Menopause and the workplace

The TUC is the voice of Britain at work. We represent more than 5.5 million working people in 48 unions across the economy. More than half of trade union members in the UK are women.1  We campaign for more and better jobs and a better working life for everyone, and we support trade unions to grow and thrive.

Menopause is the ceasing of menstruation and is usually identified as having occurred when menstruation has stopped for 12 months or more. Menopause will typically occur between the ages of 45 and 55. The average age for a woman in the UK to experience menopause is 51 years of age.2 However, menopause can be experienced much younger, 1 in 100 women in the UK experiencing menopause before the age of 40.3  Similarly, the perimenopause (meaning ‘around menopause’ and refers to the time during which the body makes the natural transition to menopause) 4  can occur years before periods cease and menopausal symptoms can last for years after menstruation has stopped. It is also important to note that trans, intersex and non-binary people can also experience menopause and/or menopausal symptoms.

Common symptoms include:

• Hot Flushes
• Night sweats
• Difficulty sleeping
• Low mood or anxiety
• Problems with memory or concentration.

However, there a many more symptoms and every experience of menopause will be different.

Menopause is a natural part of the ageing process and is something that nearly all women will experience. Given that women make up roughly 51 per cent of the population, and that 1 in 3 women in the UK are estimated to be going through or have reached menopause, it is shocking that there is still so much stigma, discrimination, and lack of awareness regarding the menopause. This reflects the structural sexism and ageism that is prevalent across our society.

Women of menopausal age (45-54) make up 11 percent of all people in employment and 23 per cent of all women in employment, which is 3.5 million women.5  Research suggests that the extent and impact of discrimination, bad practice, and general lack of awareness regarding menopause is forcing women out of the workforce. BUPA research estimates nearly 1 million women have been forced out of the labour market due to menopausal symptoms6 , or perhaps more accurately due to the lack of workplace support for them as they try to manage their symptoms and cope with a natural but often difficult process.

All workplaces need to adopt workplace policies that support women and others who experience menopause. In doing so it will help challenge the stigma surrounding menopause and other conditions that affect women, as well as supporting experienced, skilled, talented, hard-working women to remain in the labour market.

Recommendations

Employers

There are several steps employers should take to support menopausal women and those with menopausal symptoms:

• Adopt a workplace menopause policy that includes employer commitments to:

-        Appropriate information and support for all workers experiencing menopause and menopausal symptoms

-        Tackling the stigma and taboo around menopause

-        Risk assessments taking into account the specific needs of the individual

-        Adjustments to working conditions proactively put in place

-        Training and awareness raising for all staff

-        A confidential, named point of contact for support and advice for women to speak to regarding any issues that arise due in regards menopause.

-        Encourage workers to seek advice, guidance and representation from their union representative.

• Individual risk assessments that consider the specific needs and experiences of the individual and the specificities of the workplace.
• Offer reasonable adjustments in consultation with the individual and their representative to help manage symptoms of menopause and reduce the impact on a persons work and their wellbeing in the workplace.
• Offer flexible working as default. This can help menopausal women manage their symptoms around their work and reduce the stigma attached to menopause.

Government

There is currently no legislation that requires employers to have a menopause workplace policy or protect workers experiencing menopausal symptoms. There is also insufficient legal guidance for workers or employers regarding the menopause.

We recommend that government:

• extend the Public Sector Equality Duty to private sector organisations.
• adopt a key strategic role in raising awareness of the impact of menopause in the workplace, the existing legislative duties on employers and promoting good guidance, training and best practice policies that should be adopted by employers.
• Make flexible working the default through:

-       introducing a legal duty on employers to consider which flexible working arrangements are available in a role and publish these in job advertisements, with the new postholder having a day one right to take up the flexible working arrangements that have been advertised. If an employer does not think that any flexible working arrangements are possible, they should be required to set out the exceptional circumstances that justify this decision.  

-       introducing a day one right to request flexible working for all workers, with the criteria for rejection mirroring the exceptional circumstances set out above. Workers should have a right to appeal and no restrictions on the number of flexible working requests made.  

