Menopause: why nurses need help from their employers
Employers have been slow to recognise the need to support nurses who are struggling with menopausal symptoms – but there are plenty of things they can do to help
Employers have been slow to recognise the need to support nurses struggling with menopausal symptoms – but there are plenty of things they can do to help
The average age of the menopause for women in the UK is 51. More than 309,000 nurses and midwives – that's 45% of the UK register – are aged between 41 and 55, putting them squarely in the age group for experiencing the wide range of symptoms the menopause can cause.
But while a significant proportion of nurses may be experiencing these physical, psychological and emotional changes, awareness among employers about the impact on staff remains poor.
The effect of the menopause can vary widely between individuals, with symptoms including hot flushes, night sweats, fatigue, difficulty concentrating, anxiety and depression. Symptoms last on average between four and eight years. One in ten women will experience symptoms for up to 12 years following their final period.
Effects on working life
Debby Holloway, a nurse consultant in gynaecology at Guy’s and St Thomas’ NHS Foundation Trust in London and RCN women’s health forum chair, says nurses at education events on the menopause often talk about the effect it is having on their own health and work.
‘For nurses, and women in general, it is about not being able to remember things as well as they used to, about poor sleeping, joint pain, about working in hospitals where it is hot anyway, and being in uniform when you are having hot flushes,’ Ms Holloway says. ‘Nurses talk about having a loss of self-confidence when they are in a meeting and start to go red, and all sorts of things about the emotional and cognitive effects. Some women don’t have any problems, while others will have lots.’
- Temporary adjustments RCN guidance on the menopause and work calls for changes at work to support nurses, including temporary adjustments to moving-and-handling requirements for those with muscular aches and pains.
- Breaks Nurses should have ready access to water and more frequent toilet breaks to cope with urogenital changes.
- Hot flushes The guidance suggests measures to reduce sweating and hot flushes, including provision of desk fans, moving desks near open windows if possible, adjusting air-conditioning, limiting the time nurses must wear personal protective equipment such as masks and avoiding having to wear nylon uniforms.
- Shift patterns Adjusted shift patterns and flexible working could help those struggling with poor sleep and night sweats, the RCN says.
- Mood Access to counselling services and open discussions with managers at one-to-one sessions can help staff struggling with psychological problems including poor concentration and low mood.
Despite there being a huge cohort going through the menopause at any one time, nurses’ employers are rarely as aware as they should be, Ms Holloway says. This is why she decided to hold a fringe event at RCN congress in Belfast in May, to discuss menopause and the nursing profession.
A University of Nottingham study found that almost half of women said it was somewhat or fairly difficult to cope with work during the menopausal transition. One in 20 reported it to be very or extremely difficult, the 2010 study found.
Difficulties at work, attributed to menopause symptoms, included poor concentration, tiredness, poor memory, feeling low or depressed and lowered confidence. Hot flushes at work were a ‘major source of distress’ for many women, the research found. Working in hot and poorly ventilated environments, sitting in formal meetings, and high-visibility work such as making formal presentations all made it harder to cope with symptoms.
The Faculty of Occupational Medicine, in guidance for employers produced in February, says research has found that women have encountered criticism and ridicule about menopausal symptoms from colleagues and managers.
The sandwich generation
This guidance points out that many women of menopausal age are caught between generations requiring care, including ageing parents, children and grandchildren, while also managing any symptoms they may be experiencing.
Kathy Abernethy, specialist nurse in a menopause service, chair of British Menopause Society and author of Menopause: The One Stop Guide, says the NHS has been lagging behind many other public and private employers, despite its large workforce of middle-aged women. While she has been giving awareness-raising talks to public and private sector employers for years, it is only in the past 12 months that she has been asked to visit NHS organisations.
‘Menopause is becoming much less taboo and women are becoming more willing to talk about it’
Kathy Abernethy, menopause specialist nurse
Ms Abernethy says the police, in particular, have made great strides, implementing policies supporting reasonable adjustments for women going through the menopause, including supporting flexible working and installing workplace rest areas.
