The menopause at work: guidance for people managers

Menopause shouldn’t be a taboo, and everyone should feel they can have a conversation with their line manager, especially when they need guidance and advice. But how confident do you think a member of your team would feel to talk to you about the menopause? Research from Bupa has shown that almost a million women have left their job because of menopausal symptoms such as hot flushes, night sweats and increased anxiety, while others are forced to take long-term absence from work to manage symptoms.

Often a few simple changes to the working environment can make a world of difference – even just talking about the menopause openly can reduce the impact of some symptoms and enable people to continue performing well in their roles. Line managers play a vital role in supporting colleagues with menopausal symptoms and this guide will help you to:

be confident about your role in managing and supporting colleagues with menopausal symptoms
understand and reduce the barriers that could potentially prevent a colleague going through the menopause transition from performing and/or developing to their full potential
identify appropriate workplace changes or adjustments to support team members and help them thrive at work
foster an inclusive working environment in which everyone is treated fairly.

While we predominantly talk about women in relation to the menopause in this guidance, we also recognise and appreciate that it can impact trans and non-binary people who don’t identify as women in the same manner. Although unusual, menopause can still be experienced by a few trans masculine and non-binary-identified people whose female characteristics may persist at this stage of their lives. They require the same support and flexibility in the workplace as others with similar symptoms.

This guide has been produced in partnership with Bupa

Helping you retain valuable talent by supporting women through menopause
What every manager needs to know about the menopause
How can I help if someone is going through the menopause?
It’s good to talk about the menopause
Carrying out risk assessments and making appropriate adjustments
How can I manage proactively and positively if someone’s performance is affected by the menopause?
Where can I find more information?

Helping you retain valuable talent by supporting women through menopause

A few simple changes can make a world of difference

Whether you’re a line manager in a large business or the leader of a small company, the chances are you employ or manage at least one woman. And most women will experience menopausal symptoms at some stage. It’s a natural stage of life experienced by around half of the workforce at some point, and yet it’s a taboo subject in many workplaces. This means many employees with menopause symptoms, which can be severe, suffer in silence. But the menopause needn’t be an awkward or embarrassing topic, and it certainly shouldn’t mean that anyone needs to press pause on their working life. Often a few simple changes to someone’s working environment can make a world of difference – enabling someone experiencing menopausal symptoms to continue performing and contributing to their full potential. Even just being able to talk openly can reduce the impact of someone’s symptoms.

The key behavioural areas that will assist you in managing this issue are:

Building and sustaining relationships – this is vital if you are to have the trusting, open relationships with team members that are needed if they are to share concerns relating to menopause. This behavioural area also involves showing empathy, concern and consideration for people and providing opportunities for them to speak to you, which will enable early, sensitive conversations about such issues and their impact on work.

Providing knowledge, clarity and guidance when needed, including providing clear feedback, clarifying expectations, making time for people and giving advice and guidance to team members on their role and adjustments that can be made if required.

The ‘seeking appropriate support’ aspect of the behaviour area Handling conflict and people management issues will ensure that you seek support for yourself and your team members when needed and use organisational resources and frameworks as appropriate.

Exercise 5, Exercise 4 and Exercise 3 offer advice on how to develop these behaviours.

This guide offers advice in managing the main areas where managers can provide support:

improving your understanding of what the menopause is and how it can affect people
knowing your role as a manager, for example, in understanding organisational policies and support
having open and honest conversations to be able to offer appropriate support
contributing to risk assessments and making adjustments
knowing how to support performance where this is impacted by health issues.

Putting menopause at the top of the business agenda: Bupa viewpoint

Menopausal women are the fastest-growing demographic in the workplace; however, many of these women may be struggling to manage the psychological and physiological changes their bodies are going through.

A quarter of menopausal women will experience debilitating symptoms – from hot flushes and night sweats to increased anxiety – and for some it forces them out of the workplace completely.

This means that experienced women are leaving the workforce. These women are likely to be at the top of their game, but without the right support, at the right time, they are unable to reach their full potential for businesses to reap the benefits from. We need to protect this talent.

It’s not really a surprise that menopause isn’t openly talked about in the workplace; symptoms are personal and sometimes embarrassing. A large number of women find their symptoms negatively affect their job performance and many lose their confidence. Our research shows that almost a million women have left their job because of these symptoms. And others are forced to take long-term absence from work to manage symptoms, taking an average of 32 weeks’ leave throughout their career, resulting in a huge loss of productivity to a business.

Businesses should be able to recognise when support is needed and facilitate open conversations with employees about what they’re experiencing. Menopause shouldn’t be a taboo, and everyone should feel confident to have a conversation with their line manager, especially when they need guidance and advice.

