View both parts of this article below or read the first part in DDN December 2021 and part two in DDN February 2022.
In the first of a two-part article looking at the impact of menopause on colleagues and service users, Helen O’Connor talks about the importance of creating menopause-inclusive workplaces.
Women make up 51 per cent of the UK workforce, with women over the age of 50 being the fastest growing segment. This is also the age at which women will commonly experience menopause transition as oestrogen levels decline, although it can also happen for younger women, transgender, and non-binary people too and the perimenopause and symptoms can begin some years before.
Some women experience the impact of oestrogen diminishment during their menopause as a ‘cliff edge’ that significantly affects their physical and mental health. About eight in ten women will experience noticeable menopause symptoms, of which 45 per cent will find their symptoms hard to deal with, both in and out of the workplace. It can also affect their relationships and may occur alongside other challenging life events, such as an ‘empty nest’, divorce, or caring for elderly relatives.
These problems can be exacerbated by a lack of understanding about the menopause and how to support people who are experiencing a difficult menopause transition at work, or when it is treated as something embarrassing, taboo, or a joke.
Results of several different surveys indicate that this has a direct impact on work life and retention of colleagues:
- 10 per cent have considered leaving work because of the menopause
- 55 per cent said the menopause impacted negatively on their work life and productivity
- 59 per cent took time off due to menopause symptoms
- 60 per cent said their workplace offered no menopause support
Issues can include conflict and tension between colleagues about room temperatures; difficulties attending meetings or running groups and keyworking sessions in confined spaces that exacerbate hot flushes; high sickness absences and the stress of meetings to discuss them; emotional problems at work including anxiety, and changes in performance because of lack of sleep and a loss of focus. Add to this the frustration that can come from trying to get help and appropriate treatment from a GP and how it might also be affecting one’s personal life, and this can be an incredibly difficult life event to navigate.
Seeing an opportunity to enhance our workforce health and safety policies to directly address the menopause, I volunteered to lead on shaping WDP’s menopause policy and toolkit. Our people and culture team were really enthusiastic and encouraging of this direction and of my involvement, and I value being part of a responsive and supportive organisation that welcomes organisation-wide initiatives and ownership of them to originate from those working within services.
After consulting other organisations’ policies and guidelines, and menopause advocates and experts, I drafted our (Peri)menopause at work policy, which was put out for a staff consultation that was open to everyone at WDP. We launched the policy internally on World Menopause Awareness Day 2021 and situated it within our new pay and reward structure, outlined by our CEO Anna Whitton in a previous issue of DDN (November, page 20).
When we put our (Peri)menopause policy out for staff consultation, a colleague within our team at WDP Merton commented: ‘I’m currently in the process of managing my own menstrual/hormonal related issues and their impacts and it feels very reassuring to be in an environment that is progressive in its ways of approaching these topics.’
This policy and the associated toolkit of information and resources, together with briefings and training that will be rolled out over the next few months, are intended to help everyone understand and appropriately support people who are experiencing difficulties with menopause symptoms.
Of course, it’s not up to us to ‘diagnose’ colleagues who may be experiencing menopause transition symptoms, and whether someone wishes to discuss them is up to them. But we do want to help managers and other colleagues to be able to support their team members who are experiencing difficulties at work, by increasing their knowledge of menopause and how to hold positive supportive conversations about it.
A quote from Kellogg’s, who recently announced how they would be providing more support to staff experiencing the menopause, expresses what we are trying to achieve: ‘We want to create a culture where people feel psychologically safe, so we’ll encourage colleagues to be allies to others impacted by these issues.’
The second part of this article will look at how we can improve our understanding of the possible impact of the menopause on our service users and how it can affect their recovery.
Emotional support
In the second of a two-part article, Helen O’Connor talks about the importance of understanding the potential impact of the menopause on service users and how it can affect their recovery.
‘It really reminded me of when I was using, and I really hated it…’ This quote is from a 2020 TV interview with Davina McCall, who has been open about her history of addiction and has more recently put menopause in the public eye by sharing her experience of the symptoms associated with her own menopause.
As we consider the impact of menopause on our colleagues, we can also improve our understanding of the possible impact of the menopause on our service users. According to the Office for Health Improvement and Disparities (OHID), across our sector 32 per cent of service users are women, and at WDP the largest segment of our women service users is the 35-54 age group, the period where someone is most likely to go through the menopause. How they experience the menopause and how they are supported during it could affect their recovery and mental health.
Perimenopausal women are twice as likely to have depressive symptoms or depression than premenopausal women and suicide rates in women of menopausal age have increased by 6 per cent in the last 20 years despite rates for older women (55+) falling by 28 per cent across the same period. A difficult menopause can affect relationships and often occurs alongside other difficult life events or transitions such as an ‘empty nest’, divorce, or being a carer for elderly relatives.
If a person’s GP does not identify the symptoms they are describing (depression, anxiety, sleep issues, ‘brain fog’) as being related to the perimenopause, or offer appropriate treatment, that can also be confusing, frustrating, and upsetting.
All of this indicates that the menopause is another factor to consider when assessing risk and developing care plans. This could include looking at how symptoms of the menopause, combined with active substance misuse, might lead to an increase in use as a way of managing moods, increase the risk of suicide or self-harm for some service users, or how menopause symptoms and concurrent life events might introduce an increased risk of relapse for service users who are abstinent.
Hannah Lidsell, an experienced coach and addiction specialist, also feels passionately about these issues. ‘Using substances to try and manage debilitating menopausal symptoms, such as anxiety, heart palpitations and hot flushes, can actually exacerbate them,’ she says. ‘Once you throw in health inequalities, stigma, and unequal access to services, you have the perfect storm for increased use/lapse/relapse.’
In Merton, our service users can access a specialist menopause service. Esha Saha, consultant gynaecologist and lead for this service at St George’s NHS Trust, believes that ‘asking for help or taking HRT (hormone replacement therapy) whilst undergoing the menopause transition should not be considered as a last resort’. She recommends that women are encouraged to use tools such as the Menopause Quality of Life Scale (MENQOL) to prepare for a discussion with their GP about how their symptoms are affecting their quality of life. It allows them to both validate and score the severity of their symptoms which should be the springboard for a discussion with their GP about the best way to manage their menopause transition. If clinicians, keyworkers, and other professionals are more informed and confident about discussing the relationship between drug and alcohol use and menopause, they can educate service users and signpost them to this tool and other support available.
Fortunately, more information and resources that can improve our understanding of, and empathy for, how symptoms of the menopause transition might affect the individuals we work with are available than ever before. WDP has created a handout of these resources and is combining them with staff lunch and learn sessions to increase confidence about having discussions with service users. The Menopause Charity also offers training for healthcare professionals, some of which is free of charge.
Considering the impact and effects of the menopause should sit within a person-centred and holistic view of the individual. Experiences of menopause can vary – some will have a difficult time with life-changing symptoms whilst others report menopause as being a time of personal growth, or simply a relief and freedom from painful periods.
As we commit to engaging more women into treatment at any age, WDP welcomes the creation of the cross-party Menopause Taskforce, alongside the development of the first ever Women’s Health Strategy for England, given our role in supporting people to improve their physical and mental wellbeing, through achieving recovery from problematic substance use.
Helen O’Connor is service manager at WDP Merton