Menopause is a normal, natural event that all women experience. It’s defined as the end of fertility and ovarian function due to a decrease in estrogen and progesterone hormones. Menopause is confirmed when a woman hasn’t had a period for 12 consecutive months, and in North America the average age of menopause is 52 years.
The time leading up to menopause is called perimenopause; it results from changes in the levels of ovarian hormones, and it may start in late 30s or early 40s and last several years. During peak reproductive years the levels of estrogen rise and fall fairly predictably throughout the menstrual cycle. But during perimenopause, estrogen levels fluctuate unpredictably, sometimes declining, other times rising even higher than in younger years. During perimenopause women may still ovulate and get pregnant, so it is important to use contraception until one year after the last menstrual period if pregnancy is to be avoided.
Premature menopause describes menopause that occurs before age 40. It can be spontaneous or it may be induced menopause, caused by medical treatments like chemotherapy or radiation, or procedures that damage or remove the ovaries. Women who experience induced menopause are usually younger and often have more severe symptoms than women who have natural menopause.
Post-menopause is the time after menopause when the ovaries have stopped producing eggs, estrogen is very low, and the risk for diseases associated with low estrogen, such as osteoporosis and heart disease, increase.
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All women will go through menopause, but each experiences menopause in a unique way.
Estrogen, the dominant hormone in women, works by binding to receptors—like a key in a lock—located in several tissues and organs of the human body, like the uterus, ovaries, breast, vagina and vulva, musculature of the pelvic floor, urethra, bladder, bone, brain, heart, and liver. During the menopause transition, from the reproductive years to postmenopause, women experience many physical changes.
Most people know that hot flashes and night sweats are common with menopause, but women may have experiences that they may not recognize as related to the hormonal changes of perimenopause and menopause, such as:
• Irregular menstrual periods, heavier or lighter, shorter or longer, absent, spotting;
• Urinary incontinence, such as peeing when coughing or laughing, urinary urgency, like having to go right way, frequent bladder infections, known as urinary tract infections (UTIs);
• Vaginal dryness and itching, pain with sex, bleeding during intercourse;
• Low sex drive;
• Weight gain, especially around the middle;
• Dry and itchy skin;
• Fatigue, lack of energy;
• Headaches, muscle and joint pain;
• Anxiety, heart palpitations;
• Mood swings, sadness, irritability, anger, low self-esteem, feeling “blue” and even depression;
• Sleep disturbances, such as difficulty falling or staying asleep, frequent awakenings, insomnia;
• Difficulty concentrating (“brain fog”) and memory problems.
Menopause is not a disease, and some women breeze right through it, but bothersome menopause symptoms affects women experiencing it—and their partners, children, family, friends, and colleagues. It not only affects quality of life, but women also report that hot flashes, night sweats, sleep disturbances, difficulty concentrating, forgetfulness, heavy periods, headaches, joint pain, fatigue and lack of energy, anxiety, and irritability also affect their working lives.
According to Statistics Canada there are over 3 million women between the ages of 45 and 64 who are employed. That’s more than the combined populations of Nova Scotia, New Brunswick, PEI, and Manitoba. About 80% of women in this age group report being affected to some degree by the physical, psychological, and emotional changes of the menopause transition.
Most women are unprepared, uninformed, and even misinformed, about menopause and many have difficulty recognizing certain experiences (e.g. joint and muscle ache, mood swings, forgetfulness, poor concentration, feeling low/depressed, lowered confidence) as related to hormonal change. They blame symptoms on other diseases like stress, dementia, and mental health, which may be frightening to them, and when misdiagnosed may be treated inappropriately.
Interested in learning more about sexual health after menopause? Dr. Brown provides advice.
MENOPAUSE AND THE WORKPLACE
It is hard to quantify the impact of menopause in the workplace because most women don’t realize that what they’re experiencing is due to hormonal changes, and the ones who do aren’t comfortable discussing their difficulties and the true reason of their sick leave because of lack of support and misunderstanding of their health needs during menopause.
A 2013 study from the UK found that women with menopause symptoms had an annual health spending 40.7% higher, took 21.3% more sick days, and had 10.9% lower productivity at work than women without symptoms. It was estimated that for women with symptoms the estimated annual cost of extra health care was $2,042.
A 2015 study in the USA followed women with untreated vasomotor symptoms (VMS)—hot flashes and night sweats— for 12 months and concluded that the direct annual costs per woman were higher and these women had 57% “more indirect work productivity loss days than controls, corresponding to an incremental cost per patient per year associated with untreated VMS of US$770”. And besides absenteeism, untreated menopause also causes presenteeism—being at work but, due to illness, underperforming.