Open cultures need to be created where women feel comfortable to say they’re struggling with symptoms. Internal campaigns or webinars for staff are a great way to do this, enabling and starting a conversation for people. External speakers are a great way to engage people.

Policies also need to be updated to reflect menopause – it needs to be included in sickness and flexible working policies to take into account symptoms such as night sweats and insomnia. Companies must be flexible to their teams’ needs to make sure they’re performing to a high standard and getting the best productivity and engagement from them.

As well as education and creating open cultures, businesses must invest in services that support women to enable them to perform at their best. It’s important that line managers are able to signpost their team to services and understand what help and support these are able to give.

Offerings such as virtual GP services and mental health helplines are incredibly valuable for women as they can access them any time from any location to get support on a range of symptoms they’re experiencing.

Bupa Health Clinics has launched Menopause Plan, a service giving women access to a menopause-trained GP, enabling them to seek help and support during a 45-minute appointment. Women will also have a follow-up appointment and access to nurses who have been skilled in menopause care for a year after their first appointment.

This service is available to businesses to help them support the women in their organisations.

It’s time to put menopause at the top of the business agenda and address the taboo. Businesses that do so will attract and retain strong female talent

Alaana Woods, Bupa Health Clinics

What every manager needs to know about the menopause 

What is it?

Every manager should know what the menopause is, when it happens and how it can affect people.

It’s a natural stage of life when oestrogen levels decline and periods stop. As menopausal symptoms are typically experienced for several years, it is best described as a ‘transition’ rather than a one-off event.

When does it happen?

The menopause typically happens between age 45 and 55, but it can be later. The ‘perimenopause’ is the phase leading up to the menopause, when hormone balance starts to change. During this time a woman may start to suffer with menopause symptoms but is still having periods. The menopause is said to be reached when periods have been absent for a year. The symptoms last on average for four years, but for some can last much longer. The average age to undergo the menopause in the UK is 51, but around 1 in 100 experience it before the age of 40. This is known as premature ovarian insufficiency (POI), premature ovarian failure or ‘premature menopause’. It is called ‘early menopause’ if it occurs between the ages of 40 and 45. Often, there is no clear cause for the early onset of menopause, but it can be as a result of surgery (for example oophorectomy), illness or treatment (such as chemotherapy or radiotherapy).

What are the symptoms?

The menopause can cause a wide range of physical and psychological symptoms that can last for several years. The majority of menopausal women experience symptoms, but everyone is different. Symptoms can fluctuate and be felt to varying degrees. Experiencing any of the typical symptoms can pose a challenge for women as they go about their daily lives, including at work.

Some of the most typical symptoms of the menopause include:

psychological issues such as mood disturbances, anxiety and/or depression, memory loss, panic attacks, loss of confidence and reduced concentration
hot flushes (brief and sudden surges of heat usually felt in the face, neck and chest)
sleep disturbance that can make people feel tired and irritable
night sweats (hot flushes that happen during the night)
irregular periods and/or periods can become light or heavy
muscle and joint stiffness, aches and pains
recurrent urinary tract infections (UTIs) including cystitis
headaches
weight gain
palpitations (heartbeats that become more noticeable)
skin changes (dryness, acne, general itchiness)
reduced sex drive.

Remember, everyone is different. Symptoms can fluctuate and be felt to varying degrees.

How can I help if someone is going through the menopause?

Your role as a manager

You have an important role to play in ensuring that anyone experiencing menopausal symptoms gets the same support and understanding as if they had any other health issue. The role of line managers in supporting those experiencing menopause transition is crucial. Effective management of team members with menopausal symptoms that are impacting on their work will help you to improve your team’s morale, retain valuable skills and talent, and reduce sickness absence. Good people management is fundamental to supporting employee health and wellbeing, spotting early signs of ill health or distress, and initiating early intervention.

Line managers are typically:

the first point of contact if someone needs to discuss their health concerns or needs a change or adjustment to their work or working hours to enable them to perform to their full potential
responsible for implementing the policies and practices that can help someone experiencing the menopause to feel supported, and to be effective in their role
responsible for managing absence and keeping in touch if someone is off work ill or because of their menopausal symptoms, as well as supporting an effective return to work.

The level of trust you build with employees will determine the extent to which colleagues are able to discuss menopausal symptoms and any support or adjustments they need at work. Simple changes to your management style can make a world of difference:

Building relationships based on trust, empathy and respect will make it easier for an employee to feel comfortable about raising a health issue like the menopause.
Regular and informal one-to-ones with members of your team can provide the forum for a conversation about any changes to someone’s health situation, including the menopause.
Asking people how they are on a regular basis will help to create an open and inclusive culture, and encourage someone to raise any concerns.
Don’t make assumptions – everyone is different, so take your lead from the individual.

