to
work,
and
have
different
reactions
to
work
stressors
than
men.
They
may
combine
caring
and
work
roles
more
than
men,
and
are
more
likely
to
be
in
low
paid,
low
status
jobs
with
working
conditions
known
to
be
stressful
[20].
The
results
from
this
study
suggest
that
for
some
women,
coping
with
menopausal
tran-
sition
might
also
be
a
contributory
factor.
Reducing
stress,
both
by
prevention
(tackling
the
causes
of
stress
at
work)
and
treatment
(mindfulness,
relaxation)
would
be
helpful.
Earlier
studies
in
non-work
contexts
suggest
psychological
interventions
to
reduce
anxiety
or
improve
mood
and
self-esteem
might
be
useful,
particularly
for
women
who
have
negative
appraisals
of
menopause
[21].
Cognitive
behaviour
therapy
(CBT)
has
proved
as
effective
in
reducing
the
frequency
of
hot
flushes
as
HRT
and
in
improving
self-efficacy
and
perceived
ability
to
cope
[11].
Women
in
the
current
study
reported
lowered
confidence,
and
avoiding
interactions
with
others
at
work.
It
might
be
the
case
that
CBT
would
improve
confidence
and
perceived
ability
to
cope
at
work
for
women
who
find
menopause
problematic.
Research
has
shown
CBT
in
group
and
self-help
formats
is
helpful
for
women
with
problematic
hot
flushes
[22].
It
would
be
possible
for
employers
and
healthcare
practitioners
to
provide
access
to
self-help
options.
With
less
frequent
prescribing
of
HRT
[23]
such
psychological
interven-
tions,
if
widely
proved
effective,
might
become
accepted.
Also
helpful
might
be
exploring
working
women’s
attributions
of
co-workers’
and
line
managers’
perceptions.
Workplace
informa-
tion
or
advice
sessions
about
menopause
might
address
women’s
possible
overestimation
of
others’
ability
to
infer
menopausal
sta-
tus
from
signs
of
hot
flushes,
and
explore
women’s
beliefs
that
hot
flushes
are
perceived
negatively
by
others.
Research
in
non-
work
contexts
has
shown
those
beliefs
may
be
unduly
negative
and
contribute
to
distress
[24].
It
is
possible
that
constantly
trying
to
conceal
menopausal
status
at
work
may
be
a
stressor
itself.
How-
ever,
some
women
feel
that
their
menopausal
status
opens
them
up
to
being
stereotyped
and
prefer
to
consider
age
and
gender
as
irrelevant
at
work
[12].
The
study’s
strengths
include
its
multi-method
approach,
a
large
sample,
use
of
a
reliable
measure
of
menopausal
status,
and
the
inclusion
of
both
perimenopausal
and
postmenopausal
women.
A
further
strong
point
is
that
women
were
recruited
at
work,
not
through
menopause
clinics,
where
they
are
known
to
have
more
health
problems,
to
report
more
stressors
and
lower
mood,
and
to
have
more
negative
beliefs
about
menopause
than
those
who
do
not
attend
[3,25].
The
study’s
limitations
include
the
lack
of
standard
measures
of
menopausal
symptoms,
mood,
sleep,
work-
related
stress
or
burnout;
hence
the
relative
impact
of
menopause
on
work
experience
is
difficult
to
establish.
A
further
limitation
is
the
fact
that
women
were
employed
solely
in
administrative,
managerial
and
professional
occupations.
Women
in
manual,
low
paid
occupations
have
physically
more
demanding,
more
stress-
ful,
and
less
comfortable
and
less
flexible
working
conditions.
In
the
present
study
nearly
a
third
of
women
could
negotiate
their
working
hours
or
practices
as
much
as
they
needed
to
help
them
deal
with
the
menopause.
This
figure
would,
in
all
likelihood,
be
much
lower
for
women
in
manual
occupations.
Thus
this
study
may
not
reveal
the
whole
range
of
difficulties
for
working
women.
Finally,
it
possible
that
respondents
were
biased
towards
those
who
found
menopausal
transition
problematic,
although
nearly
half
of
the
women
in
the
sample
described
menopausal
symptoms
as
not
causing
them
difficulties
for
work.
However,
the
main
purpose
of
this
study
was
not
to
establish
prevalence
of
symptoms
in
a
rep-
resentative
sample
of
working
women,
but
rather
to
explore
the
landscape
with
regard
to
women’s
range
of
experiences
of
man-
aging
menopausal
symptoms
and
working
life,
and
to
investigate
coping
strategies
and
support.
