A significant and growing portion of the world’s population consists of women who face an uncomfortable challenge: the transition into menopause.
According to a 2021 article in Maturitas, approximately 657 million women across the globe are aged 45–59, and half of them contribute to the labor force during their menopausal years. The symptoms and stigma of menopause can negatively impact them, so it is crucial for us to not only remove the stigma, but also to properly support women during this phase of their working years. Relatively minor changes and accommodations during the transition can have major impacts on long-term well-being, as well as on decades of women’s professional productivity
Somi Javaid, MD explains, “For far too long women have been underrepresented in clinical research trials, dismissed by the medical community, and have faced significant delays in diagnoses. Menopause symptoms greatly affect women’s personal and professional lives. Menopause can lead to mild cognitive decline, impaired sleep, and hot flashes. Symptoms can present as word-finding difficulties, misplacing everyday items, or difficulty with focus. When human beings do not sleep well, it affects our ability to function and focus. Seeing as approximately half of the world’s population will experience menopause, the cost of leaving it untreated is too great.”
Fed up with the status quo, Dr. Javaid founded HerMD, a company that focuses on gynecology, menopause, and other women’s health issues. She says, “Women do not have to live in their discomfort. We need to provide education to women about what is happening with their bodies and let them know that there are treatment options, so that they are not leaving their careers in their prime. I believe that employers should prioritize partnering with menopause experts, providing education, early intervention, and access to care for menopause.
The good news is that as representation of diversity has improved in popular culture, so too has the portrayal of menopause. Menopause has often been humorously exaggerated in film and television, but relatively recently, this life transition has been represented with greater subtlety and empathy, for instance in such series as Fleabag, House of Cards, and Nine Perfect Strangers. Enhanced, fairer depictions of women’s varied experiences during the transition serve to remove the stigma around this phase of life. Global days of recognition are another part of the effort to normalize discussion of menopause and to provide support for those experiencing the transition. World Menopause Day, sponsored by the International Menopause Society, is celebrated each year on October 18 to raise awareness of the transition and of options for support. The European Menopause and Andropause Society (EMAS) launched the first World Menopause & Work Day on September 7, 2021. EMAS explains that this day “promotes the consideration of menopausal health in the workplace as part of broader frameworks and policies on wellness, gender, and age equality in the corporate culture.”
Scientists are actively researching the cause or causes of menopause symptoms. For example, it’s clear that some symptoms have a neurological basis. These include hot flashes, night sweats, anxiety, depression, insomnia, and brain fog. However, researchers don’t yet know how these effects on the brain are associated with changing hormone levels. Hormone therapy (HT) itself can be effective, but for a time it was largely suspended when the Women’s Health Initiative tied it to an increased risk of breast cancer and to certain cardiovascular diseases. More recent research suggests that there’s a window of opportunity in which short-term use of HT can be safe and effective.
Soma Mandal, MD, an internal medicine specialist in Berkeley Heights, N.J., and the author of the book Dear Menopause, I Do Not Fear You! shares, “We have realized that a ‘one size fits all’ approach to menopause does not work, and we must tailor individual treatment to every single person who is struggling with menopause. Hormone replacement can be effective (and safe) for some women but requires a detailed conversation with your health-care practitioner. There are non-hormonal options available as well, including medications that can help with the vasomotor symptoms (think hot flashes and night sweats). A variety of herbs and vitamins have also come on the market to help women through perimenopause and menopause, but [these] should also be used judiciously.”
Another line of questioning revolves around understanding the influence of such factors as ethnicity, nationality, immigration history, religion, cultural beliefs, and education on the different experiences women have during their menopause transition. For instance, one study reports that US Latinas may experience more adverse changes during this phase if they are affected by lower socioeconomic status and lower social support. However, the study also reports that positive attitudes toward the transition, greater social support, and strong religious beliefs can serve as protective factors against psychological distress for US Latinas during menopause.
One other source of emerging information comes from the Study of Women’s Health Across the Nation (SWAN), a multi-site, longitudinal, epidemiologic study designed to examine the health of women during their middle years. SWAN research includes investigations seeking to link symptoms, activities, or treatments in perimenopause with health conditions that occur postmenopause. For instance, more intense vasomotor symptoms, called hot flashes or hot flushes, have been correlated with a higher risk of cardiovascular disease events.
In addition, the Women’s Brain Initiative provides education and also funds research to combat brain-aging diseases that affect women. Some of its funded projects focus on understanding the female protective advantage in Parkinson’s disease and on defining the early signs for Alzheimer’s, a disease that disproportionately affects women.
In July 2020, the journal Tissue Engineering published a special issue focusing on women’s health. The journal has also included work characterizing the effect of estrogen on stem cells that leads to sex differences in tissue repair. Other recent research published in Obesity Week seeks to understand why weight gain or changes in body composition and fat distribution are associated with menopause. Effective interventions may not just be cosmetic; they may also help reduce the risk of cardiovascular disease that becomes elevated in the post-menopause stage.
