Suffering in silence: The stigma and impact of menopause in the workplace

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As companies endeavour to embrace diversity, equity, and inclusion, it’s time to focus on the health-related needs of women during menopause as well. What are the essential steps employers can take to unleash the full potential of this increasingly important workforce demographic?

Menopause is a normal part of aging and a natural transition that all females experience. Some believe that when menstruation stops, a woman is in menopause and the transition is over. In fact, menopause is divided into three stages: perimenopause, menopause, and post-menopause. A typical woman enters perimenopause in her 40s, reaches menopause between the ages of 45 and 55, and remains in post-menopause for the rest of her life. While each menopause journey is unique, a landmark survey sponsored and published by the Menopause Foundation of Canada in 2022 showed that 95 percent of the women surveyed said that they experienced symptoms, with an average of seven symptoms reported. Symptoms can range from the commonly known – such as hot flashes, sleep disturbances, night sweats, fatigue, and mood swings – to the lesser known – such as depression, anxiety, urinary incontinence, memory issues, and heart palpitations. The transition from perimenopause to menopause to post-menopause usually lasts many years and, thus, so can some of the symptoms.

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Menopause Foundation of Canada survey statistics

95% of women experience menopause symptoms

The transition from perimenopause to menopause to post-menopause usually lasts many years and, thus, so can some of the symptoms

Parvathy Sree, AmTrust Financial Services

While hot flashes generally subside three to five years after menopause, in some women they persist for 15 years or more. These symptoms may occur multiple times per day and can be severe enough to cause functional impairment. Given the prevalence and duration of VMS, it is critical for everyone, not just women, to understand the underlying biology of these symptoms, the extent to which VMS may impair quality of life, and whether VMS may serve as a marker for other important health conditions. The SWAN study (Vasomotor Symptoms and Menopause: Findings from the Study of Women’s Health Across the Nation), first published in the journal Obstetrics and Gynecology Clinics of North America in 2011, is one of the largest and most ethnically diverse longitudinal studies of the menopausal transition. The study enrolled 3,302 women across five racial/ethnic groups, and these women were followed for over 10 years. Thus, it provides a wealth of information and unique insights about vasomotor and other symptoms, health behaviours, and social and psychological functioning related to women in their midlife. The incidence rate of VMS can vary between race/ethnic groups. Of the five racial/ethnic groups studied in SWAN, African-American women were most likely to report VMS, followed by Caucasian and Hispanic women, while Chinese and Japanese women in SWAN were the least likely to report VMS.

information from the SWAN study suggests that VMS may be linked to certain adverse physical health outcomes, including subclinical cardiovascular disease and lower bone density.

46 percent of the respondents felt unprepared for perimenopause/menopause, while 55 percent wished that they had learned about it earlier in life. Women going through perimenopause/menopause saw their family physician as their most trusted source of information and advice for menopause. Despite this trust, only 27 percent of the respondents reported that their family physician proactively discussed menopause with them. Of the 41 percent who decided to seek out medical advice themselves, 72 percent found that the advice provided by their physician was not helpful or only somewhat helpful. 38 percent of the surveyed women felt that their symptoms were undertreated. While three-quarters (74 percent) of working women felt that their employer was not supportive or did not know if they had support to help them manage this stage of life, 29 percent of surveyed respondents reported fearing that others may see them as “weak, old, or past their prime.” 87 percent of surveyed respondents believed working women needed support through all stages of life, including menopause. 41 percent of surveyed respondents believed that their menopausal symptoms negatively impacted their relationship with a spouse or partner.

attributed to menopause. Despite its impact, talking about menopause at work remains taboo, with 40 percent of working women believing that there is a stigma around discussing the topic. Surveys and testimonials highlight their suffering, often in silence, while impacting their performance and causing them to feel uncomfortable when seeking support within the workplace.

There can be a genuine fear of prejudice and ageism; and empirical data have shown that ageism exists within the workplace. As a result, these women choose to cope and suffer in silence

Pamela Davis, Nonprofits Insurance Alliance

Menopause is often viewed negatively in our society. The stereotype of the menopausal woman is unflattering and is often fuelled by ageism, which devalues women as they get older. It is not surprising that women fear harsh judgment at this time of their lives. This fear prevents many women from talking openly about their health and seeking wider support when required. As companies endeavour to embrace diversity, equity, and inclusion, it is time to focus on the needs of older women. Three-quarters of women surveyed would like to see their workplaces offering support. The most common recommendations were as follows:

Creating workplaces that are truly welcoming and inclusive of menopausal employees while incorporating a robust benefits plan are essential steps for employers to institute to unleash the full potential of this increasingly important workforce demographic.

Mature adult woman working at home. Menopause.

