30 May, 2016:
The relationship between menopause, paid employment and workplace environments is under the spotlight with the review of existing studies presented in our multi-authored paper .
We report that since 2000 there has been a growing number of studies which have systematically explored two interrelated concerns: whether, to what extent, and how menopausal symptoms influence women's work, including costs to employers; and the role of physical and psychosocial aspects of the workplace environment in aggravating or alleviating symptoms.
Work factors as well as menopause-related symptoms and disease affect working women. Work stress/overload, long/inflexible working hours, perceived job control, and gendered/aged-based workplace norms and stigmas, and anticipated supervisor/collegial responses, are key psychosocial factors that compound and complicate the impact of women's symptom experience. Vasomotor symptoms (VMS) are often reported as having a negative effect on women's productivity and experience at work. In some studies, the psychological and somatic symptoms accompanying VMS are more significant than the hot flashes per se.
Suggestions for employers are made which would support working women through menopause and the years that follow. Changes which could be made in the workplace are recommended, including health promotion programs.
Given the fact that a large and growing number of women are transitioning through menopause whilst in work, it makes sense that workplaces are key places where women might be able to inform themselves about menopause (either formally through information provided by organizations, or informally through social networks). The report by Jack and colleagues  is part of a wider project on women, work and the menopause (see www.womenworkandthemenopause.com) which approaches the study of menopause with a broader concern for mid-/late career women's health and well-being. It breathes fresh air into the field of menopause research about quality of life issues and brings with it the perspectives and concerns of research scholars and educators in the business world.
The initial search of the business and management literature found almost nothing about menopause issues in the workplace. In reviewing the medical literature, the business-oriented researchers concluded that little attention had been paid to the particular social contexts in which women experience menopause. It is not that there has been a lack of interest in medical research in studying how menopause impacts workability . It is more an issue of the narrowness of the focus of that interest, i.e. the economic costs and health-care burden of menopause symptoms and related diseases. Jack and colleagues  cite several recent studies indicating that it is very expensive, in health insurance bills, lost work and demand for health care, for businesses to fail to recognize the value and needs of their menopausal employees. For example, one study compared half a million working women, half with and half without VMS coded in their medical records. The findings showed that the symptomatic women, in a 12-month time period, had an extra health insurance bill of USD $339,000,000, USD $27,000,000 cost for lost work and 1.5 million more medical visits than the women without VMS .
Can hormone therapy help in the work-place? Menopause-induced, estrogen-deficiency symptoms which have been related to impairing work function include â€›trouble in remembering', disturbed sleep, hot flushes, depression and anxiety attacks [4, 5]. Hormone therapy is very effective for the control of these symptoms. It seems reasonable to assume that hormone therapies would be helpful to symptomatic working women. In one small (n = 130) prospective, double-blind, placebo vs. estradiol study, it was found that two-thirds of the women described symptoms that affected workability . All of these symptoms improved after estradiol treatment and were not responsive to placebo at the 6-month evaluation . This study did go into the details of the women's everyday work experience but, in that regard, it is the exception.
Current concepts about hormone replacement therapies are changing. For women who start hormones before age 60 and/or within 10 years of hysterectomy, the benefits outweigh the risks. Treatment is no longer considered to be only for the control of symptoms but also for reducing disease risk and mortality . This is the type of information that employers could make available to their employees, i.e. replacing misinformation about hormone therapy with accurate data encouraging use of hormone therapy when indicated.
There are alternative ways to help women cope with menopause symptoms. Jack and colleagues suggest steps which could be taken by employers including stress reduction and physical changes in the workplace. Lifestyle changes can make a difference in controlling menopause symptoms, and the recent algorithm proposed by NAMS on â€›hormonal/non-hormonal therapy decision-making' regarding menopausal symptoms is worth noting .
Business studies scholarship teaches us that the physical and psychosocial environment of the workplace shapes the health and well-being of workers, either negatively through stress, long working hours, sexism/ageism or physically demanding work, or positively, through social support, rewards and self-esteem for example [8, 9]. It is vital that these contextual aspects of work are drawn into research questions by menopause researchers, and that employers pay attention to them. It is part of the requirement to provide a safe, healthy and discrimination-free working environment mandated by law in many OECD countries.
If we view menopause as a multidimensional biopsychosocial phenomenon, then it behoves us to pursue research from a multidisciplinary perspective, and to capture women's experiences through multiple research methods.
Professor of Management, Department of Management, Monash Business School, Monash University, Melbourne, Australia
Philip M. Sarrel
Emeritus Professor of Obstetrics, Gynecology and Reproductive Sciences and Psychiatry, Departments of Obstetrics, Gynecology, and Reproductive Sciences and Psychiatry, Yale University School of Medicine, Yale University, New Haven, CT, USA
- Jack G, Riach K, Bariola E, Pitts M, Schapper J, Sarrel P. Menopause in the workplace: What employers should be doing. Maturitas 2016;85:88-95
- Geukes M, van Aalst MP, Nauta MC, Oosterhof H. The impact of menopausal symptoms on work ability. Menopause 2012;19:278-82
- Sarrel P, Portman D, Lefebvre P, et al. Incremental direct and indirect costs of untreated vasomotor symptoms. Menopause 2015;22:260-6
- Sarrel P, Rousseau M, Mazure C, Glazer W. Ovarian steroids and the capacity to function at home and in the workplace. N Y Acad Sci 1990;592:156-61
- Hunter M, Battersby R, Whitehead M. Relationships between psychological symptoms, somatic complaints and menopausal status. Maturitas 1986;8:217-28
- LaCroix AZ, Chlebowski RT, Manson JE, et al. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial. JAMA 2011;305:1305-14
- Manson JE, Ames JM, Shapiro M, et al. Algorithm and mobile app for menopausal symptom management and hormonal/non-hormonal therapy decision making: a clinical decision-support tool of the North American Menopause Society. Menopause 2015;22:247-53
- Griffiths A, MacLennan SJ, Hassard J. Menopause and work: An electronic survey of employees' attitudes in the UK. Maturitas 2013;76:155-9
- Gartoulla P, Bell RJ, Worsley R, Davis SR. Menopausal vasomotor symptoms are associated with poor self-assessed work ability. Maturitas 2016;87:33-9