Why is menopause a workplace issue?

In focusing on menopausal women in the labour market and specific workplaces, this edited volume aims to re-theorize the management of people as it relates to the connections between gender, age and the body in organizations. The ‘bodily turn’ in management and organization studies is now nearing the end of its fourth decade (see, for early examples of this research, Burrell, 1984; Hearn et al, 1989; Acker, 1990; Brewis and Grey, 1994), and work which critically unpicks diversity initiatives dates back at least to the early 2000s (for example, Kersten, 2000; Lorbiecki and Jack, 2000; Dick and Cassell, 2002). Despite this, the menopause is still rarely discussed in management and organization studies, the sociology of work and employment literature or HRM research.

Menopause transitions encompass perimenopause where symptoms begin, through menopause which marks the day when a woman’s periods have stopped for 12 months, to post-menopause thereafter, during which symptoms often continue. Symptoms can be both physical (for example, erratic periods, hot flushes, night sweats, insomnia and aches and pains) and psychological (for example, anxiety, irritability, loss of focus and forgetfulness). Research from the UK suggests that some 54 per cent of women will experience at least one severe symptom – that is, one that significantly affects their quality of life (Evandrou et al, 2021). That said, menopause is also unique to everyone that goes through it – as Karen Throsby and Celia Roberts establish in Chapter 2 in this volume, there is no such thing as THE menopause. One of the most common variations is premature menopause, defined as occurring before the age of 40, which is something 1 per cent of women experience. Menopause can also be precipitated by surgery – such as the removal of ovaries – or certain medications, like Tamoxifen which may be used to treat breast cancer.

Further, and importantly for our purposes here, menopause transitions have implications for work and are, in turn, affected by work. Indeed, and as we establish elsewhere (Atkinson et al, 2021a), this is a very important area for employers and academic researchers, given that:

• The global north workforce is ageing, and older women have been one of the fastest growing groups among this workforce.

• There are legal frameworks (for example, the UK Equality Act, 2010) which protect against discrimination including on the basis of sex and age: to date there have been five successful menopause-based employment tribunals in the UK.

• Women experiencing menopause transition may consider leaving work altogether and losing their experience and expertise is costly for employers (incurring direct and indirect costs of replacement), with some tacit knowledge lost for good.

• In order to be a good employer with decent employment relations, managers at all levels need to be aware of menopause issues, be able to discuss them, and provide appropriate support where necessary.

In this editorial introduction, we review progress to date in workplace practice and academic research in this area, and provide an overview of how the chapters in the volume speak to some of the existing gaps in our knowledge.

Before we continue, we should also note that ‘woman’, ‘women’, ‘she’, ‘her’, ‘female’ and so on are used in the main as placeholders in this chapter and throughout the volume. This is because anyone who has ovaries, including some transgender men and other gender-diverse people, will experience menopause – not just cis women. Karen Throsby and Celia Roberts make this argument very clearly and in more depth in the next chapter.

Where is workplace practice in this area now?

In the global north, and the UK especially, there has in fact been a huge groundswell of interest in issues related to menopause in the workplace since the late 2010s. As editors of this book, we have been acutely aware of this since our report for the Government Equalities Office was published (Brewis et al, 2017). This examined the effects of menopause transition on women’s economic participation in the UK and was based on a systematic evidence review of existing literature, specifically 104 English language publications dating from the beginning of January 1990 to the end of March 2016.

At the time the report was published, there was only a handful of organizations in the UK who took menopause seriously as a workplace issue. It was poorly understood in the context of both wider society and employment, even somewhat of a taboo due to what Jack et al (2014) refer to as gendered ageism. This is the intersection of sexist attitudes towards women and stereotyping of people in mid-life and older age. As such, the prevailing climate certainly reflected Jack et al’s argument that mid-life women at work were unsupported around menopause and felt side-lined, invisible, even unwelcome.

Looking back over the ensuing period of time, the situation today – in the UK at least – is significantly different. Very important work has been undertaken by consultancies like Henpicked: Menopause in the Workplace (nd) and their sister organization the Menopause Friendly Accreditation (nd) – both of whom we have been lucky enough to work with over the years. The same is true of awareness raising by women in the public eye including Davina McCall, Mariella Frostrup, Louise Minchin and Meg Mathews and, more recently, reports from the Women and Equalities Committee (WEC, 2022) and the All-Party Parliamentary Group on Menopause (APPGM, 2022), following championing by MPs including Carolyn Harris and Caroline Nokes. There are also prominent actors in this space who advocate a natural approach to managing menopause symptoms, particularly by following a specific diet and taking supplements, such as Dr Marilyn Glenville and Maryon Stewart.

