Managing the menopause and work: support for nurses

Nurse specialist in sexual health and the menopause Ruth Bailey explains how nurses should be supported to manage the symptoms of menopause in the workplace

Why should nurses recognise menopause as workplace issue?

The nursing workforce is predominantly female with a significant proportion of nurses in the age group affected by menopause.¹ The experience of menopause can result in sickness and absence, under-performance, reduction in hours and a high turnover, so managing the menopause is an important occupational health issue. In December 2023, the Royal College of Nursing published a menopause position statement containing principles of good practice and evidence-based resources to support nurses and their employers.²

What is menopause and perimenopause?

Menopause is defined by the cessation of periods and perimenopause is the time that leads up to this, often characterised by irregular periods and symptoms of menopause. In the UK the average age of menopause is 51, early menopause occurs between 40-45 and 1% of women experience Premature Ovarian Insufficiency (POI) which occurs under the age of 40. Menopause usually happens naturally but it can be the result of other causes such as surgery, cancer treatment or autoimmune disease.

The experience of menopause varies widely and there is a broad range of symptoms (see Table 1). Hot flushes are the most common and can be extremely disabling.³ The most common symptoms affecting work are poor memory and concentration and loss of confidence.⁴. It is vital that nurses have an individual assessment so that a personalised plan can be put in place to support them. This should involve asking about their personal experience of symptoms and advice on the risks and benefits of specific treatment options that will address their concerns, including lifestyle measures, HRT, non-HRT options and additional medication that may help symptoms, for example adding in contraceptive methods to manage heavy menstrual bleeding.

Table 1 Some Common Symptoms of Menopause⁵

Vasomotor	Psychological	Reproductive system	Systemic
Hot Flushes	Anxiety	Irregular periods	Joint aches
Night Sweats	Mood swings	Heavy bleeding	Fatigue
Insomnia	Irritability	Dry vagina	Weight gain
Palpitations	Brain fog	Painful sex	Headaches
Dizziness	Difficulty concentrating	Low libido	Dry eyes/skin

Self-care and accessing treatment.

Menopause is a time of transition when women’s lives and responsibilities are changing. It can be a good opportunity to take stock, reassess the work-life balance and re-evaluate priorities. It can be uncomfortable for women, particularly nurses, to put their own needs first, but addressing symptoms of menopause can be life changing.

Lifestyle measures such as alcohol reduction, smoking cessation increasing movement and managing weight can be effective in managing symptoms and improving health.⁵ This can feel challenging for overstretched nurses, but simple measures such as parking further away on patient visits or going for a walk around the block at lunchtime can be useful strategies to increase a daily step count.

Cognitive behavioural therapy can be effective in giving women control over hot flushes and anxiety.⁶ This may be difficult to access on the NHS, but menopause specialists have produced an excellent self-help guide which is full of practical exercises and effective strategies.⁷ Talking therapies for community nurses are also available through the Queen’s Nurse Institute and Cavell Trust, and the award winning ShinyMind App offers digital support – although not specifically related to menopause, they can be extremely effective support strategies.

The use of HRT is first-line treatment and has the added advantage of protecting the cardiovascular system and bone health.⁶ This includes oestrogen replacement for symptom management and, for women with a uterus, progesterone to protect the womb lining. HRT can be given as an oral tablet, but transdermal administration using a patch, gel or spray lowers the risk of venous thromboembolism.^6,8 Topical oestrogen is useful for relieving vaginal dryness and can have sex more comfortable and women experiencing low libido may benefit from testosterone available off-licence.⁵

Women should have the opportunity to discuss the risks and benefits of all their options to find treatment that is right for them. If HRT is contra indicated or unacceptable, suitable alternatives should be offered.

Employer responsibilities

Menopause is not a protected characteristic, but employers have a duty of care to staff and nurses disadvantaged by menopause could claim discrimination on grounds of age, gender, disability or gender affirmation.⁹ For example, a nurse experiencing menopause related joint pain could reasonably expect an employer to make reasonable adjusts to a caseload that was physically demanding. Nurses undergoing performance management for issues driven by menopause symptoms, such as poor concentration, could expect to these to be taken into account as mitigating factors.

Each of the four countries within the UK has legislative framework to support menopause at work.² Employers are required to have a clearly defined policy that normalises menopause and creates a supportive environment for staff to recognise symptoms, access help and make reasonable adjustments to enable staff to thrive. Policies should outline the training and education for managers and the strategies they have in place to support staff. This may include introducing ‘menopause cafés’ which offer informal peer support, or ‘menopause champions’ who can raise awareness and be a point of contact for advice.² Nurses should expect their employer to normalise menopause and recognise it as an occupational health issue.² Supporting policies and education and awareness for managers can be impactful strategies.¹⁰

Reasonable adjustments at work

Simple adjustments at work can have an enormous impact on employee performance. The specific adjustments will depend on the needs of the nurse and should be balanced with service requirements, so it is important for nurses to discuss this with their line manager to negotiate a person-centred approach. Examples of reasonable adjustments include working flexibly, avoiding manual handling and reducing the time spent wearing PPE.¹¹ Providing good ventilation and fans can be helpful, and alternatives to uniforms with lightweight fabric can make women much more comfortable. It is important for nurses to take regular breaks, stay adequately hydrated and work to their set shift times.

Menopause is a significant occupational health issue that effects the nursing profession. It is crucial that nurses are encouraged to recognise their symptoms, and access appropriate treatment and support to enable them to practise effectively and thrive at work.

Checklist for managing the menopause and work

Don’t put up with symptoms that impact upon your working life, seek help from a healthcare professional trained in menopause management.
Prioritise self-care; make sure you are getting the breaks you need, leave work on time, and do something for yourself every day.
Employ effective lifestyle strategies: aim for 150 minutes of movement a week, eat a balanced Mediterranean style diet which includes calcium, ensure you are well hydrated and take a vitamin D supplement.
Talk to your line manager to discuss your experience of menopause and negotiate reasonable adjustments that may help.
Access your employer’s menopause policy and menopause champion for support.

Ruth Bailey is an ANP in sexual health, BMS accredited menopause specialist, Queen’s Nurse, Chair, RCN Women’s Health Forum and FSRH Council Nurse Rep.

References