Menopause in the workplace – extent, impact and discrimination

• Women of menopausal age (45-54) make up 11 percent of all people in employment and 23 per cent of all women in employment, which is 3.5 million women.7
• It is estimated that in the UK around 1 in 3 (13 million) women are going through or have reached menopause.8
• Women can experience perimenopause for months or years before menopause and afterwards. Menopausal symptoms can persist after menstruation has ceased. On average symptoms persist for around 4 years but can last for as long as 12 years once menstruation has stopped. 9 1 in 100 women in the UK experience early menopause before the age of 40.10
• There are also many younger women receiving treatments for common conditions such as endometriosis (estimated to affect around 1 in 10 women of reproductive age)11 and infertility (which affects around 1 in 7 couples).12 Many of these women also experience menopausal symptoms whilst receiving treatments which may be carried out over months or years intermittently.
• Anecdotal evidence from our sister centre in Wales has also highlighted that many women’s symptoms are misdiagnosed, particularly if they are experiencing psychological symptoms associated with the menopause. GPs do not have to have compulsory menopause training and many women said they were more likely to be prescribed anti-depressants rather than any information or medical support for the menopause. This reflects other research that has highlighted that misdiagnosis and delays to diagnosis and treatment are a common barrier to menopausal women seeking support.13
• BUPA Research from 2019 found that nearly a million women had left the workforce over an unspecified period due to menopausal symptoms and the lack of support to help manage them.14
• The Government Equalities Office published an evidence review in 2017 of the extent to which menopause transition impacts on women’s economic participation in the UK.15
• The evidence paints a consistent picture of women in menopause transition feeling those around them at work are unsympathetic or treat them badly, because of “gendered ageism.”
• Survey research conducted by Wales TUC found that 85 per cent of respondents, the majority of whom were women workers, said that menopause affected their working lives. This rose to 9 out of 10 for women workers with direct experience of the menopause and fell to just over three quarters (77 per cent) of those with no direct experience of the menopause.16
• Usdaw, the union representing shop, distribution and allied workers have conducted research of their women members experiences of menopause (please see appendix A). They found that 1 in 5 women had taken time off work due to menopause related symptoms.
• The Menopause Survey 2018, 17 a joint project conducted by researchers at the Police Federation of England and Wales (PFEW) on behalf of PFEW, UNISON, the Police Superintendents’ Association and the British Transport Police Federation, examined the experiences and awareness of the menopause amongst police officers and police staff at a national level in England and Wales.

Key findings included: -        76% of respondents who had either gone through or were going through the menopause said that they had found symptoms of the menopause either moderately or extremely problematic at work. -        Overall, 20% of respondents said that they had considered leaving because they found it difficult to deal with the menopause at work; this increased to 44% of respondents who found their symptoms extremely problematic. -        44% of respondents who had taken sickness absence due to the menopause had not told their manager the real reason for their absence; only 9% who had told their manager the real reason said that their absence had been recorded accurately. -        35% of respondents had taken annual leave or rest days to take time off because of their symptoms. Over half (54 per cent) of Usdaw’s women members said they do not feel comfortable approaching their managers if they are experiencing menopause symptoms in the workplace. Over a quarter of women workers in the Wales TUC research on menopause and the workplace said that menopause was treated negatively in their workplace, this rose to 29 per cent for those who had direct experience of menopause.18  We consulted affiliates on their members experiences of menopause and in line with Wales TUC research a common theme is lack of awareness and empathy, and ignorance around menopause and its impact from line managers, and colleagues in general. Common issues included: -        Lack of awareness and training, particularly if the line manager or colleague is male, and particularly if they are a younger male. -        The issue being dismissed as a ‘women’s issue’. -        Feeling embarrassed to raise or worrying that they will not be taken seriously. -        Colleagues and managers treating symptoms as a ‘joke’. -        Being worried about or having experience of disciplinary action or negative judgements about performance at work. Wales TUC found that treating menopause and menopausal symptoms as a joke was common in the workplace. Over half (56 per cent) of respondents to their menopause survey said menopause had been treated as a joke within their place of work. This reflected qualitative evidence gathered from our affiliates whose members shared similar experiences. While making jokes may be seen by some as a way of coping or easing embarrassment, it can undermine how seriously this important issue is taken and is discriminatory. Many of our affiliates shared members concerns about this gendered form of ageism and highlighted that making jokes about other groups with protected characteristics would not be acceptable in the workplace. Other common issues that can exacerbate and/ or make managing symptoms of menopause more difficult for those experiencing them include: -        Lack of appropriate gender sensitive risk assessments -        Poor ventilation and air quality -        Inadequate access to drinking water -        Inadequate or non-existent toilet/washing facilities -        Lack of control of temperature/light -        Lack of appropriate uniforms or personal protective equipment (PPE) -        Inflexible working time rules/break times -        Inflexible policies which penalise women because of their symptoms, particularly sickness and absence policies -        Excessive workloads -        Workplace stress -        Insecure employment (e.g. fixed-term, casual or zero-hour contracts) Research from 2019 from the Newson Health and Wellbeing Centre looking at the impact of menopause and peri-menopausal symptoms on women in the workplace  found that 9 per cent of women had to undergo a disciplinary procedure at work due to ‘poor performance’ because of the impact of their symptoms on their work.19