Professional and advocacy organizations have been equally active in this space. These include:

• Advance HE (Brewis, 2020);

• the Advisory, Conciliation and Arbitration Service (2022);

• the British Medical Society, the Royal College of Gynaecologists, the Royal College of General Practitioners, the Faculty of Sexual and Reproductive Health, the Faculty of Occupational Medicine and the Faculty of Public Health (Hamoda et al, 2021);

• Business in the Community (2022);

• the Chartered Institute of Personnel and Development (2022);

• NHS Employers (2020);

• sectoral skill bodies (Standard Chartered and Financial Services Skills Commission, 2021);

• and a wide range of trade unions and union confederations (see, for example, GMB, nd; NASUWT, nd; UNISON, nd; Wales TUC Cymru, 2017).

The same is true of many mid-life women workers who have campaigned tirelessly for menopause to be placed on the agenda in their organizations; and their employers who have taken up the baton internally but in some cases also done outreach work across their sectors to spread the word. The Labour Party (2019) have, further, pledged to ensure that employers provide flexible working arrangements for women transitioning through menopause if it gains power – although of course this kind of set up won’t necessarily benefit those in jobs where only very limited forms of flexibility are available and/or women for whom reduced hours arrangements like part-time work are not easy to sustain economically.

UK society and UK workplaces are therefore now far more attuned to menopause as a mainly natural and normal phase of life for women. This is obvious when we consider that a survey we ran in summer 2018 in conjunction with TUC Education (n = 5,399) indicated that menopause guidelines or policies existed in only 10 per cent of organizations (Beck, Brewis and Davies 2020, 2021). Comparing this to recent data published by the Chartered Institute of Personnel and Development (2022, p 3), their estimate is that 30 per cent of UK employers now provide support of this kind – a tripling of the original numbers in just four years. As suggested previously, organizations across the private, public and third sectors have made enormous progress on this front, exemplified by case studies on the Henpicked: Menopause in the Workplace and The Menopause Friendly Accreditation websites. And, in September 2022, the first Menopause Friendly Employers Awards ceremony was held in London, with ten categories, and is now an annual event.

Where is academic knowledge in this area now?

Academic research has also moved on considerably since our government report was published. We now know more about some of the gaps we identified then. To begin with, there is additional research which evaluates workplace interventions around menopause. For example, Hardy et al (2018a) report the success of a self-help cognitive behaviour therapy manual used by working women struggling with hot flushes and night sweats. Those taking part reported reduced symptoms, less problematic symptoms, better sleep, less impact on work and an improved attitude to menopause per se. Similarly, Verburgh et al (2020) look at a work-life programme designed for mid-life women in low paid jobs in a Dutch hospital. Their findings show that this programme had a positive ameliorative effect on these women’s menopausal symptoms. Hardy, Griffiths and Hunter (2019a) also wrote a short online training package for managers around menopause. This was intended to be educational and attitude-changing as well as improving their confidence to support menopausal colleagues at work. It was extremely well received by those who trialled it.

There are, in addition, now studies which feature the voices of working menopausal women beyond those in professional and managerial occupations. One example is Verburgh et al’s (2020) Dutch research as cited earlier. Yoeli, Macnaughton and McLusky (2021) have published a metareview of women’s experiences in casual, informal or precarious jobs. Moreover, Riach and Jack’s (2021) survey across universities and healthcare organizations in Australia includes respondents holding administrative posts in higher education as well as nurses, healthcare assistants and those providing care in domestic settings.

Equally, more studies featuring data from the UK have been published since 2017, when they constituted just 19 per cent of the evidence base.¹ The increase here is actually marked and includes the Hardy et al (2018a, Hardy, Griffiths and Hunter, 2019a) papers indexed previously. Evandrou et al (2021) and Bryson et al (2022), which we discuss next, also fall into this category. The same is true of our aforementioned research discussing the results from the TUC Education survey (Beck et al, 2020, 2021). Atkinson et al (2021b) report data from their survey of female police officers, staff and volunteers; and Hardy, Griffiths and Hunter’s (2019b), Butler’s (2020) and Steffan’s (2021; Steffan and Potočnik, 2023) research was based on qualitative interviews with UK respondents. Bodza, Morrey and Hogan’s (2019) data also came from qualitative interviews with a small sample of UK counsellors. Hardy, Griffiths and Hunter (2017, Hardy et al, 2018b), on the other hand, rely on UK survey data to discuss what mid-life women workers want from their employers and managers around menopause; and its effects on their working lives.