The more frequent and bothersome symptoms are, the less engaged and less satisfied women are with their jobs, the lower their commitment to the organization, and the higher the intention to quit. Even though the symptoms of menopause last only a few years, women severely affected may quit their jobs at the peak of their careers with a significant personal and economic burden to them and to their employer, since replacing an employee with many years of accumulated knowledge and experience is costly in many ways.
Sometimes work conditions and organizational factors—e.g. stress, crowding, poorly-ventilated places, lack of access to appropriate toilet facilities, and formal meetings—can contribute to a worsening of menopause symptoms at work. Women should have the highest possible quality of working life, and be able to work for as long as they choose, and not be held back by menopause-related challenges. Mid-life women do not need formal management and special considerations but although we shouldn’t problematize a natural event like menopause, it should be treated as an occupational health issue, like pregnancy, for example. The availability of education, information, support, and treatment improves the quality of life and enables mid-life women to maintain their important role in the workforce.
EMPLOYERS CAN HELP – HERE’S HOW
Because of the wide variation in women’s experiences, a “one-size-fits-all” approach to menopause in the workplace will not be effective. Organizations with a strong sense of corporate social responsibility can provide employees with education, information, and support by:
• Raising awareness of the potential impact of menopause in the workplace;
• Providing education about menopause, e.g. Lunch & Learns and Wellness Days focused on menopause;
• Providing written and online educational materials about menopause, easily accessible by workers and managers;
• Informing women of available resources, e.g. menopause specialists, psychotherapists, dietitians, physiotherapists and personal trainers who can help them through the menopause transition;
• Implementing inexpensive adjustments to physical working environments, e.g. temperature adjustments and proper ventilation, desk fans, cold drinking water and ice, clean, well-equipped and easily-accessible bathrooms, access to female-only showers, quiet work places and rest areas, and wellness rooms;
• Allowing work from home or flexibility of working hours (women who experience night sweats and difficulty sleeping may be less productive in the morning or they may want to leave early, perhaps to resume working later in the day or evening);
• Restructuring work, e.g. teleconferences instead of formal meetings and high-visibility work, since hot flashes and sweats can make women feel self-conscious and embarrassed in public;
• Flexibility within the uniform dress code (uniforms made of natural fibers are more comfortable for women with sweats, layers allow women with hot flashes to take something off and still look professional);
• Job sharing (some women may be more productive and perform better with a decreased hour workload);
• Making menopause part of a wider health and well-being agenda;
• Generating a positive cultural environment for menopausal women at work.
Most women aren’t comfortable discussing menopause particularly if their supervisor is male or younger. It is important for women in the workforce to find understanding, sympathetic, and appropriate support from their managers and colleagues. Employers can help by communicating to their workforce that health-related issues such as menopause are normal and that it is important to listen to women.
NEXT STEPS FOR WOMEN AND MENOPAUSE
Women shouldn’t regard menopause as something to be embarrassed about, ashamed of, a taboo. Women should not suffer in silence believing that they are the only one and there’s no relief. It is crucial for women to be assured that menopause is not “all in their heads”, that they are not alone—millions of women all over the world are going through menopause and have similar symptoms, worries, and complaints. Women need evidence-based information and education to understand what their bodies are going through during the menopause transition and where to find treatment and support.
Societal attitudes towards aging are usually negative but menopause can be a positive time in women’s lives, associated with personal reflection, independence, self-renewal, a sense of inner connectedness to the world, self-esteem, and looking forward to the third stage of life. Menopause is a great time for women to continue or start healthier lifestyles to prevent aging diseases worsened by decreased estrogen, such as cardiovascular disease, osteoporosis and bone fractures, and dementia.
Menopause is not a disease but it affects women experiencing it—and their partners, children, family, friends, and colleagues. The potential impact of this important life event should be taken more seriously, and talked about more openly. Women should be aware of the physical changes of menopause and know where to get education, information, treatment, and support, when they need it. Employers can ensure that menopause is highlighted in wider occupational health awareness campaigns. Inexpensive measures—such as adjustments to women’s physical working environment, providing information and support, and raising awareness about menopause with workers and managers—generate a positive cultural environment for menopausal women and those working with them. When employers are sympathetic it is good for the bottom line and women are supported through the change—a win-win situation. Women have to be educators to change the workplace — let’s talk about menopause.
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About the author
Teresa is a community and drug information pharmacist with over 20 years of experience. She became a Certified Menopause Practitioner (NCMP) with the North American Menopause Society (NAMS) because she noticed women lack knowledge about the menopause transition. Her mission is to raise awareness, provide education, and empower women to make healthy decisions to improve their quality of life during the menopause and beyond. Teresa provides online and in-person one-on-one consultations, Lunch & Learn presentations, and workshops.