Menopause and work: A narrative literature review about menopause, work and health.

Women’s bodily experiences and biological changes interact with the social and cultural context, such as work, in which women’s lives are embedded. This complicates the study of the biological phenomenon of menopause from a psychological or sociological perspective [ 9 ]. According to Dillaway, a holistic view of menopause is important for adequate treatment of menopausal complaints [ 11, 30 ]. She illustrates how women, doctors and researchers define and describe menopause mainly in terms of chronological age. However, age- and time-bound characterisations are insufficient. When health care professionals and women themselves do not recognize menopause as a life phase, for instance because they confine themselves to a certain age category to indicate menopause, negative consequences may occur: it may limit recognition and treatment options, influence complaints that women experience and undermine women’s confidence in their own bodies, which in turn can lead to a feeling of insecurity, to suboptimal treatment or delay in adequate treatment and influence quality of life. This leads us to the following research questions: 1. What is the state of the art in the literature about the relationship between menopause, work and health? 2. Which knowledge gaps can be identified? What is the state of the art in the literature about the relationship between menopause, work and health? Which knowledge gaps can be identified?

This study was funded by WOMEN Inc. and Instituut GAK (2018-2019).

In this literature review, we conducted a narrative analysis and covered a broad range of topics by using studies of various complexity and design [ 31 ]. Our search was conducted between December 2018 and February 2019 in the databases PubMed, CINAHL, MEDLINE and ScienceDirect, originally using the MeSH terms ‘menopause AND work’. Our choice for the MeSH terms instead of the author’s key words was deliberate, because MeSH terms are assigned by the database specialists and function as stronger identifiers of the content. MEDLINE is a subset of PubMed, but given the low rate of the search hits found in PubMed we decided to include the searches in both databases as MEDLINE (1946) is older than PubMed (1996). This strategy resulted in many doubles, which were deleted during the fourth step of the search process. Inclusion criteria were the English language, empirical research and review articles to contextualise our findings. We screened articles and excluded those with an exclusionary medical content (see Fig. 1 Flowchart). Flowchart of empirical studies and reviews. We excluded articles based on our selection criteria. We deleted doubles, after which two researchers checked abstracts of remaining articles. Finally, we analysed the subset of 36 articles (see Appendix). Selected articles have been read by at least two researchers. Notes have been compared and arranged thematically. Besides these 36 selected articles, we used another 27 articles in our results section to contextualise and interpret our findings. Additional articles were found through snowballing, including in selected articles’ references, and were included when they helped to contextualise the findings. In these studies, the relationship between menopause and work was often secondary or marginal. A few sources were found via Google, e.g. union surveys.

Both women and employers hardly receive information or training on menopause and thus, lack the knowledge about menopause-related health complaints and their impact on work [ 25, 32 ]. According to Fenton and Panay, this is out of balance when compared to the attention and support for pregnancy (leave) [ 33 ]. Female workers report a need to discuss menopause and break taboos surrounding menopause in the workplace. Often, women either do not see the opportunity or fear to discuss menopausal complaints and how they may affect their job performance [ 8, 25 ]. They fear speaking of menopause, in particular women in higher positions, for being ridiculed, stereotyped and stigmatised [ 2, 33 ]. Hammam et al. found that adverse (physical) working conditions (e.g. no ventilation, inflexible working hours, no possibility to change workload or tasks) were related to increased health complaints among postmenopausal women [ 34 ]. Discussing this with supervisors was uncommon, because of a lack of opportunity or time, or social and cultural barriers. According to Hardy et al., an open culture and a supervisor with basic knowledge about menopause facilitated the conversation about menopause and work, while supervisors’ gender (male), male dominance in the workplace, stigmatisation, fear, discrimination and shame were mentioned as barriers [ 35 ]. In the communication itself, being understanding, jointly looking for solutions and an empathic sense of humour were important, whereas not being taken seriously was felt as a barrier. Education and training programmes for women themselves are important and may help to diminish menopausal complaints [ 36 ].