Studies acknowledging that menopause transition at work can be positive are also more common now. Jack, Riach and Bariola (2019), for example, draw on interview data from university staff in Australia to conclude that some women felt they knew themselves and their bodies better as well as developing more creativity and resourcefulness due to menopause. In addition, they talked about not feeling the pressure to look sexually attractive or be subservient at work any longer, as well as sensing an obligation to discuss menopause at work to make life easier for younger women in future. Relatedly, Butler’s (2020) local government participants developed very strong collective bonds during their transitions, which they reported meant they were much better able to cope with any attendant challenges at work and elsewhere as a result. These women also talked about resisting the biomedical discourse of decline and failure around menopause, something which is discussed at length in Throsby and Roberts in this volume.

In addition, two studies speaking to the economic cost of menopause transition, along both the extensive margin which is associated with leaving work and the intensive margin which focuses on the costs connected with staying at work, are now available. Both draw on longitudinal data from the UK National Childhood Development Study (NCDS), and as such also contribute to filling another gap in the evidence base, which hitherto was dominated by cross-sectional research. In addition, these studies add to our knowledge around the relationship between continued employment and menopause. The first is Evandrou et al (2021) who use successive waves of the NCDS to find that women reporting problematic menopausal symptoms at age 50 were much more likely to have either left work altogether or to have reduced their hours by age 55 than those who did not. The second is Bryson et al (2022) who use a similar methodology to conclude that women who experience early menopause, i.e., before the age of 45², and/ or women who have psychological symptoms have lower employment rates as they enter their 50s than their counterparts.

We revisit the government’s response to the WEC report in the conclusion to this volume. As for academic research, the volume at hand will add to the still relatively small knowledge base in this space as we explain next.

Outline of this volume

The next chapter in this volume is titled ‘Bodies of Change: Menopause as Biopsychosocial Process’ by Karen Throsby and Celia Roberts. In a discussion which sets the theoretical and conceptual tone for the whole book, Karen and Celia begin with the observation that it is only humans and two species of whale who go through menopause and that they are also the only living beings who survive beyond their reproductive years. Unlike killer whales in particular, who are vital to their pod’s survival after menopause, the same phenomenon in humans is still understood in the prevailing biomedical discourse as a period of decline, failure, loss and ending. As Karen and Celia point out, this construction limits not just the questions we can ask about menopause but also the ways we answer those questions. They argue that menopause in human beings who are assigned female at birth has been pathologized since the 1950s. Instead, they suggest, we need to understand it through a biopsychosocial³ lens and specifically as a transition. Menopause is, as they point out, not a catastrophic ending or solely biological but an experience that is significantly inflected by an individual’s social context and their psyche.

Looking at menopause this way, Karen and Celia aver, also allows us to move beyond the biomedical insistence that women are woefully uneducated about it, necessitating concerted awareness raising, pharmaceutical interventions (that is, hormone replacement therapy) and lifestyle changes. They suggest this lack of education is actually an unlikely scenario which overlooks the hormonal and technological interventions we are all used to in what they call the age of biological control and its imperatives to live as healthy a life as possible, especially aimed at those assigned female at birth. Karen and Celia go on to suggest that we need to consider whose bodies count in the prevailing discourse and ensuing policy and practice around menopause, and that the bodies of those who are LGBTQI+, have disabilities, experience premature menopause and/ or are childless (whether by choice or not) are largely if not entirely absent.

Next comes ‘Exploring menopause transition in the workplace’ by Carol Atkinson, Jo Duberley and Catrina Page. This chapter is one of two that focus specifically on organizational practice, workplace interventions and possibilities for further provisions in this area, here with a particular focus on evaluating (potential) employer interventions. It is based on UK survey data gathered from a range of sectors, thus further addressing aspects of the aforementioned dearth of knowledge about the UK context. Moreover, with over 5,000 responses and a combination of closed and open-ended questions, these data provide a methodological breadth which has not been common so far. The data also extend the evaluation of menopausal interventions to considerations of what works for respondents, as well as foregrounding others’ responses to colleagues experiencing menopause in the workplace, another area which was largely invisible in the publications we reviewed for our 2017 government report.

