Menopausal women struggling with symptoms at work – a conundrum unsolved?

A record number of women enter menopause daily, as can be extrapolated from population age data (>50 years) which is taken as a mark for menopause. It is estimated that a million women worldwide reached menopause in 2020 (United Nations, Department of Economic and Social Affairs, Population Division 2019). Menopause is a time of transition marked by fluctuating physiologic changes in steroid hormones that impact the quality of life of many women in the short term with vasomotor symptoms (VMS), sleep, and mood disturbances, lack of concentration (“brain fog”), prostration, and sexual dysfunction as well as long-term changes such as genitourinary symptoms such vaginal dryness, pain during sex, irritation, and itching as well as urinary symptoms, and a reduction in bone density.

Women who have not had menses for more than twelve consecutive months are menopausal, and those who are more than 45 years old and experiencing vasomotor symptoms with irregular menses are assumed to be in perimenopause (Baber et al. 2016; Harlow et al. 2012). Hot flashes and night sweats are characteristic of peri- and post-menopause. Most women (>75 percent) present these symptoms, which can persist, on average, for nine years. About half of this group of women suffer moderate to severe VMS (7 or more per day) (Freeman, Sammel, and Sanders 2014). The resulting fatigue and exhaustion can be a significant burden. Despite the potential impact of menopause on women’s professional lives, only in the last decade has this issue started to be addressed in the literature (Geukes et al. 2016).

Menopause hormone therapy (MHT) is recognized as the gold standard treatment for relieving women with menopausal symptoms. However, since initial publications from The Women Health Initiative (WHI) Study demonstrating an increase in adverse events in women using estrogen with or without a progestogen (Rossouw et al. 2002), a damaging impact on the prescriptions was observed quite immediately (Hing and Brett 2006) which lingers on. After WHI results were published, a wave of fear took over menopause care which made MHT prescription and use plummeted.

In a survey with gynecologists regarding the use of MHT after WHI, most respondents (53.3 percent) reported that their prescribing practices were unlikely to change; however, the others reported that they would have restrictions to prescribe MHT. Furthermore, they reported that their patients were less likely to request hormone therapy (91.8 percent) and were more likely to discontinue use (93.0 percent) (Power, Zinberg, and Schulkin 2006). Subsequently, limitations of the WHI study design and its interpretation in the context of other clinical studies have contributed to a more nuanced appreciation of the risk – benefit profile of differing MHT regimens regarding the risk associated with the class of progestogen prescribed, its pattern of prescription, duration of use and timing of initiation related to menopause onset (Stute et al. 2023).

As the population ages and longevity increases, while birth rates decline, people are required to work for more years to keep social security systems balanced and capable of paying pensions to all. For these reasons, women’s participation in the labor force has increased rapidly over the past two generations due to many females taking up paid labor and continuing to work full-time into their fifth, sixth, or even seventh decade (Reday-Mulvey 2005). It should also be considered that many women return to the job market in maturity if family commitments allow it or for financial reasons. Data from the United Kingdom (UK) shows that women over 50 comprise 45 percent of the workforce. Consequently, more women, typically aged between 45 and 55, will be professionally active when they reach menopause (https://committees.parliament.uk/work/1416/menopause-and-the-workplace/).

According to the Work Productivity Activity Impairment Scale (Reilly, Zbrozek, and Dukes 1993), it has been observed that women’s self-reported work ability is affected to a greater extent among those with more severe menopausal symptoms. Higher absenteeism rates and lower productivity, implying increased indirect costs for employers, were reported among women with severe menopausal symptoms. This group of women feels less motivated to do their best and is more prone to consider changing jobs, reducing their working hours, or leaving their jobs altogether (Whiteley et al. 2013).

Some studies have explored the effects of different types of menopausal symptoms. For instance, irritability and mood swings were found to have the worst impact on job performance in a study of older female employees, although less so among women acting as managers. After adjusting for demographic and lifestyle factors, another study found that vasomotor symptoms were associated with impaired work productivity (Whiteley et al. 2013).

A 2019 survey by the Chartered Institute for Personnel and Development (CIPD) (Whiteley et al. 2013) found that three out of five menopausal women – typically aged between 45 and 55 - have been negatively affected at work. The menopausal symptoms, the lack of awareness regarding menopause, and the impact of discrimination might have induced almost one million women in the UK to abandon their jobs for an indefinite period. As a result, women might leave companies “at the height of their careers,” directly impacting the overall productivity.” It can also contribute to gender pay and pension gaps (https://www.cipd.org/uk/about/press-releases/menopause-at-work/; Geukes et al. 2016).

It is worth noting that not all women who experience climacteric symptoms seek medical help. Therefore, this burden is likely to be underestimated when only evaluating women diagnosed with VMS in a health-care setting (Nappi et al. 2021). Although there are still gaps in the literature concerning the correlation between menopause and professional performance, there is strong evidence that treating menopause symptoms and a greater understanding of this topic might help women improve their quality of life and professional performance (https://www.cipd.org/uk/about/press-releases/menopause-at-work/; Geukes et al. 2016; Whiteley et al. 2013).

Unfortunately, this scenario has barely changed and women facing the menopause still have unmet needs and misconceptions concerning symptoms and options to relieve them such as MHT. Moreover, physicians are usually not properly prepared to discuss menopause management. To complicate matters further, there is a lack of awareness about menopause and related symptoms, specifically for those who employ these women.

The discussion about menopause and related symptoms should not be neglected. It is undeniable that MHT is a great option to tackle menopausal symptoms for those with bothersome symptoms that compromise their quality of life. Conversely, this period of life is an excellent opportunity to discuss this topic, not only at the workplace, improving the awareness of women concerning their rights, promoting knowledge in menopause and diseases more prevalent at this time, and encouraging them to reach out to a physician and, so, pass through this transition of their lives without additional stress among those women who need to deal with menopausal issues.

MHT ameliorates menopausal symptoms while preventing menopause-associated bone loss and cardiometabolic changes. Importantly, comprehensive care of postmenopausal women involves lifestyle optimization (attention to nutrition and physical activity, reducing alcohol consumption and not smoking) and treating other established chronic disease risk factors (Davis and Baber 2022). During the period of the menopause transition and early post-menopause, besides the improvement of VMS, data shows a beneficial effect of MHT use on cognition that was partially mediated by protection against diabetes risk, supporting MHT use in midlife as protective against late-life cognitive decline and adverse health outcomes (Williams et al. 2023).

Disclosure statement

Prof. Ana Valadares has received consulting and lecture fees from Libbs, Besins, Eurofafarma and Herbarium.

Prof. Marcio Rodrigues has received travel grants and lecture fees from Besins and Theramex.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.