Heather, a newly hired dental hygienist at a private clinic, was doing well at work until she started experiencing menopause-induced hot flashes and migraines. Unable to sleep well at night, she also had difficulty finding words and focusing at work. She was perplexed and frustrated by these changes, and people were noticing her cognitive lapses at work and in social situations. She tried to get help from her physician, who was fearful of using hormone therapy due to potential cancer risks, and prescribed Gabapentin, which made her even more fatigued and slow at work. All of this began to affect her mood and overall well-being. Her hesitation to discuss the symptoms with her supervisor, and the absence of answers made things even worse. Given the high demand nature of her job, Heather decided to quit to avoid the embarrassment of being laid off by her relatively new employer.
Menopause, a universal experience of women as they transition to older adulthood, occurs on average at age 52. It can result in multiple symptoms—hot flashes, night sweats, sleep disturbances, cognitive difficulties, and mood problems—issues that act in isolation, or in combination to have a significant impact on women’s quality of life. Moreover, menopause symptoms are often under-recognized and undertreated for a variety of reasons. The use of hormone therapy, the most effective treatment for menopause symptoms, has declined across the past two decades, due to concerns regarding long-term risk, particularly the risk of estrogen-sensitive cancers, including breast cancer. As a result, the burden of untreated menopause symptoms is significant.
Because women of this age make up a substantial proportion of the global workforce, menopause symptoms have the potential to impact workplace productivity. Our group at the Mayo Clinic recently completed a study to evaluate the impact of menopause symptoms on women in the workplace. The findings were published in the Mayo Clinic Proceedings.
We invited more than 32,000 women between ages 45 and 60 who were receiving primary care at our institution to participate in a survey study. We received more than 5,000 responses, out of which 4,440 women reported current employment, and were included in the study.
Lost workdays due to menopause symptoms add up to an annual loss in the U.S. of $1.8 billion.
We found an association between menopause symptoms and adverse work outcomes, including lost work productivity. The severity of menopause symptoms strongly correlated with the odds of an adverse work outcome, with those experiencing the most severe symptoms being 16 times more likely to report an adverse work outcome. A little over 13% of the women who were surveyed reported at least one adverse outcome due to their menopause symptoms. About 11% women were missing days of work because of these symptoms. A little over 1% reported severe symptoms that caused them to quit their jobs, or to be laid off in the six months preceding the survey.
We also found that women belonging to racial and ethnic minority groups tended to have more severe menopause symptoms, with a greater impact on their work performance. Based on the lost workdays due to menopause symptoms, we estimated the annual loss in the United States to be $1.8 billion. When medical care–related costs are added to this figure, the total annual loss in the United States alone is estimated to be about $26 billion.
The findings of this study were shocking and brought to the forefront the significant challenges midlife women face in the workplace. These difficulties unfortunately come at the crucial time in many women’s careers when they are being considered for leadership roles. These experiences likely contribute to the highly prevalent sex-based disparity in leadership positions. Women are often at a disadvantage in their career advancement due to childbearing and childrearing responsibilities. To experience yet another impediment in their career path when they are finally past those responsibilities, during their midlife years, can be devastating.
The findings of this study, and other similar studies that have been conducted across the past few years, bring out the acute need to provide better menopause symptom management. This requires education of patients and healthcare professionals. Moreover, there's an immense need to educate supervisors and managers regarding the impact of menopause in the workplace.
The topic of menopause is taboo in general, and even more so in the workplace. Women often do not bring up menopause symptoms due to the fear of discrimination and stigmatization. They worry about being labeled as “complainers.” Workplace policies that promote a supportive environment, where women can talk about their concerns without fearing any negative consequences, would go a long way in reducing the psychological burden associated with menopause symptoms in the workplace. In addition, policies that provide some flexibility regarding building temperature control, work hours, and time away from work when needed, would be welcome as well.
Our study, and other similar studies, have received substantial media attention, and have generated thought-provoking discussions among the general public and healthcare professionals. We have seen a greater number of self-referred patients in our clinics, who have sought consultation for managing menopause symptoms.
We hope that with research like this we can positively impact the care of menopause symptoms in general and promote implementation of workplace policies that make this inevitable transition for midlife women as smooth as possible.
Ekta Kapoor, M.B.B.S., is an associate professor of Medicine at the Mayo Clinic College of Medicine in Rochester, Minn.