Impact on work and economic burden

Employer and benefits plan call to action

Published Mar. 25, 2024

27% of respondents report their family physician proactively discussing menopause with them

Women experience an average of 7 symptoms

80% of women experience hot flashes, the most common symptom

38% feel their symptoms are underrated

in lost productivity

The workplace cost of menopause

$3.5 billion

estimated lost days of work attributed to menopause

540,000

would not feel comfortable speaking to their supervisor about their symptoms

67%

Menopause and Work in Canada statistics

would not feel comfortable speaking with HR about their symptoms

70%

would be embarrassed to ask for support that could make a difference

48%

What is menopause?

VMS, or hot flashes and night sweats, are often considered the cardinal symptoms of menopause. VMS are episodes of profuse heat accompanied by sweating and flushing experienced predominantly around the head, neck, chest, and upper back. VMS are the most common symptoms experienced by women during their menopausal years. The physiology is not fully understood, and it is believed that changes in reproductive hormone levels likely play an integral role.

Vasomotor symptoms (VMS) and menopause

In addition, pronounced variations across different ethnic groups of Hispanic women were noted in SWAN, with the highest rates of VMS reported among Central American women and the lowest rates among Cuban women. Other key risk factors for VMS as documented in SWAN include socioeconomic factors, smoking, and negative mood. VMS have shown to negatively impact sleep, mood, mental health, productivity, and presenteeism. Finally, emerging

There are an estimated 10 million women over the age of 40 in Canada, making up more than one-quarter of the population. Despite the size of this cohort, their healthcare and societal needs related to menopause have often been overlooked by healthcare professionals and not included as part of workplace health initiatives. Additionally, the Menopause Foundation of Canada survey showed that many women are suffering in silence and are not receiving the required support from home or the workplace.

Women over the age of 40 make up one-quarter of our workforce and, as a group, are a key driver of Canada’s economy. The fastest-growing segment of working women in Canada are those aged 45 to 55 – the time when most women reach menopause. For many, this is the prime age during their careers –when they are most likely to move into top leadership positions. However, when the symptoms of menopause hit suddenly, women in the workforce may be

afraid to bring this topic to the forefront and may be uncomfortable asking for support. There can be a genuine fear of prejudice and ageism; and empirical data have shown that ageism exists within the workplace. As a result, these women choose to cope and suffer in silence. Data from the Menopause and Work in Canada publication showed that:

67 percent would not feel comfortable speaking to their supervisor about their symptoms 70 percent would not feel comfortable speaking with HR about their symptoms 48 percent would be embarrassed to ask for support that could make a difference

Stigma of menopause in the workplace

For many women, the symptoms of perimenopause and menopause can be severe, and to just “live with it” becomes difficult. To help cope with the symptoms, some choose to reduce the number of working hours, while others pass on promotional opportunities or challenging roles. Some even choose to leave the workforce altogether.

32 percent of working women said that their menopause symptoms negatively impacted their performance at work 24 percent said they hid their symptoms at work 22 percent believed that their symptoms could affect their progression at work

Working women account for almost half of the workforce in Canada, with more than five million working women over the age of 40. This means that an estimated one-quarter of Canada’s 19 million-person labour force is either going through the menopause transition or is already post-menopausal. In 2023, The Menopause Foundation of Canada engaged Deloitte Canada to assess the economic impact of menopause. The results showed a staggering impact of $3.5 billion in lost productivity and an estimated 540,000 lost days of work

Ensure medical insurance plans provide coverage for menopause treatments and therapies Provide a toolkit for education and awareness among colleagues and managers Institute menopause-awareness sessions for employees, and encourage everyone to talk more openly about menopause Adopt policies incorporating time off and flexible work arrangements for menopausal symptoms Structure adjustments to the work environment for those going through menopause (e.g., cooler temperatures at work or providing a fan)

Sangkyung Bae & Moon Choi. (2023). Age and workplace ageism: A systematic review and meta-analysis. Journal of Gerontological Social Work, 66(6), 724–738, DOI: 10.1080/01634372.2022.2161685 Maria Manuela Jacob Cebola, Nuno Rebelo dos Santos, & Andreia Dionisio. (August 2023). Worker-related ageism: A systematic review of empirical research. Ageing & Society. 43(8), 1882–1914. Menopause Foundation of Canada. (2022). The silence and the stigma: Menopause in Canada (pp.7 and 12). Menopause Foundation of Canada. “Menopause and Work in Canada”, p. 11.

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Key findings from the survey were as follows:

"Menopause is not a doorway that you transition through, but a period of life that you continue to live in"

Excerpts, Mapol national webinar – February 28, 2024

Dr. Marla Shapiro, CM CCFP, MHSc, FRCPC, FCFP, NCMP Professor, DFCM, University of Toronto

"We really want to be able to do something to keep these very knowledgeable and highly trained women in the workplace and not leave because of symptoms that go unmanaged, unrecognized, or untreated"

"The bottom line for women and their employers is there has been a lack of information about menopause-related health complaints and the impact on work"