Intersecting characteristics and the menopause

• Trans, intersex, and some non-binary people can also experience menopause, as will anyone who has had their ovaries removed. Trans people who take hormones may also experience menopausal symptoms if they stop taking them for any reason, for example, to prepare for a procedure, or if hormone levels are unstable. Trans, intersex, and non-binary people experiencing menopause symptoms may also face difficulties in getting their symptoms taken seriously at work.  Concerns about stigma and prejudice may present barriers for them in raising these difficulties, particularly if they have not disclosed their trans status. It is important for employers to be inclusive of trans and non-binary people in the support they offer and for this to be explicit in policies.
•  Black women may face additional difficulties dealing with menopausal symptoms, particularly if there is racial discrimination in the workplace, which can mean problems in accessing appropriate support or having their symptoms taken seriously. They may not have access to the same standard of healthcare due to health inequalities and consequently may experience inferior diagnosis and treatment of the menopause. This could lead to prolonged symptoms and more time off to attend additional appointments.
• Evidence suggests that there may also be some variations in the average age at which the menopause takes place between women of different ethnic backgrounds. Some studies suggest that symptoms may be more prevalent and more severe for Black women, although research is not yet clear on the reasons for this. Black workers are also more likely to be in insecure work on casual or zero hours contracts, making it even more difficult to cope with significant menopausal symptoms.
•  It is also reported by disabled women and those with underlying health conditions, that the menopause can exacerbate their existing impairments and health conditions or even trigger new ones. Medication that is commonly prescribed for the menopause can conflict with other medication or have an adverse effect on other medical conditions. Examples reported include women with diabetes who find it more difficult to keep blood sugar levels stable, or conditions such as multiple sclerosis (MS), mental health problems, skin conditions, chronic fatigue syndrome, fibromyalgia etc. being exacerbated. Menopausal symptoms can in turn also be made worse by the disabled woman’s impairment or health condition. The nature of the impairment may also make it more difficult for the disabled woman to get the medical support they require, or to recognise the symptoms as being related to the menopause.
• Recent case law (Davies v Scottish Courts and Tribunals Service (2018)) has found that some women experiencing the menopause may well be disabled persons for the purposes of the Equality Act. In such cases the employer has a duty to provide reasonable adjustments. However, this is not widely known by employers or workers. Many women with menopausal symptoms which would amount to an impairment with substantial and long-term impact on their ability to carry out normal day to day activities (the definition of a disabled person under the Act) struggle to get the employer to accept the need for adjustments. 

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What should employers do to support workers going through the menopause and address workplace discrimination related to menopause?

Menopause is a key workplace issue. It will affect all women at some point in their lives and is an equality as well as a health and safety issue. This is why unions have and continue to lead calls for workplace policies to support women going through menopause and raise awareness of menopause as a workplace issue.

Legal responsibilities

• Employers have several legal responsibilities that are relevant to menopause in the workplace, though there is no specific legal requirement for employers to have a workplace menopause policy or protect workers from the effects of menopausal symptoms.
• The Health and Safety at Work Act (1974) requires all employers to ensure the health, safety and welfare of all workers.
• Under the Management of Health and Safety at Work Act employers are requires undertaking risk assessments under the management regulations, this should include specific risks to those going through the menopause.
• The Equality Act (2010) prohibits discrimination against people with protected characteristics, including sex and age. Menopause may also meet the definition of a disability under the Equality Act 2010, that is a “physical or mental impairment…[that] has a substantial and long-term adverse effect on [their] ability to carry out normal day-to-day activities”. Government guidance makes clear that 'substantial' means more than minor or trivial and 'long-term' means 12 months or more. (this could include fluctuating symptoms which do not consistently affect individuals in the same way every day)
• The guidance also highlights the importance of considering the cumulative impact of multiple impairments that a person might have and states that even if individual impairments might not have a substantial impact if considered in isolation “account should be taken of whether the impairments together have a substantial effect overall on the person’s ability to carry out normal day-today activities”.20
• Disabled people are protected by the Equality Act from discrimination, harassment and victimisation. Employers also have a duty to take steps to make sure that disabled people can access jobs as easily as non-disabled people: known as the duty to make reasonable adjustments. Reasonable adjustments can include flexible working arrangements and longer rest breaks.
• The Public Sector Equality Duty places a legal obligation on public sector organisations to consider how they can contribute to a fairer society and advance equality by:21

-       Eliminating unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act.

-       Advancing equality of opportunity between people who share a protected characteristic and those who do not.

