Menopause is receiving a wave of increased attention about its relevance to businesses and economic prosperity more broadly. Many high-profile initiatives, including British TV presenter Davina McCall’s documentary, Sex, Mind and the Menopause, are working to increase people’s understanding of how symptoms can affect working lives. But whose menopausal workplace experiences are being taken into account to shape this understanding?
This was a question that my colleague Margaret Rees and I asked ourselves recently when exploring the evidence about the diversity of menopause experience and work. And what we found was that how we think about menopause at work is heavily skewed towards the experience of women in professional occupations, and often those who are white and middle class.
Menopause is a shared yet unique time of life for women and people who menstruate. While menopause marks the one-year anniversary of a person’s final period, it often includes symptoms in the years running up to and after this time. Awareness, education and acceptance are key to supporting menopause at work.
But using a diversity lens suggests that the way people experience menopause at work can be significantly affected by socioeconomic position, ethnicity and racialised cultures. It can also be particularly complex for people who go through menopause but do not identify as women. These are all groups that are already more likely to face discrimination at work, marginalisation in the labour market, and are more likely to be in poverty in later life.
One of our key findings is that we need to better understand and account for the menopausal experiences of those who are in low-paid and precarious modes of work. These areas of the labour market are often less likely to see provision and support that proactively challenges inequality or discriminatory practices surrounding menopause.
Research has found that socioeconomic conditions affect where women are located in the labour market as well as their experience of menopause. Some reviews suggest that women in manual jobs may experience more psychological menopausal symptoms such as anxiety or low mood than those in white-collar workplace settings. Others suggest women in casual or irregular work will experience more muscular skeletal symptoms during the menopausal transition.
For many, there is a financial necessity that requires someone to continue working, even if experiencing severe symptoms. Estimates by the Living Wage Foundation also suggest that around 17% of women of typical menopausal age also experience insecure work (temporary contracts, agency work or self-employment, for example). This adds additional pressure at a time of life when they are more vulnerable to age and gender inequality – also called “gendered ageism” – in the workforce.
This is even more important for the economic landscape of menopause, given that those in lower socioeconomic groups or within minoritised ethnic communities in the UK are more likely to face financial insecurity and poverty in later life. Such patterns are similar in OECD countries, such as Australia, where older women represent the fastest-growing group experiencing homelessness.
Ethnicity and race
As valuable resources such as Menopause whilst Black and work by Dr Nighat Arif highlight, ethnicity and race is important to consider in relation to menopause. This is not only because of the experience of different menopausal symptoms and their differential effects such as hair thinning and melasma (skin pigmentation), or the impact of previous health episodes such as uterine fibroids, but also due to intersectional discrimination at work.
Checking inclusivity around menopause health access is also vital if we are to support all employees working through menopause. An employee’s ability and motivation to continue working is influenced by what health-related help, support or resources they feel are open or relevant to them during menopause.
For example, while hormone replacement therapy (HRT) is only one of many routes to support menopausal transition, those from poorer backgrounds or from minority ethnic groups are far less likely to use this treatment, suggesting institutional or cultural barriers to access.
Black women are also less likely to have affirming healthcare encounters that can improve an ability to work through menopause. We lack published evidence about the experience of those from minority communities who do seek healthcare advice about menopause. But studies of other health-seeking experiences linked to a wide variety of conditions including mental health suggest they may be more likely to receive under-diagnoses, misdiagnoses and late diagnoses.
All of this is central to the economic consequences of menopause for black and minority ethnic groups who are already twice as likely to be in poverty in the UK than white groups, and to be disproportionately represented in lower-paid employment.
Raising awareness and inclusivity
The UK has made some positive inroads in highlighting menopause as a workplace concern. And the recent release of the concluding inquiry report by the government’s All-Party Parliamentary Group on Menopause recommended that “the government must coordinate and support an employer-led campaign to raise awareness of menopause in the workplace”. But without a clear inclusivity lens, a wider range of menopausal experiences will not be heard.
We also need to ensure all businesses consider supporting menopause as being in their interest. Calls for policy or legislation to make menopause a protected characteristic may not attract employers of those in low-paid or insecure workforce settings. They may view this as “another thing to do” simply to avoid litigation.
However, forums that have a low barrier or cost to entry for inclusive menopause and work information-sharing could help businesses of all sizes. The research community – myself included – can also do better by listening and generating evidence to show a more diverse menopause experience to government, the media and business.
Being sensitive in how we choose to represent menopause at work, as well as in social and political spaces, is important. But without more knowledge of the wide range of menopausal experiences that employees face, we can only reproduce a rather pale and privileged picture of menopause.
Kathleen Riach receives funding from The British Academy. She sits of the Scottish Government's Menstrual Health and Menopause Advisory Group and advised the BSI (British Standards Institute) on their forthcoming Menstruation and Menopause in the Workplace Standard.