Based on this literature review we identified several knowledge gaps. First, we need to understand why a topic that is relevant to (almost) all working women is systematically being ignored in research and in organisations. Women’s health issues such as menopause and reproductive health, breast cancer or endometriosis, but also sexual or intimate partner violence, are major public health matters [ 81 ]. Gender bias in medicine has been described for decades already and women’s health advocates have called for integration of women’s health in research agendas and curricula [ 81 ]. Our review indicates that epistemic injustice in organisational and health research is still effectively in place. The taboo on menopause that is referred to in studies is reinforced by women themselves, but this takes place in a context which values (women’s) youth over midlife, mind over body and productivity over reflection [ 82 ]. Second, menopause must be studied in relation to: (a) physical working conditions, such as temperature and ventilation, but also nightshifts, working with chemical substances and physical requirements such as heavy lifting, and (b) health issues later in life. In order to provide women with the opportunities to live up to their potential, we need to know how psychosocial working conditions, such as coping with menopausal complaints at work, or the relationship between menopausal complaints and job demands and job autonomy, or social support, are associated with menopausal complaints and with health problems such as cardiovascular conditions later in life. At organisational and policy level, it is important that we understand how organisations and work can be designed in ways that support sustainable employment of women in this life stage, including women with severe menopausal complaints. Third, we need comparative studies about the relationship between menopause and work across professions and sectors, but also across cultures. Most of the incorporated studies concern women who work in education and health care, or conduct administrative work, which reflects gender segregation in the labour market [ 80 ]. However, specific studies are required on the health and experiences of women during menopause, not just in the ‘female-typed’ sectors, but also in sectors where women represent a minority such as the military, the police force and the industry [ 83 ]. Being member of a minority group may bring about even more complex issues regarding menopause and health. In this respect we point for instance towards Gnudi et al.’s work, in which the authors explore the relationship between lifelong physical job demands and retired women’s lower back pain [ 84 ]. The study was not included in this review, because the relationship between work and health is only indirectly related to menopause. However, the authors did address professions that were characterised by heavy physical job demands (carrying, pushing, lifting heavy weights) in sectors where women work, such as farming, ceramics and glass industry, paper production and steel industry. In our review, we only found few examples of studies that associated menopause with a particular profession, such as Ilmarinen et al.’s study [ 44 ]. In a small number of studies such as Ariyoshi’s study or Cau-Bareille’s study about the motivations of female kindergarten teachers for early retirement, attempts were made to connect experiences with menopause to (quitting) work [ 74, 85 ]. However, these were small studies. Chau et al. searched for studies on night shifts and women’s reproductive health in CINAHL, MEDLINE and other databases using the search terms ‘shift-work’ and ‘female/women’[ 86 ]. They identified 20 articles related to pregnancy, fertility and the menstrual cycle and zero results related to menopause and work. We support their urgent call to critically evaluate research agendas regarding changing labour market demographics and expected upcoming labour shortages. Breast cancer in women has been studied in relation to night shifts [ 87 ]. Other research could focus on wearing uniforms in relation to hot flashes, negative stereotypes that hamper women’s functioning and exclusion of women in ‘typical male’ environments, or the intersection of sexism and ageism towards working women during menopause. Comparative intercultural studies are lacking as well. In 1996, Kaufert already wrote that studies on menopause conducted outside of the United States or Europe, often use similar methodological research designs, whereas the cultural, economic and social context on other continents is very different, including the role of ageing women in societies [ 34, 88, 89 ]. Existing knowledge is to a large extent based on white, middle class, urban and mostly healthy women. Research methods and recommendations for practice require accommodation to multicultural societies. Fourth, there is a need for innovative methodological and theoretical frameworks. Most available studies used instruments such as GCS, WAI, MENQOL, assessing both biomedical and psychosocial aspects of menopause. Since these domains cannot be separated, we need research instruments that do justice to the complexity of the relationship between work and menopause. Studying work and menopause is far from simple. As moving targets, menopause and menopausal complaints pose difficulties for researchers to demarcate menopause as a life stage during the life course, but also to demarcate menopausal complaints in relation to other health complaints. These complexities show the different layers of menopause as a phenomenon, the study of which requires further development of methodological and theoretical frameworks. Jack et al. address this gap and advocate for research from a feminist perspective [ 57 ]. Their study is an example of how the approach to studying menopause and work can be extended from a single biomedical endocrinological perspective (hormone fluctuations) or a psychological perspective (individual coping and self-management approaches) to a broader framework. We firmly believe that research on menopause and work will benefit from a transdisciplinary approach, preferably from an intersectional perspective [e.g. 81]. Therefore we advocate for a broader methodological framework, which incorporates the use of existing scales and instruments but also mixed-method research designs, as well as narrative, ethnographic and participatory action research designs with stakeholder and end-user approaches [ 90 ]. Participatory research is suitable to map multiple perspectives and bring about a dialogue between employers, employees and other stakeholders about experiences, problems and possibilities for support, for instance in the form of adapted HR-policies [ 91 ]. Given the many open endings, our recommendations for practice need to be taken with caution. Based on our literature review, we do recommend that: (a) awareness about menopause and work is raised among occupational health professionals, including physicians, by developing guidelines for menopause and work; (b) organisations map health problems, job characteristics and sickness absenteeism in relation to female-specific life stages, and (c) a broad awareness raising programme about menopause at work is developed for employers, employees and the public at large.