For nurses, shift patterns, hard physical work, synthetic uniforms that encourage sweating, overheated environments, sometimes restricted access to cold water and hydration, and workplace pressures can add to the burden of menopause symptoms, Ms Abernethy says.
‘The NHS is being slow in implementing policies and holding awareness-raising sessions,’ she says. ‘The police have been really good at recognising this, and the NHS is lagging behind. But menopause is becoming much less taboo and women are becoming more willing to talk about it.’
She is starting to be asked to give more talks in the NHS, which she believes is the beginning of the process to improve the workplace conditions for staff.
‘Firstly staff, especially managers, need to become much more aware of menopause and the impact it can have,’ Ms Abernethy says. ‘And I would like to see changes to uniforms, improved facilities so individuals can access a staff room with comfy chairs, and flexible working policies that allow nurses to change their shifts. I have worked with midwives who managed to do that.’
Why it happens, what it feels like
Menopause is the time when a woman’s periods stop and her ovaries lose their reproductive function. Usually, this occurs between the ages of 45 and 55. It is caused by a drop in the production of the three hormones, known collectively as oestrogen, which control the reproductive cycle. The reduction of oestrogen, known as the perimenopause, can take several years.
Women can experience a wide range of symptoms that vary significantly in effect, duration and severity. Hot flushes are the most common symptom, 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, increased anxiety and a reduced interest in sex.
Among the long-term risks to health of menopause is the loss of strength and density of bones, increasing the risk of osteoporosis.
While most women who need treatment or support during the menopause should be able to receive this in primary care, skills among GPs and practice nurses in this area remain low, according to the British Menopause Society. The society provides training to healthcare professionals to try to improve this critical shortage of primary care knowledge. Access to secondary care can also be difficult, with too few specialist services and those that are available concentrated in the south of England.
But there is a huge demand for change among nurses. Blackpool Teaching Hospitals NHS Foundation Trust runs menopause education sessions for staff; the 20 places are full within minutes of being made available. When Carole Richardson, a nurse and senior therapist in the occupational health department, put on the first session three years ago she had a waiting list of 100 staff within 30 minutes.
Tackling the taboo
Ms Richardson now works at University Hospitals of Morecambe Bay NHS Foundation Trust, but still runs sessions for the Blackpool trust as well as at her current workplace. She says she started the sessions when she realised that 62% of the workforce was aged 40 and over but no one was discussing the impact of the menopause.
These three-hour sessions held once a month by the occupational health team focus on education and awareness-raising for women, with details on the wide range of symptoms, including incontinence and loss of libido, treatments and management techniques. An education session for male managers is planned in Blackpool.
‘There was a huge demand when I started the sessions,’ Ms Richardson says. ‘There is something wonderful about being together in a room with 20 hormonal women who can talk about their symptoms, and straight away it brought a degree of therapy. We also offer cognitive behavioural therapy, counselling and hypnotherapy in occupational health, and after the courses we get a lot of women referring themselves.
‘I think women feel empowered by the sessions and say they are going to go back to where they work and talk about this. Unless we talk about it, how can people make changes?’
Treatment and management
- Women should be offered hormone replacement therapy (HRT) as first-line treatment for vasomotor symptoms such as hot flushes and sweating. HRT should be considered for low mood/anxiety related to menopause after discussing the benefits and risks
- Cognitive behavioural therapy should be considered to alleviate low mood or anxiety that arises as a result of the menopause
- HRT does not increase cardiovascular disease risk when started in women aged under 60 years
- Any increase in the risk of breast cancer is related to treatment duration and reduces after stopping HRT
Women should be referred to specialist menopause services if:
- Treatments do not improve their menopausal symptoms
- They have ongoing troublesome side effects
- They have contraindications to HRT
- There is uncertainty about the most suitable treatment options for their menopausal symptoms
Erin Dean is a freelance health journalist