-       Fostering good relations between people who share a protected characteristic and those who do not.

Having due regard for advancing equality involves:

-       Removing or minimising disadvantages suffered by people due to their protected characteristics.

-       Taking steps to meet the needs of people from protected groups where these are different from the needs of other people.

-       Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low.

For public sector employers this means looking at existing policies and policies that they are developing and the impact they may have on menopausal women, and ensuring they are tackling the discrimination they face on the grounds of menopause.

Risk assessments

• Employers have a duty to prevent workplace discrimination and to make adjustments to ensure women can work safely through the menopause.
• Being aware of issues relating to gender in occupational health and safety ensures that workplaces are safer and healthier for everyone. Gender specific risk assessments where the differences between men and women (such as with the menopause) are acknowledged, means there is a greater chance of ensuring that the health, safety and welfare of all workers are protected.

Reasonable adjustments

• All employers have a legal duty under the Equality Act 2010 to proactively make reasonable adjustments to remove, reduce or prevent any disadvantages that disabled workers face. As noted, menopause may meet the definition of a disability under the Equality Act.

• The law recognises that to secure equality for disabled people work may need to be structured differently, support given, and barriers removed. An employer who fails to meet their legal duty under the Equality Act 2010 to make reasonable adjustments is in breach of the law and could be taken to an employment tribunal.

• These adjustments are meant to remove workplace barriers and are crucial to ensuring disabled people have equal and fair participation at work. Examples of reasonable adjustments include home working, providing adapted work equipment like an appropriate chair or keyboard, making an alteration to a building or providing specialist computer software. In the context of menopause reasonable adjustments could include home working, flexibility around working days or shift patterns, more frequent breaks, ensuring good ventilation in the workplace, providing more comfortable uniforms or relaxing uniform guidelines.

•  Employers should always seek to discuss appropriate adjustments with the individual and their named representative to make sure they are suitable for the individuals needs and likely to be effective.

Sickness and absence

•  Research from the Newson Health and Wellbeing Centre found that22 :

-        Around half of respondents reported having time off work due to menopausal or perimenopausal symptoms with 19% being absent for more than 8 weeks.

-        In total, 37% of women had been provided with a sickness certificate from their doctor; of these, 52% listed anxiety/ stress as the cause, with only 7% stating menopause as a reason for sickness leave.

- As a result of their menopausal and perimenopausal symptoms, 31% of women had thought about reducing their working hours and 32% had thought about leaving their job.

• Qualitative information gathered from our affiliates for this consultation highlighted that workplace sickness and absence procedures act as a barrier to women who need to support in managing their symptoms. The fear of being disciplined for having time off due to symptoms or to seek medical support is a significant problem for menopausal women.
• Unfortunately, many employers use sickness absence policies with arbitrary triggers for instigating processes. The Bradford Factor is one example commonly used to evaluate sickness absence, which penalises frequent short-term absences by assigning a negative score to the employee, whilst making allowances for a few periods of long-term absence.
• As noted, menopause may meet the criteria for disability under the Equality Act. Employers should record disability related absence separately from sickness absence separately from sick leave that is unconnected to this. This recognises that disabled workers may have different and higher forms of sickness absence and would be at a disadvantage if sick leave and disability related leave were recorded in the same place with different HR processes being triggered as a result.23
• Difficult symptoms related to the menopause leading to absence should be recorded as an ongoing issue, rather than as individual absences. As with any long-term health condition or impairment, adjustments should be offered to resolve any barriers that the employee experiencing the menopause encounters including flexible working options.

Model workplace policies

• Less than 1 per cent of women who responded to the Wales TUC survey in 2017 said that their workplace had a menopause policy.24
• Trade unions have been leading the way on developing and negotiating menopause policies in workplaces where they have recognition. But more needs to be done to raise awareness and get employers to adopt workplace menopause policies as well as highlighting legal rights and protections for workers.
•  A good workplace menopause policy will need to take account of the specificities of workplace environment and job roles for any individual workplace/ sector and should be negotiated with the recognised workplace union. However, all policies should cover the below key areas as set out in the TUC Menopause Toolkit:

-       Policy statement

-       Aims and objectives

-       Legislative compliance

-       Key principles

-       Definition

-       Symptoms

-       Who is affected

-       Workplace factors

-       Access to workplace adjustments and support

-       Key actions and adjustments

-       Self-help measures

-       Signposting and support

Key principles should include employer commitments to:

-       Appropriate information and support for all workers experiencing menopause and menopausal symptoms.

-       Tackling the stigma and taboo around menopause

-       Risk assessments taking into account the specific needs of the individual

-       Adjustments to working conditions proactively put in place

-       Training and awareness raising for all staff

-       A confidential named point of contact for support and advice for women to speak to regarding any issues that arise due to menopause.

