Written evidence submitted by Professor Katherine Sang, Edinburgh Business School, Heriot Watt University [MEW0002]

Background and research design: There is very little extant research on menopause, menstruation and gynaecological health conditions at work. Most of this is quantitative and does not take into account the lived experience. Further trans and non-binary people are omitted from the limited extant work. The existing research is largely focussed on developing economies.

We therefore addressed this gap with qualitative work with two research projects.  Our research aimed to understand how women, trans men and non-binary people navigate employment while living with the menopause, as well as gynaecological health conditions. This research was inspired by our work on disability at work (www.disc.hw.ac.uk)  which revealed gynaecological health conditions (such as endometriosis) as a potential barrier to remaining in a scientific career.

In 2017 an electronic survey was distributed via social media (convenience sampling) exploring the experiences of menstruation and menopause in scientific careers, noting the difficulties many women report in accessing a science career. The survey elicited 627 responses across a range of academic disciplines. The data revealed a range of concerns by participants. It is important to note that we also surveyed trans men and non-binary people. Follow up interviews were conducted in 2019 (n=23), again with those pursuing a scientific or research career.

In addition to experiencing menopause, respondents also reported conditions covered include endometriosis, PCOS, interstitial cystitis, infertility, abnormal uterine bleeding, lichens scleroses, vaginismus, continence, PMDD.

Below we summarise the key findings of the data will illustrative quotes from the interviews and survey

Findings Our data shows the following concerns at work

1. Difficulty attending work during heavy menstrual flow/high pain days – although this would not be recorded as gynaecological health. Rather participants reported they would declare other reasons for absence.

For women (and trans/non-binary people)with underlying conditions, the menopause can exacerbate the effects of these conditions and a number of participants reported being unable to work full time (with serious financial and career consequences). While unpredictable menstruation was an issue (see below) there were also continence problems and mental health conditions associated with menopause and made employment difficult.

Many women reported that their GPs were poorly informed about menopause and frequently denied women’s own narratives of their health and dismissed concerns about menopause. This will then be associated with problems accessing medication and other treatments but also would have knock-on effects on accessing support to remain in work.

2. Menopause and perimenopause were associated with unpredictable periods, psychological distress, migraines and fatigue which employees reported were difficult to manage at work

‘when periods become really heavy towards sort of approaching menopause, that kind of, it became a bit unpredictable’

‘That's not an issue, it’s just the tiredness really I suppose, so I, it's difficult to say.   I've got through all the teaching, so it’s been fine, but it's just that feeling of more increased anxiety overnight, unnecessarily kind of thing … While teaching’

While access to hormone replacement therapy can help to manage effects and symptoms of menopause, not all respondents were happy with HRT. One participant reported that anti-depressants helped managing the distress and this was helpful at work:

‘It [antidepressant] just absolutely helped massively because it just meant like, like I slept much better and it did actually elevate my mood.  I wasn't feeling that I had a low mood, but it did elevate my mood which made, sort of made me aware of the fact that I was possibly a little bit more affected by that than I thought I had been.’

Women who experienced a cliff-edge menopause for example due to cancer treatment reported considerable difficulties as they were not allowed to take up HRT

3. Shame, embarrassment and stigma at work – specifically that they were ashamed of menstruation, and worried colleagues and students may detect blood or odour. Those experiencing menopause reported that hot flashes, sweating, blood and bathroom visits were incompatible with maintaining professional authority at work.

One participant’s story illustrated this stigma, as she had experienced brain fog associated with cliff-edge menopause and as a result was removed from her senior management position:

‘I think it’s, certainly since menopause, it’s knocked my confidence. Because like l say when you get brain fog and stuff. My confidence had completely gone and I would say my self-esteem and I could be talking about, so I’ll give an example. I was participation champion for our department, and I was talking about statistics and in my brain it just really went really muddy and foggy and I just got it all back to front and stuff, and I couldn’t get myself out of it even though I knew I was wrong. I should have just said ‘look, I’m really sorry, I’m just having a bit of a brain fog moment.’ But when you’re with your senior management that’s not so easy so I kind of muddle my way through it. And anyway the role’s now been taken off me.’

Rather than being given support, the employer decided to remove the position which will have detrimental effects on the respondent’s future career and earning potential.

4. Trans men and non-binary participants reported that they experienced increased gender dysphoria at work when managing heavy menstrual bleeding
5. Lack of access to bathrooms at work, including bathrooms with menstrual product disposal bins caused embarrassment
6. Participants reported requiring simple adjustments such as a fan, open windows, breaks to attend to menstrual needs, access to flexible working, kettles for hot water bottles but these were often not available. These adjustments are not costly and could significantly improve women’s experiences at work while they progress through menopause
7. Participants reported lack of sympathy and understanding from line managers regarding menopause and a lack of access to specific menopause policies. Respondents were strongly in support of menopause policies and raising awareness and understanding among employees, employers and line managers of the menopause, its processes and how it may affect people at work.

Generally survey respondents had not disclosed menopause to their employer due to shame and embarrassment. Participants reported that they felt menopause trigged discrimination which is the result of ageism and sexism and they would be laughed at or ridiculed at work when their menopause become known

‘You can also feel undermined because of ageist attitudes amongst colleagues, - in particular younger members of staff, and your male colleagues of similar age, but less so from female colleagues of similar age’

Recommendations

Our data shows the need for:

1. Improved access to facilities such as toilets at work and that  staff are allowed to access bathrooms as they need to.
2. Greater awareness amongst managers, employers and trade unions of menopause and its effects at work to enable workers to disclose menopause and to access support
3. Employers would benefit from devising menopause policies that aim to reduce shame and stigma, allow flexibility and which recognise the diversity of people’s experiences of menopause
4. An urgent need to tackle stigma and shame surrounding womens’ health and menopause
5. More awareness among clinicians of how to support women at work
6. Greater sensitivity to trans men and non-binary people’s gynaecological health
7. An urgent need for increased research funding to understand how menopause affect workers and strategies to reduce the extent of these effects, for example, what employers can do to support women and trans/non-binary workers experiencing menopause.
8. Recognise that menopause can affect people differently and that a ‘one size fits all’ approach by employers could create new inequalities for women and trans/non-binary people.

July 2021