In
terms
of
practical
implications,
women
in
this
study
pro-
duced
a
list
of
personal
coping
strategies
that
they
found
helpful.
Managers,
and
healthcare
practitioners
who
advise
menopausal
women,
need
to
be
aware
that
some
women
may
find
it
helpful
to
change
their
normal
working
practices.
In
contrast
to
an
earlier
study
in
the
UK
where
women
believed
menopause
was
largely
an
individual
problem
that
required
personal
coping
skills
[12],
in
the
present
study
women
suggested
their
employers
could
do
much
to
support
them.
Four
major
areas
for
organisational-level
support
emerged,
none
of
which
need
be
complex
or
costly:
(i)
a
greater
awareness
among
managers
about
menopause
as
a
possible
occupational
health
issue,
(ii)
flexibility
in
working
hours
and
arrangements,
(iii)
access
to
information,
and
to
formal
and
informal
sources
of
support
at
work,
and
(iv)
attention
to
work-
place
temperature
and
ventilation.
Some
of
these
actions
have
also
been
suggested
in
a
consultation
with
trades
unions’
health
and
safety
representatives
in
the
UK
[8].
Employers
could
provide
training
for
managers
on
health
issues
relevant
to
the
management
of
an
age-diverse
workforce
[26].
They
could
provide
access
to
on-line
information
designed
for
managers,
for
health
and
safety
representatives,
and
for
women
[27–30].
Larger
employers
could
call
upon
the
services
of
occupational
health
functions.
In
conclusion,
with
any
health
condition,
short-term
or
long-
standing,
appropriate
support
from
employers
is
essential.
It
is
likely
to
reduce
the
risk
of
stress,
help
maintain
performance,

A.
Griffiths
et
al.
/
Maturitas
76 (2013) 155–
159 159
enhance
employee
loyalty
and
facilitate
continued
participation
in
the
workforce.
However,
managers
cannot
provide
support
or
offer
suitable
adjustments
if
they
are
not
made
aware
of
prob-
lems.
Only
a
quarter
of
the
women
in
this
study
had
disclosed
their
menopausal
status
or
symptoms
at
work.
This
is
a
similar
figure
to
an
earlier,
smaller
study
[12].
It
was
clear
during
interviews
that
where
women
had
disclosed
to
co-workers
and
line
managers,
their
subsequent
support
was
highly
valued.
It
is
important
for
employ-
ers
to
communicate
to
employees
that
it
is
acceptable
to
discuss
menopause
and
any
other
health
issue
that
impacts
on
working
life,
and
to
create
a
culture
where
to
do
so
is
normal
and
not
stig-
matising.
Providing
information
and
support
about
coping
with
the
menopause
at
work,
much
of
which
could
be
on-line,
and
facilitat-
ing
the
establishment
of
an
informal
support
network,
need
not
be
expensive
and
would
convey
an
important
and
reassuring
message
to
women.
Contributors
Amanda
Griffiths
was
principal
investigator,
originator
of
the
study,
collected
and
analysed
the
data,
and
wrote
the
paper.
Sara
MacLennan
was
coinvestigator,
contributed
to
the
design
of
the
study,
collected
and
analysed
the
data,
and
commented
on
the
first
draft
of
the
paper.
Juliet
Hassard
performed
the
literature
review,
analysed
and
summarised
the
data
and
contributed
to
the
first
draft
of
the
paper.
Competing
interests
The
authors
declare
no
conflict
of
interest.
Funding
Funding
was
received
from
the
British
Occupational
Health
Research
Foundation
(Project
199E04).
They
had
no
role
in
the
col-
lection,
analysis
or
interpretation
of
the
data,
or
in
the
decision
to
publish.
Acknowledgements
The
authors
would
like
to
acknowledge
the
financial
support
of
the
British
Occupational
Health
Research
Foundation
(Project
199E04)
and
particularly
to
thank
Vida
Wong,
Brian
Kazer,
Peter
Bowen-Simpkins,
Sean
Kehoe,
contact
persons
in
the
10
partici-
pating
organisations,
the
experts
and
practitioners
who
reviewed
the
content
of
the
questionnaire
and,
most
of
all,
the
women
who
took
time
to
share
their
experiences
with
us.
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