Being a nurse in the menopause: why it’s no time for taboos
Women coping with menopause symptoms deserve support and empathy in the workplace
Women coping with menopause symptoms deserve support and empathy in the workplace
- Too many healthcare employers are failing to meet the needs of a large section of their workforce – menopausal and perimenopausal nursing staff
- Workplace policies on lightweight uniforms, ventilation and rest areas are not always put into practice
- Advice on how to support team members or colleagues who are experiencing menopause symptoms at work
With almost half of the UK nursing workforce aged 41 or over, it's likely that many will be in the throes of menopause or perimenopause now or in the near future.
Survey exposes lack of support for menopausal women in nursing roles
But a Nursing Standard survey of 2,241 UK nurses has laid bare just how poorly-supported some staff are when it comes to coping with menopause symptoms at work.
Only five in every 100 nurses in our survey said they work for an employer that has a workplace policy on the menopause.
Many respondents going through the menopause highlighted a lack of understanding and empathy in the way their debilitating symptoms were viewed.
'I have mentioned at work that I struggle sometimes with symptoms but no-one has directed me to information,' one respondent said.
'I am in the last stages of the menopause… its difficult,' said another. 'There is no help and support at work and in fact I find most people are quite flippant about it.'
One nurse said: 'The menopause never gets mentioned even though quite a few of the team are affected.'
Are you menopause-aware? Signs and symptoms
- Menopause refers to the time when a woman has not had a period for 12 months and is no longer able to get pregnant
- It usually happens between age 45 and 55. In the UK the average age is 51
- The time before the menopause, when oestrogen levels gradually begin to decline, is called the perimenopause
- Hot flushes are the most common symptom of the menopause, occurring in three in every four menopausal women
- Other common symptoms include night sweats, sleeplessness, vaginal dryness, irritated skin, more frequent urinary incontinence and urinary tract infections, low mood and a reduced interest in sex
- Symptoms vary hugely in duration, severity and effect
What kind of help am I entitled to?
Employers, in the NHS or otherwise, are under no legal obligation to have a menopause policy for their staff.
However, they do have a legal duty to ensure working conditions do not exacerbate someone’s symptoms, and they must protect employees from discrimination, the Chartered Institute for Personnel Development (CIPD) points out.
‘I regularly have nurses and midwives knocking on my door informally asking for menopause advice because they are struggling with symptoms at work’
Kathy Abernethy, menopause specialist nurse
The CIPD has called for the menopause to be seen as an occupational health issue.
In guidance issued earlier this year, it says employers should provide menopause awareness training for line managers and offer adjustments to help women cope with symptoms at work. These could include late start times for women experiencing sleep disturbance, or regulating room temperature to help women who are experiencing hot flushes.
Lack of workplace menopause policies
MPs have called for more action on the issue too, stating that every employer should have a menopause policy, just as they have maternity policies.
But more than half (55%) of respondents to the Nursing Standard survey said they were unaware whether there was a menopause policy where they work. A further 41% said such a policy did not exist in their workplace.
One told us: ‘Wish it did [have a policy]. I’ve been through the menopause and it’s hard when you have to work through it. I suffered bad hot flushes and depression.’
‘Managers do not ensure any of the policy is followed… No air-conditioning or regular rest periods – another tick-box exercise’
Nursing Standard survey participant
‘I regularly have nurses and midwives knocking on my office door informally asking for menopause advice because they are struggling with symptoms at work,’ adds Ms Abernathy, director of menopause services at Peppy Health.
'Menopause policies or guidelines are useful as they highlight the importance of the subject, but it should already be easy to support staff if the will is there.
'The Health and Safety at Work Act covers work environment; the Gender Act and Equality Act support the need for consideration of menopause, without specifically naming it.
‘More important is the message that an employer gives that this is taken seriously, that it can be discussed openly and that the nurse can report difficulties and expect action and support.
'Occupational health staff tell me the problem is that understanding is one thing but implementing flexible changes is much harder within the constraints of a stretched NHS service.’
Memo to line managers – how to help your staff cope with menopause
- Regular informal conversations between you and your staff could enable discussion of changes in health, including issues relating to the menopause
- It may be valuable simply to acknowledge this is a normal stage of life and that adjustments can easily be made
- Review control of workplace temperature and ventilation and see how they might be adapted. This might include having a fan in an office, or locating a workstation near an opening window or away from a heat source
- Consider flexible working hours or shift changes. If sleep is disturbed, later start times might be helpful
- Provide access to cold drinking water in all work situations, including community settings
- Ensure access to toilets and washing facilities, including when travelling or working in temporary locations
- Where practicable, a flexible approach to uniforms can be helpful. This might include the use of thermally comfortable fabrics and optional layers, as well as providing somewhere to change clothes
- Where work requires constant standing or prolonged sitting, offering access to a rest room is helpful
Evidence that employers are starting to take action
A significant number of nurses who responded to our survey said their employers were currently developing a menopause policy, suggesting that awareness is expanding.
'Our well-being team is looking into it at the moment,' said one.
Some highlighted initiatives including information workshops and meetings, although attending could be difficult due to staff shortages.