The chapter draws on a psychological contract framework and considers (and updates) our knowledge on the experience of menopause at work as it relates to the impact it has on working, as well as the compensations that are undertaken by those experiencing it to ‘overcome difficulties’ (Atkinson, Duberley and Page, this volume, Chapter 3). This is linked to disclosure; embarrassment; the fear of discrimination and workplace incivility; attempts to normalize the conversation around menopause; the role of line managers in these processes; and, overall, to help and support those in transition at work. The psychological contract lens allows Carol, Jo and Catrina to pull these issues together to consider the overall implications for the employment relationship. Cross-tabulating organizational and line managers’ support with women’s willingness to disclose highlights the shared responsibility to create workplaces in which meaningful help and support around menopause can be provided.

This leads Carol, Jo and Catrina to conclude with the call that ‘substantial cultural change is needed to normalize the conversation around menopause’ (Chapter 3). Their work shows how central such menopause support is for anything from organizational commitment, via job satisfaction, turnover intentions, organizational citizenship behaviour, and in-role performance, all the way to well-being. The breadth of this list reinforces the final challenge voiced in this chapter: that organizations ignore this at their peril.

Then we move to Jane Parry’s chapter ‘Workplace Policies, Menopause and Flexible Working: The Need for a More Collective Approach’. Jane’s chapter considers the poor fit between workplace policy, and in particular flexible working, and menopausal experiences. It is also based on UK data and again draws on considerations based on the psychological contract as well as evaluating organizational interventions around menopause. However, and importantly, Jane’s chapter clarifies that this is about psychological contract fulfilment rather than breach, given that there are still relatively few workplaces with well-established menopause provisions. Alongside the previous chapter by Carol, Jo and Catrina, which is based on similar conceptions, a theme emerges here that demonstrates the personal side of the two-way relationship between menopause and work: just as menopause symptoms affect work and work affects symptoms, so do individuals within workplaces interact. Without a supportive network of colleagues and understanding line managers, menopause in the workplace can become a serious issue that may, ultimately, lead to the withdrawal of experienced women from the workplace. However, Jane’s chapter is testament to how preventable such an outcome is.

Importantly, this highlights how existing approaches to providing menopause support may exclude the individuals who may feel most vulnerable as a result of their experiences and therefore feel unable to discuss their situation with their line manager. At the same time, Jane makes suggestions around a more clearly defined psychological contract that would help to address these issues and create a supportive employment context around changing working needs related to menopause transitions.

Vanessa’s chapter ‘Menopause and Trade Unions’ is our sixth chapter. Again it is based on UK data gathered as part of our TUC Education survey and elsewhere and draws out findings from these data as they relate directly to trade union activities and trade union members as well as evaluating workplace interventions. Trade unions themselves assert that menopause in the workplace is a trade union issue, which they are increasingly willing to tackle as we have suggested earlier in this chapter. Taking a union lens to consider menopause issues in workplaces also has the advantage that a broad range of sectoral and occupational contexts can be investigated. Our data provide insights into, for example, public services (UNISON), construction and manufacturing (Unite), engineering and managers (Prospect), nurses (Royal College of Nursing), retail (GMB) and education (University and College Union). Vanessa compares our TUC Education survey data with four other data sets: a survey taking place after menopause awareness workshops for union representatives that we ran as part of the TUC Education project; qualitative data from interviews with representatives who attended the workshops; and data from two surveys sent to staff in a local council. These data taken together show that raising awareness among trade unionists leads to an increase in conversations about menopause, and that a more diverse group of individuals, including cis men, are participating in these conversations.

The chapter also draws two broader conclusions about the role of menopause in trade union work. The first is that the engagement that trade union representatives stimulate and encourage around menopause shows the relevance and importance of the trade union movement to diverse workforces. Following periods of at times volatile and turbulent union membership, this means that such engagement with the still partially taboo subject of menopause can be utilized as part of a trade union renewal strategy. Second, and relatedly, Vanessa argues that addressing the needs of individuals experiencing menopause transition at work can lead to improvements in employment and working conditions overall. Many of the workplace adjustments recommended to address menopause transitions, such as availability of drinking water, control over temperature regulation, addressing working times and the intensity of work at certain times, would benefit most members of staff. Vanessa thus concludes that

[t]he two arguments are co-dependent in that increasing social awareness of menopause and of trade union activity in this field would make for greater union leverage to ensure broader workplace change. In addition, both sit within a broader understanding of employment relations and collegiality which benefits from solidarity among and between workforces. (Beck, this volume, Chapter 5)