Various individual coping strategies are described in the literature [ 2, 8, 33 ]. For sleeping problems and possible consequences, such as fatigue, solutions are not simple. Coping with hot flashes is often resolved by bringing extra clothes, dressing in ‘layers’, or bringing along a (mini) fan. Sometimes, windows can be opened, or women refresh themselves in bathrooms. Strategies for concentration problems or forgetfulness are for instance double checking one’s work or making to do lists. Adapting tasks or changing work schedules are also mentioned. Other coping strategies, more lifestyle-oriented, are changes in diet, (extra) exercise or sleeping extra hours [ 2, 8, 33 ]. The use of humour or talking about menopause with other people is mentioned least often by women themselves [ 8 ]. Less beneficial coping strategies that some women use, are for instance working extra hard in order to make up for the ‘shortcomings’ that result from menopausal complaints, compensating hours or hiding these ‘shortcomings’, taking sick leave or holidays without mentioning the real reasons [ 2, 33 ]. In short, strategies directed at adjustment in the workplace and openness seem to be used less often than strategies that focus on coping with or diminishing the complaints.

A main limitation to the review is the small number of available studies. That is why we incorporated studies of all qualities, which affects the robustness of our findings. Authors tend to refer to each other, which poses the risk that conclusions from a single study are generalised and exaggerated. Available studies are often based on known scales and instruments, often self-report, such as the WAI, and used in Western settings, but not necessarily validated for women in menopause and not validated cross-culturally. The results of the studies usually only indicate the possible negative effects of certain physical symptoms such as VSM and sleeping problems, and of certain psychological symptoms such as stress, anxiety and shame, on women’s work ability and their well-being. Positive aspects of menopause and ageing in relation to work are not studied. Furthermore, these instruments do not necessarily tap into women’s lived experiences. Other types of research may provide insight in women’s embodied experiences in this life stage within the context of women’s lives.

Our review is one of few literature studies on menopause, work and health [ 77 ]. Even though the number of studies on the subject has been increasing during the past years, we still consider the scarcity of studies on menopause, health and work as an epistemic gap. Our critical stance does not diminish the relevance of the studies that were conducted during the past 20 years, and the outcomes of the pioneering studies incorporated in this review help us move forward and stimulate further research. The resilience of working women in this life stage is very high, but under pressure. Good health is important for women, for the work organisation, and for society as a whole. Menopause in relation to work requires serious consideration, both in research and policy at all levels.

Menopause in relation to work is hardly studied, but the number of studies is increasing [ 4, 77 ]. The first cautious conclusions from our findings are: (a) menopause can play a role in diminished work ability of women in this life stage but evidence is inconclusive; (b) menopausal complaints could be a likely explanation for older women’s higher sickness absence rates; (c) women with menopausal complaints continue to work (presenteeism), and (d) women remain silent about their menopausal complaints (taboo) and seek individual solutions to cope with work. In particular, work ability among women with severe menopausal complaints may be negatively affected [ 1 ]. Negative consequences of diminished work ability are sickness absenteeism, turnover intention and other health related issues. At the same time less favourable working conditions, such as the lack of job autonomy or a lack of control over the physical working environment, seem to negatively affect menopausal complaints [ 42, 49 ]. Women use several individual strategies to cope with menopausal complaints at work which can be more (healthy lifestyle changes) or less adequate (working more hours to make up for lower productivity). Such interventions at an individual level (self-help interventions) and at the workplace (e.g. educating supervisors) could be successful. They are positively valued, by women themselves and also by supervisors [ 8, 71 ]. Menopause is hardly discussed in the workplace, which is related to the taboos surrounding menopause, as well as to the lack of knowledge by the women themselves, health care professionals and employers [ 35, 79 ]. Organisational policies about menopause and work are hardly described. Further stigmatization of (older) women needs to be avoided when menopause at work and its taboo are being addressed –a leap from women’s work-related health problems to women themselves being a problem is easily made. We conclude that menopause is rather seen as a woman’s individual problem than as an organisationally and societally relevant issue. The lack of knowledge about the relationship between menopause, work and health directly affects women’s health as well as their position in the labour market, since they are not offered workplace interventions or professional support. Individual solutions of women can (continue to) lead to diminished well-being at work and eventually to distancing from or leaving the labour market altogether [ 40 ]. However, work is essential not in the least for women’s economic independence also in midlife and in old age. For both men and women, work is a source of self-fulfilment, health, self-development, self-confidence, and empowerment [ 80 ]. However, the lack of attention for menopause in research and organisational policies gives the impression that older women’s work and health are taken less seriously and are found less important. We conclude that the resilience of working women in this life stage is very high, but it is put under pressure in times of increasing intensification of work, an ageing labour market population and labour market shortages. Good health is important for women’s sustainable employment and a dignified life during retirement, but also for the work organisation and society as a whole. Menopause in relation to work requires serious consideration, both in research and policy at all levels.