Yet another recent study focuses on defining the impact of menopause on careers in diverse settings. A 2021 survey of more than 5,000 women in 5 countries experiencing menopause identified several trends, including naming the top 5 menopause symptoms that impact them at work: general fatigue, mood changes, broken sleep; hot/cold flashes; and increased stress.
Gaining a better understanding of the way menopause symptoms and their treatments affect women’s health will help in the development and use of safe and effective treatments and of supportive workplace policies.
Women approaching menopause may benefit from resources even beyond what general medical practitioners are prepared to offer. This is especially true because the experience of menopause can be very different for each individual, and because this is still an area of active research. Some of these resources include: the International Menopause Society, which promotes menopause research and education; the North American Menopause Society, which assists medical professionals in the management of menopause; and the menopause fact sheet page of the Australasian Menopause Society website, which is another excellent resource. Several new companies also provide evidence-based recommendations for care directly to women experiencing the menopause transition. Three examples are Evernow, Vira Health, and HerMD. And the company Gameto aims to delay menopause through regenerative medicine.
Some social support groups welcome women experiencing similar menopause challenges, providing them with an important sense of belonging. Associating with peers also provides a unique opportunity to create and maintain a sustainable lifestyle program, which is essential for improving overall health through menopause and beyond. Examples of these supportive communities include the Red Hot Mamas in Canada and the United States and menopause cafés in the United Kingdom, all of which provide forums for openly discussing the challenges of managing menopause.
Additional help could be offered by employers, who should consider providing workplace accommodations to support lifestyle practices that alleviate menopause symptoms and the anxiety they generate. Dr. Mandal states, “A 2018 study published in Women’s Midlife Health found that experiencing hot flashes at work increased intent to leave. Work outcomes were also much more correlated with job stress and lack of support. Women often experience shame or fear to disclose their struggles related to menopause. There can be a fear of discrimination. Women are afraid of being viewed as emotional or weak/incompetent. They often use their vacation or sick leave to compensate for a lack of time to deal with their struggles.”
Many organizations, fortunately, are launching initiatives to support those experiencing menopause symptoms, in order to retain senior women and to boost organizational productivity. For example, Sadiq Khan, the mayor of London, announced a groundbreaking menopause policy in March 2022. The policy supports all workers going through menopause at City Hall, and it aims to ensure that the work environment allows temperature-controlled areas, flexible adjustments in the work day, and time off to attend medical appointments. (See this Nature Career Feature for more on this topic.)
“Workplace accommodations can often include the use of age- and gender-specific assessments and can provide training throughout the workplace about menopause (for employers, managers, and human resources),” says Dr. Mandal. Specific suggestions include:
- creating better ventilation—by providing desk fans, for example, or, better still, by using innovative approaches to interior architecture and design (this has other benefits too, e.g., reducing the risk of infectious disease transmission);
- reducing taboos and allowing open discussions;
- providing training and education;
- offering advice on how to manage symptoms or providing information on where to obtain such advice as it evolves;
- offering flexible working hours;
- accepting menopause symptoms as a valid reason to take sick leave;
- creating quiet and private spaces for staff, which will help
- alleviate concentration difficulties,
- offer a place to rest briefly in order to manage symptoms, and
- provide help to those experiencing noise sensitivity, hot flashes, and other symptoms of menopause, which will in turn also benefit those seeking quiet time for other reasons (e.g., pregnancy, breastfeeding, disability, or chronic illness);
- setting up a company/firm menopause support group;
- offering an e-learning module for firm managers and supervisors;
- creating a dedicated resource hub about menopause;
- giving access to apps that provide menopause support;
- offering enhanced, private medical insurance to cover specialist consultations for conditions related to menopause;
- sharing portable neck fans for discreet cooling in such situations as giving lectures or working at a lab bench; and
- ensuring access to natural light and climate control to help alleviate symptoms.
Menopause and relevant medical treatments are still not openly discussed in the workplace and can carry a stigma; people may not seek treatment or accommodation for menopause symptoms because they’re unaware of options or are embarrassed to discuss the topic. However, as increasing numbers of people around the world enter menopause, their treatment needs grow in importance, and the urgency of overcoming these challenges accelerates.
Research suggests that changes made during the extended menopausal transition might significantly improve health even after menopause. Since menopause occurs at midlife, such health improvements made during the transition could last for decades, which will in turn foster decades of productive professional life. Emerging research will provide treatments to benefit ever more people, and health-care providers and educators will have to keep up with these new developments. Happily, these developments will provide new career opportunities for scientists and others working to innovate in the field of menopause treatments, accommodations, and education.
Georgina To’a Salazar, PhD works to create innovative solutions in science communication, research, and policy. With a BS in chemical engineering from Stanford University and a PhD in biomedical engineering from the University of California, Irvine, Dr. Salazar has fulfilled her dream of exploring the world, by taking research positions in Singapore and Japan before returning to the United States to focus on science communication.