This is followed by Jo’s chapter ‘Spatial (In)Justice and Hot Flushes in the Workplace: Some Musings and Provocations’. This is also based on data gathered in the UK and as such contributes to the aforementioned gap in the knowledge base. In addition, it draws on accounts from women in a wide range of occupations, many of which are not professional or managerial. Here Jo draws on our TUC Education survey data as well as data she gathered via surveys and semi-structured interviews at Northshire, a pseudonymous NHS hospital trust. She develops an argument around shared space at work and the common menopausal symptom of hot flushes. Open plan offices and other communal work areas are often, as Jo points out, ‘beset with tensions around temperature and ventilation as a result’ (Brewis, this volume, Chapter 6) of these symptoms. Many women are not as fortunate as journalist and television presenter Louise Minchin, who was able to negotiate with her BBC colleagues to have the thermostat in the studio where she presented the flagship breakfast programme turned down when she was working so it stayed ‘super cool’ (cited in Brewis, this volume, Chapter 6). We also know that high temperatures and poor ventilation can make the experience of hot flushes at work more unpleasant; and extant data suggest they are one of the main symptoms which make work more challenging.

With this context in place, Jo moves to analyse the survey and interview data through a lens provided by Philippopoulos-Mihalopoulos’ concept of spatial justice and Watson’s application of this concept to the Muslim practice of wudu, ‘the ritual washing of head, neck, hands, arms and feet before prayer’ (Brewis, this volume, Chapter 6), in public places. Philippopoulos-Mihalopoulos begins from the premise that human beings very frequently share the same physical space and thus that spatial justice is rooted in ‘the conflict between bodies that are moved by a desire to occupy the same space at the same time … the emergence of a negotiation between bodies’ (2015, p 3). Arguments between workers experiencing hot flushes and those who don’t over how high a thermostat should be set, whether desktop fans are permissible in an open plan office and whether windows and doors should be open or closed speak to precisely this conflict. Some of this is regulated by organizational policies and regulations, like the requirement that all portable electrical appliances in use at work (such as fans) are regularly tested. But, as Philippopoulos-Mihalopoulos points out, these regulations are enacted, or resisted, by bodies in what he calls the lawscape. Moreover, negotiations about spatial justice are not just verbal but also corporeal, like shutting a window or turning a thermostat up in the case of the workplace. And, as Watson’s analysis emphasizes, spatial justice ‘is not an interaction between or negotiation of equals’ (Brewis, this volume, Chapter 6). This is also illustrated in the data Jo deploys, for example in scenarios where managers refuse requests from staff for environmental adjustments like fans.

Jo’s analysis moves somewhat beyond Philippopoulos-Mihalopoulos in presenting arguments around how lawscapes can be over-interpreted by those in authority especially so as to impose regulations in ways not intended by the authors of said regulations, and the way in which custom and practice at work can settle into patterns of inequality. She concludes by emphasizing Philippopoulos-Mihalopoulos’ point that our ‘shared world’ has ‘physical limits’, pointing to the ‘broader implications of [the concept of spatial justice] for menopause as an organizational issue and employment relations more generally’ (Brewis, this volume, Chapter 6).

Hannah, Gavin and Kathleen’s findings suggest, on the positive side, that their young male respondents were very aware that menopause is not simply a biological phenomenon – per Karen and Celia’s emphasis on the biopsychocultural model as outlined in Chapter 2. These young men also accepted that it was their responsibility to become more educated about menopause at work in particular. On the more contentious side, the respondents also identified tensions in advocating for people based on an experience they themselves could only ever approximate. They also found the question of who should be doing the necessary education a tricky one as well as suggesting that ‘how, and where, to publicly acknowledge and engage with menopause as an issue of workplace inequality’ was a difficult issue (Bardett, Riach and Jack, this volume, Chapter 7).

Finally, our editorial conclusion summarizes the volume’s key messages and establishes a clear research agenda to follow going forward around menopause in the workplace.

Before we move on to Karen and Celia’s chapter, we would like to sincerely thank all of our contributors for their patience and understanding with us while we worked to put this volume together, with the COVID-19 pandemic as a backdrop during most of this process. They have made a challenging process as enjoyable and straightforward as it could have been! We also very much hope that readers find the book interesting and thought-provoking and that it encourages you to undertake – or progress – your own research and/ or practice in this important area.