In Western countries, women make up half of the labour force in full- and part-time jobs [ 1–3 ]. Furthermore, labour market patterns are changing rapidly: women’s participation in the labour market has increased, the percentage of full-time working women is rising, and retirement age is increasing in many countries. As a result, a growing number of women aged 45 years and older participates in the labour market, hence, menopause is part of working women’s lives. Aim of this narrative literature study is to provide an insight in the state of the art in the literature about the relationship between menopause, work and health and to identify knowledge gaps as input for further research. Virtually all women will go through menopause and, often, experience menopausal symptoms and complaints [ 4 ]. Given their high prevalence, symptoms can impact on women’s working lives. In a large representative Dutch study, older (> 45 yrs) and in particular highly educated female employees, reported high work-related fatigue [ 5 ]. The authors state that menopause may partly account for the unexplained differences in work-related fatigue between older highly educated men and women. To date, only few studies directly relate menopause to work, for instance to lower work ability [ 6–9 ], and show that both women and employers possess little knowledge about menopause. Employers are therefore unaware of how to contribute to a healthy working environment for female employees in this life phase, and women do not recognise their bodily signals or do not dare to ask for help [ 2 ].

None to report.

The British UNISON’s (The Public Service Union) guide to menopause states that menopause is too often considered to be a private issue instead of an occupational health issue [ 75 ]. According to UNISON, employers should realise that women going through menopause may need special support to continue working and be productive [ 75 ]. Griffiths et al. state that at least four issues need to be addressed [ 8, 76 ]: (1) awareness among supervisors that menopause can cause problems at work, (2) flexible schedules, (3) access to information and resources, and (4) temperature and ventilation at work. According to Fenton and Panay, offering awareness training to supervisors can be useful [ 33 ]. They emphasise the importance of a positive attitude and organisational culture, which offers a safe environment for women to address menopausal complaints. There should be options to talk with a confidential advisor, preferably a female colleague with experience, because women feel uncomfortable addressing these issues with their (male) supervisor [ 2 ]. These authors advocate for flexible sick leave procedures in case of menopausal complaints, and warn against the negative consequences of sick leave. Policies directed at taking (extra) breaks or leaving early when menopausal complaints occur, are also suggested as improvements of a sustainable working environment that takes menopause as a phenomenon seriously [ 33 ]. Hickey et al. studied the relationship between menopausal symptoms as measured with the Menopause Rating Scale (MRC) and work-related outcomes such as job performance, frequency of mistakes, autonomy and turnover intention [ 14 ]. Symptomatic women received a number of suggestions for possible support. Addressing temperature control, flexible hours, seminars about healthy ageing, flexible work spaces, physical exercise programs and table fans were the most attractive to the participants. Organisations benefit from policies directed at healthy ageing, and the working environment must be designed to not exaggerate menopausal symptoms. Furthermore, specific needs of women in menopause deserve attention in risk-inventories and evaluations. Studies show that menopausal complaints are affected by situational factors and can be aggravated by the work environment [ 8, 13, 42 ]. Hardy et al. studied female employees’ perspectives on their employers [ 13 ]. For some women it was difficult to deal with menopause in the workplace, partly due to aspects of the work environment such as lack of knowledge or awareness among colleagues, a lack of communication skills among employees and employers and the lack of organisational policies. This was in line with other studies, and organisational policies for women in this stage are helpful [ 2, 13, 14, 76–78 ]. Hardy et al.’s recent work describes a first attempt to address difficulties with talking about menopause [ 79 ]. In their study, the supervisors of three large British organisations (one public and two private) received a 30-minute online training with the aim to raise awareness, increase knowledge and improve attitudes towards menopause, and to develop their skills in communication about menopause with employees. Most of the trainees would recommend the training to colleagues.

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