Menopause at work: managing hot flushes and PPE

The workplace changes that can minimise discomfort for staff with menopause symptoms

RCN guidance explains the workplace changes that can minimise discomfort for staff with menopause symptoms

  • PPE can be particularly uncomfortable to wear for healthcare professionals experiencing menopause symptoms
  • Symptoms can include hot flushes and sweats, fatigue, sleeplessness, joint pain, weight gain, loss of confidence and forgetfulness, and will vary from person to person
  • The RCN says employers are getting better at considering staff well-being relating to the menopause, but there is room for improvement
PIcture: Dan Mitchell

Donning and doffing plastic aprons, face masks, visors, gowns and gloves in the workplace can be hot and uncomfortable at the best of times – but for a healthcare professional going through the menopause, it can be unbearable.

COVID-19 has meant nurses having to wear more personal protective equipment (PPE) than ever before in their professional and personal lives.

Guidance on making PPE more comfortable for nursing staff during the menopause

Issues related to PPE and the discomfort it can cause are among the areas covered in new RCN guidance on menopause and the workplace.

The guidance includes adjustments employers can make to support nursing staff experiencing menopause symptoms.


The average age of menopause in UK

The average age of the menopause for women in the UK is 51, according to NHS guidance.

More than 309,000 nurses and midwives – that’s 45% of the UK register – are aged between 41 and 55, putting them in the age group for experiencing the wide range of symptoms related to perimenopause and menopause.

Younger members of the workforce may also be affected: according to charity the Daisy Network, about one in 100 women will go through the menopause before the age of 40. This is known as premature ovarian insufficiency.

The menopause explained

Picture: iStock
  • 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

Source: Women’s Health Concern: The menopause factsheet

How menopause symptoms can cause workplace problems for staff

Symptoms, which include hot flushes and sweats, fatigue, sleeplessness, joint pain, weight gain, loss of confidence and forgetfulness, vary between women and in their severity.


of women aged under 40 experience premature ovarian insufficiency

(Source: Daisy Network)

One in four women going through the menopause experience hot flushes that affect their quality of life and work.

The RCN says employers should recognise menopause as an equality and occupational health issue and make practical adjustments to help nurses alleviate symptoms.

For some, going through the menopause may be uneventful and may not have an impact on their working life, but for others it may become increasingly difficult to function effectively at work and their working conditions may exacerbate their symptoms, according to the new RCN resource, The Menopause and Work: Guidance for RCN Representatives.

Menopausal symptoms: how employers can help

Daytime sweats and hot flushes

  • Ensure easy access to cold drinking water and washroom facilities
  • Avoid use of nylon and close-fitting uniforms
  • Take account of peripatetic workers’ schedules and allow them to access washroom facilities during their working day
  • Limit time wearing personal protective equipment (PPE)

Night-time sweats, hot flushes and poor sleep

  • Consider temporary adjustment of shift patterns to accommodate any difficulties
  • Allow for flexible working
  • Recognise the potential need for sickness absence

Urogenital problems, such as increased need and frequency to urinate and irregular periods

  • Ensure staff have easy access to toilet and washroom facilities
  • Allow for more frequent work breaks to use toilet facilities
  • Ensure easy access to supply of cold drinking water
  • Ensure peripatetic workers can access facilities

Psychological problems, including loss of confidence, memory loss, difficulty concentrating and changes in mood

  • Encourage employees to discuss concerns openly at one-to-one meetings with their managers or occupational health representative, and negotiate possible adjustments
  • Provide access to counselling services
  • Address work-related stress through risk assessment and implementation of the Health and Safety Executive’s management standards

Itchy skin and formication (crawling sensation on skin)

  • Avoid use of nylon uniforms
  • Ensure working temperatures are comfortable

Muscular aches and bone and joint pain

  • Be aware that moving and handling or adopting static postures may be more uncomfortable
  • Make any necessary temporary adjustments through review of risk assessments and work schedules

Weight gain

  • Be aware that individuals’ uniforms may become uncomfortable and they may experience difficulties with mobility
  • Promote physical well-being at work

Psychosocial and social impact

  • Be aware these symptoms can leave nurses feeling isolated from work colleagues
  • Promote physical and mental well-being at work
  • Provide access to counselling
  • Provide opportunities to network with colleagues experiencing similar issues

Source: The Menopause and Work: Guidance for RCN Representatives

How COVID-19 measures can compound the effects of menopause

Carmel Bagness Picture: David Gee

The RCN says that employers in the healthcare sector are getting better at looking after staff going through the menopause.

‘There has been real progress, though there is always room for further improvement,’ says Carmel Bagness, RCN professional lead for women’s health.

‘Employers, managers and occupational health teams need to understand and actively engage with the issue. Those that have in recent years have generally moved things forward, including initiatives in the public and private sectors. However, the situation does vary between employers, and much more can be achieved.’

While the world’s population struggles with the unprecedented challenge of COVID-19, the need for, and challenges of wearing, PPE will continue. But building in regular breaks, where nurses can doff their PPE, cool down and drink cool water, can help, menopause experts say.

