By Dr Nuttan Tanna, Pharmacist Consultant, Women’s Health & Osteoporosis/Bone Health, London North West University Healthcare NHS Trust and RPS representative on the Clinical Reference Group of the NHSE Menopause Program
Menopause is in the spotlight at the moment, and about time too. There are some 3.5 million women over the age of 50 in the workplace in the UK, and women make up 77 percent of the 13 million people of the NHS workforce. With the extension of the retirement age in the UK, many women are still working whilst going through the menopause.
Typical symptoms of menopause
The average age of menopause is 51 years. However, the climacteric phase accompanied by declining hormone levels can occur any time between 45 to 55 years of age. Medically, the climacteric is considered the period of life when fertility and sexual activity are in decline. As many as 3 out of 4 women will struggle with menopausal symptoms due to fluctuating hormone levels. These include cognitive, physical, and psychological symptoms with women commonly presenting with hot flushes, muscular aches, poor concentration, night sweats and problems with sleep, anxiety and headaches, and an erratic period pattern. A woman is classified as being postmenopausal if she has been naturally bleed-free for a year.
Impact in the workplace
Studies have shown that menopause symptoms can have a significant impact on attendance and performance in the workplace. The Chartered Institute of Personnel and Development has useful resources on menopause for Human Resources teams to support colleagues wherever they work.
The updated ACAS menopause in the workplace guidance includes tips for workers on how to raise concerns and good practice guidance for employers to help manage menopause at work and includes a section on the menopause and the law.
Equality in the workplace
The Equality Act 2010 protects workers against discrimination and the Health and Safety at Work Act 1974 says an employer must, where reasonably practical, ensure everyone’s health, safety and welfare at work. Although the menopause is not a specific protected characteristic under the Equality Act 2010, if an employee or worker is put at a disadvantage and treated less favourably because of their menopause symptoms, this could be discrimination if it is considered that it is related to a protected characteristic such as age, disability and sex.
Covid pressures can impact symptoms
The COVID-19 pandemic has also placed inevitable pressure on all NHS personnel. Line managers need to consider the additional struggles some people may face, including the wearing of personal protective equipment (PPE) and menopausal symptoms. The physical environment can impact on people who are menopausal, and wearing PPE is now an everyday requirement for those working in NHS settings. Wearing additional layers, such as PPE, can exacerbate menopause symptoms such as hot flushes and stress. There is a signal from emerging evidence that low oestrogen levels could be associated with an individual having long COVID, and organisations are being advised to be aware on how to support recovery after long COVID.
In England, where I live, the NHS is currently championing a menopause program with a view to mapping the menopause patient pathway. This group will also be developing workforce support programs to include educational initiatives to help raise awareness amongst management. With the mapping exercise, there will inevitably be some discussion on the training needs of primary care teams, and this will include pharmacists who can help optimise menopause management and care delivery and prescribing. The NHS is also working with the Department of Health to address supply problems and HRT prescription costs.
The NHS Employers website has collated information and practical guidance on how employers can improve workplace environments for women. There are also some case studies of what NHS Trusts are doing to support the workforce. The East Midlands Ambulance Service NHS Trust provides examples of menopause guidance as well as interestingly andropause guidance for employees and line managers with the expectation that reasonable adjustments can be made in the workplace to support staff. The term andropause or male menopause recognises a collection of symptoms including fatigue and decrease in libido experienced by some older men which is caused by declining testosterone levels.
Menopause and support for the workforce is definitely in the spotlight!
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