‘I work in a unit where it can be 28°C. We’re not allowed a fan because of infection control. Some team members who have not experienced menopause symptoms do not understand’
Nursing Standard survey participant
But a nurse working for an employer with a policy pointed out it is only effective if implemented.
‘Managers do not ensure any of the policy is followed,' the nurse said. ‘No air-conditioning or regular rest periods for the menopausal woman, despite saying that they do in the policy. Another tick-box exercise.’
Ms Abernethy says changes that employers can implement to help staff include providing fans, placing computers near windows that open and offering shorter working hours.
Stifling wards and uncomfortable uniforms: it’s hard being a nurse during menopause
Nursing Standard survey respondents said they particularly struggled with hot flushes at work in heavy and uncomfortable uniforms.
‘I work in a unit [that is] 26-28°C,’ one said. ‘Not allowed fan because [of] infection control. Challenge doing job. Not understood by some team members who [have] not experienced menopause symptoms.’
Several nurses said they were not allowed to wear a summer or lighter uniform, which would help those with hot flushes.
One said: ‘I suffer extreme hot flushes but am told I have to wear a plastic apron which ties up and covers my front and back, leaving me soaked in sweat when doing the drug round,’ a nurse said.
‘Also scrubs are only allowed when weather is extreme and above a certain temperature. I find the uniforms unbearable at times and ill-fitting.’
Another added: 'I know management have not allowed a summer uniform which would be very beneficial to those of us who suffer from hot flushes.'
Others said the warmer working environment made her symptoms worse.
‘One of the most difficult issues is heat,’ the nurse said. ‘My ward is sometimes 29°C, which is a nightmare combined with hot flushes.’
7 ways to make menopause more manageable in and outside work
- Look after your health If you are experiencing symptoms, see your a health professional (such as your GP) for advice on treatments
- Get the help you need Discuss your practical needs with your line manager, human resources manager or other manager you feel comfortable talking to. You could make an appointment with occupational health to discuss support and possible work adjustments
- Be open Talk about your symptoms with colleagues, particularly those who are also experiencing symptoms. Share tips on how to cope and sources of support
- Avoid symptom triggers Caffeine and spicy foods can trigger hot flushes, so avoid where possible while at work, especially before presentations or meetings
- Use technology Hormone changes can affect memory and cognition, so use your phone or email calendar to set reminders
- Take time out Relaxation techniques such as mindfulness may help. The National Institute for Health and Care Excellence recommends cognitive behavioural therapy as a way to combat menopause-related anxiety and low mood
- Lifestyle changes Hormone changes as a result of the menopause can put women at risk of osteoporosis and cardiovascular disease, so consider lifestyle changes such as weight reduction, smoking cessation and doing weight-bearing exercises to help protect your bones
Adapted from the Faculty of Occupational Medicine guidance on menopause the workplace
The power of peer support when coping with symptoms
One nurse described how hard working life can be for nurses in perimenopause, when they may be having heavy and unpredictable bleeds.
She pointed out the difficulty of accessing toilets when working in the community.
‘It’s not just menopause, what about perimenopausal symptoms? Excessive heavy periods as a community nurse – where are the public toilets? Carrying used sanitary products in your car as you can use patients’ toilets but not leave the products there. If there’s no toilet, you mess your uniform but still have to carry on with visits.’
One thing that was clear from our survey was the power of peer support.
‘[My employer] was really supportive, saw the GP and was on treatment within 48 hours,’ said one nurse.
’There's lots of women in their early 50s in my clinical area, including the boss, so we support each other,’ another said.
We had menopause symptoms and knew we had to take action
Breaking the taboo of menopause to improve the experience for staff has led to significant changes at Sherwood Forest Hospitals NHS Foundation Trust in Nottinghamshire.
Trust chief nurse Suzanne Banks and a number of women on her team were going through the menopause and discussing the significant impact it was having.
‘Some members of my team were raising concerns, saying they didn’t feel at the top of their game any more, were constantly tired and questioned their credibility and competence, which all made me think we need to do something about it.’
Ms Banks realised that with women making up 81% of the trust’s permanent workforce – and 47% of them over the age of 45 – it must be a significant problem for a large number of staff.
The group developed guidelines, an information leaflet and a conference focused on all line managers, particularly those who were younger or male, and staff going through the menopause.
The trust has run two conferences, and is planning two more this year. The conferences are always opened by the medical director and the chief executive, both of whom are men.
‘This is really important to show staff that they are supported, it isn’t just a female thing,’ Ms Banks says.
A menopause support group has been also been set up, and university-led research into the efficacy of menopause support is currently following a cohort of women at the hospital.
Simple, practical ways to minimise symptoms
Desk fans are available for offices and access to water stations and changing facilities is supported. And women struggling with menopausal symptoms can apply for flexible working.
‘If someone is particularly struggling with hot flushes or night-time sweats, they may need flexibility around the hours they are working because the last thing they want is to come in on an early shift, and we don’t want them to come in if they are really tired. They can go through the flexible working policy with their manager,’ Ms Banks says.
It is difficult to know whether changes are having an effect on staff retention and absence, because the electronic staff record does not give menopause as a reason for sick leave, a fact that frustrates Ms Banks.
But she is confident the trust has a new open approach to the issue. ‘Menopause is spoken about all the time in the organisation and it is no longer a taboo subject here,’ she says.
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