Being aware of the discomfort PPE can cause to women experiencing hot flushes and sweats is one of the areas that employers should be aware of, the guidance says. Limiting the time spent in PPE could help nurses who have become less tolerant of workplace temperatures.

Making cool drinking water widely available can help nurses with urogenital problems (another menopause symptom) or experiencing a hot flush.

Other measures include providing access to changing facilities during shifts so nurses can change their uniforms, and providing comfortable uniforms in natural fibres to help with hot flushes and itching. Some women gain weight when going through the menopause and making different sizes of uniform available can help improve comfort.

Discussing symptoms can raise awareness and set changes in motion

Menopause specialist Kathy Abernethy

Encouraging nurses to discuss symptoms with their managers, colleagues and the HR department can help support discussions around actions that can be taken, the RCN document says.

London NHS menopause specialist Kathy Abernethy, director of menopause services at Peppy Health, says awareness about the impact of the menopause among employers, including NHS organisations, has improved significantly over the past two or three years.

But she says that she is often still approached by nurses with questions about symptoms. This is because there is still not a good pathway for NHS staff who need rapid access to support when coping with symptoms, she says.

Putting in place direct access to help and support, similar to that available if employees experience back problems or other injuries, would not only benefit the nurses affected, but makes good business sense for the NHS as it can help retain staff and reduce sickness absence, she says.

Barriers to making effective changes in the workplace

Such change in the workplace can make a big difference for nurses, but remains difficult to achieve, Ms Abernethy says.

‘The pressures on the NHS are so large that there is little flexibility,’ she says.

‘In a private organisation there may be a bit more space for changing or reducing hours or coming in to work a bit later, but in the NHS there is no flex as there is no space or time. The impact of the menopause on the health workforce is still a much bigger issue than we understand, and nurses are still not clued up any more than the rest of the population.’

Advanced nurse practitioner in menopause Nikki Noble, of Aneurin Bevan University Health Board, stresses that relatively small changes in the workplace can make a big difference for a nurse struggling with menopausal symptoms.

‘Changes can include allowing nurses to have regular short breaks if they are working, especially in a ward environment, so they can get five minutes to themselves, cool down and drink some water if they are feeling hot and flustered,’ she says.

‘Having access to changing facilities can help women experiencing hot flushes. These small allowances can be the difference between a woman coming in to work if she’s had a bad night’s sleep and is not feeling great, or her calling in sick.’

Taking regular breaks to rehydrate is important Picture: Chris Balcombe

Measures can also be taken to help nurses struggling with PPE, she says.

‘PPE is a difficult one at the moment, and in my experience it’s not so much women in intensive therapy units, as they tend to have good air conditioning that keeps temperatures down, but more in other areas like high dependency units and general wards, where wearing full PPE is not so normal,’ she says.

Importance of access to toilet facilities

During perimenopause and menopause, some women experience irregular periods while others have a more frequent need to urinate, meaning access to washroom facilities is essential. This stands for all affected nurses, including those working shifts and in the community, where accessing toilet facilities can be difficult.

Wendy Lanham, a nutrition specialist nurse in the community, says accessing toilets can be a big problem, even more so at the moment with many being closed for COVID-19 restrictions. She is looking at creating an NHS-friendly toilet scheme for community nurses in her area in the West Midlands, to make access easier.


of the NHS workforce is female

(Source: NHS Employers)

‘With buildings shut, nurses are often having to queue to access places and potentially pay parking fees to use a toilet. It has a knock-on effect on staff and the working day, and also causes issues when employing bank staff, who don’t know where the open toilets are.’

Workplace policies on menopause and well-being

The RCN and nursing experts say that a workplace well-being policy which recognises the menopause is a good starting point for workplace improvements, along with raising managers’ and colleagues’ awareness of the menopause and its impact on work.

This should also include providing information for woman on how they can alleviate symptoms themselves.

Recognising that the experience of menopause will differ greatly for different individuals is important when supporting staff, the RCN says.

People who identify themselves as non-binary, transgender or intersex may experience menopausal symptoms, and their menopause may be different.

Healthcare professionals need to understand that the perceptions of the menopause may also differ in relation to disability, age, race, religion, sexual orientation and/or partnership status.

‘The key is to always consider an individual in their own circumstances and support them according to their particular needs,’ the RCN document says.

A staff menopause clinic where self-referral is an option

Clinic staff can prescribe HRT
Picture: iStock

Nikki Noble, advanced nurse practitioner in menopause at Aneurin Bevan University Health Board, runs a specialist menopause clinic for NHS staff in the Gwent region.

Nurses can self-refer and all the service staff can prescribe hormone replacement therapy (HRT).

‘It is extremely popular,’ Ms Noble says. ‘It offers quicker access to a specialist service, and some nurses who come say they haven’t always got the response they want from GPs. If they are having any difficulty with any HRT we have prescribed, they can email us and we are accessible.’

In Wales there is also an NHS Wales Menopause Policy that says employers should ‘work proactively to make adjustments where necessary to support individuals experiencing the menopause and to ensure the workplace does not make their symptoms worse’.

Staff who use her service have used the policy to successfully get adjustments at work, such as shorter hours or later starts, Ms Noble says.

Erin Dean is a health journalist

Further information