-       Encourage employees to seek advice, guidance and representation from their union representative.

• Example model policies from UNISON, NEU and GMB are linked in this response. Workplace menopause policies should be negotiated with recognised trade unions and employees should be advised that they are able to seek advice and support from their union representative.  

Flexible working

• Flexible working is a key workplace policy that can support menopausal women and those experiencing menopausal symptoms. Research from the Newson Health and Wellbeing Centre found that because of their menopausal and perimenopausal symptoms, 31% of women had thought about reducing their working hours and 32% had thought about leaving their job.25
• Adopting flexibility by default will help women to feel supported in managing their symptoms around their work. And it will help to tackle the culture that sees women judged and discriminated against because of a natural process that will happen to all women at some point in their lives.

Training

• More and better workplace training regarding the menopause was highlighted as a key tool for change by affiliates who provided us with evidence for this consultation response.
• All workplaces should provide training to all employees and managers regarding the menopause. Not only will this help managers in particular understand the symptoms and potential impacts of menopause on women in the workplace, but it will also help to reduce the stigma around such issues and challenge cultures that can lead to women being discriminated against and judged because of their symptoms.
• Training should include:

• 1 [1] BEIS, (2021), Trade Union Statistics, available at https://www.gov.uk/government/collections/trade-union-statistics
• 2 NHS, Overview: Menopause, available at https://www.nhs.uk/conditions/menopause/
• 3 NHS, Overview: Menopause, available at https://www.nhs.uk/conditions/menopause/
• 4 BUPA, Menopause, available at https://www.bupa.co.uk/health-information/womens-health/menopause
• 5 Labour Force Survey, Q2 2021
• 6 Burden, L. Bloomberg Equality, (2021), ‘Many Women Exit Workforce for a Little Talked About Reason’,  available at https://www.bloomberg.com/news/articles/2021-06-18/women-are-leaving-the-workforce-for-a-little-talked-about-reason
• 7 Labour Force Survey, Q2 2021
• 8 Local Government Association, Menopause Factfile, available at https://local.gov.uk/our-support/workforce-and-hr-support/wellbeing/menopause/menopause-factfile
• 9 NHS, Overview: Menopause, available at https://www.nhs.uk/conditions/menopause/
• 10 Ibid
• 11 Endometriosis UK, available at https://www.endometriosis-uk.org/information
• 12 NHS, Overview: Infertility, available at https://www.nhs.uk/conditions/infertility/
• 13 Hunt, A, (2019), Woman and Home, ‘The Real Cost of Menopause Misdiagnosis: How Women are Suffering Due to a Lack of Understanding’, available at https://www.womanandhome.com/health-and-wellbeing/menopause-diagnosis-delay-337072/
• 14Burden, L. Bloomberg Equality, (2021), ‘Many Women Exit Workforce for a Little Talked About Reason’,  available at https://www.bloomberg.com/news/articles/2021-06-18/women-are-leaving-the-workforce-for-a-little-talked-about-reason
• 15 Government Equalities Office (2017) ‘The effects of menopause transition on women’s economic participation in the UK’, available at https://www.gov.uk/government/publications/menopause-transition-effects-on-womens-economic-participation
• 16 Wales TUC, (2017), Menopause: A Workplace Issue, available at https://www.tuc.org.uk/sites/default/files/Menopause%20survey%20report%20FINAL_0.pdf
• 17  www.polfed.org and search ‘menopause survey’
• 18Wales TUC, (2017), Menopause: A Workplace Issue, available at https://www.tuc.org.uk/sites/default/files/Menopause%20survey%20report%20FINAL_0.pdf
• 19 Newson Health and Wellbeing Centre, https://www.newsonhealth.co.uk/
• 20 HM Government, Office for Disability Issues, Equality Act Guidance, available at  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/570382/Equality_Act_2010-disability_definition.pdf 
• 21 EHRC, Public Sector Equality Duty, available at https://www.equalityhumanrights.com/en/advice-and-guidance/public-sector-equality-duty
• 22 Newson Health and Wellbeing Centre, https://www.newsonhealth.co.uk/
• 23 TUC, Disability and Work, available at https://www.tuc.org.uk/sites/default/files/extras/disabilityandwork.pdf
• 24 Wales TUC, (2017), Menopause: A Workplace Issue, available at https://www.tuc.org.uk/sites/default/files/Menopause%20survey%20report%20FINAL_0.pdf
• 25 Newson Health and Wellbeing Centre, https://www.newsonhealth.co.uk/