These aspects of your management style relate closely to the behaviour area Building and sustaining relationships. Exercise 5 offers advice on how to develop these behaviours.

You also need to be aware of the frameworks, policies and duties employers have relating to the menopause transition. If you’re a manager in a larger organisation, it’s essential that you know about your employer’s framework (if one exists) for managing people experiencing menopause transition and understand your role within that. Even if you don’t have a formal policy or framework in place, it’s important to understand the employer’s legal duty to make reasonable adjustments where needed. Seek support from your HR team or refer to our guide for people professionals. You can also ensure that members of your team are given information on events like health and wellbeing days that may take place in your organisation and know how to access any information and support offered by your organisation.

This relates to the ‘seeking appropriate support’ aspect of the behaviour area Handling conflict and people management issues. Exercise 3 offers advice on how to develop these behaviours. In addition, giving your team guidance and advice is part of the behaviour area Providing knowledge, clarity and guidance. Exercise 4 offers advice on how to develop these behaviours.

It’s good to talk about the menopause

Open and honest conversations

The easier you make it for someone to open up to you, the easier it will be to identify the support they need. Menopause can affect people’s confidence and it can be very daunting talking to someone who has no knowledge/awareness of the menopause. The more supportive and knowledgeable you are about the range of menopausal symptoms, the less likely that women will feel embarrassed to approach you and discuss how the menopause is affecting their health and their work. Awareness about the symptoms and range of support available in the organisation will also increase your own confidence in discussing the issue. Refer to the section above for information on what you need to know about the menopause or the useful resources at the end of this guide.

Starting the conversation

While any health condition can understandably be a sensitive and personal issue for many, some of the symptoms associated with the menopause can manifest themselves in a particularly intimate, even visible, way. It’s therefore understandable why many women could feel embarrassed and reluctant to discuss the impact of their symptoms. However, most people would prefer a concerned and genuine enquiry about how they are instead of silence.

Don’t make assumptions about someone’s health condition or ask them a direct question about their menopause symptoms. If you have concerns about someone’s wellbeing or performance, ask general, open questions such as, ‘How are you doing at the moment?’ or ‘I’ve noticed you’ve been arriving late recently, and I wondered if you’re okay?’ It’s up to the individual to disclose any particular symptoms or health issues they may be experiencing.

Approach conversations with empathy and try not to be embarrassed by the issue and how the individual is feeling. Regular catch-ups or one-to-ones are an opportunity to start the conversation, which should always be in a private, confidential setting where the employee feels at ease.

How to approach a sensitive conversation

It’s important to set the right tone when opening a conversation about any sensitive issue. But try not to worry too much – being oversensitive will stop you from doing or saying anything. Review the following checklist before approaching a sensitive conversation, and you won’t go far wrong:

Avoid interruptions – switch off phones, ensure colleagues can’t walk in and interrupt.
Ask simple, open, non-judgmental questions.
Avoid judgmental or patronising responses.
Speak calmly.
Maintain good eye contact.
Listen actively and carefully.
Encourage the employee to talk.
Give the employee ample opportunity to explain the situation in their own words.
Show empathy and understanding.
Be prepared for some silences and be patient.
Focus on the person, not the problem.
Avoid making assumptions or being prescriptive.

This checklist has been adapted from the CIPD and Mind’s People Managers’ Guide to Mental Health.

This relates closely to the behaviour area Building and sustaining relationships. Exercise 5 offers advice on how to develop these behaviours.

Confidentiality

If someone tells you about their health condition, including menopausal symptoms, this should be treated as confidential. If they want information about their condition to be shared, consent must be explicit. You should discuss with them who will be told and by whom, as well as the information they do or don’t want shared with colleagues.

Carrying out risk assessments and making appropriate adjustments

Why do I need to carry out an assessment?

In the UK, employers have a legal duty to make a suitable and sufficient assessment of the workplace risks to the health and safety of their employees. This includes making adjustments for women who are experiencing menopausal symptoms. It will also help ensure an employee’s menopause symptoms are not being exacerbated by their job.

Risk assessments

Risk assessments should consider the specific needs of menopausal women and ensure that the working environment will not make their symptoms worse. Often, making simple changes to the working environment can help to alleviate the impact of some symptoms. A risk assessment should look at issues such as:

temperature and ventilation
the materials used in any uniform or corporate clothing
access to toilet facilities and access to cold water.

The Health and Safety Executive offers tools and templates for carrying out risk assessments, including how to control risks.

What are the symptoms?

Some of the most typical symptoms of the menopause include:

psychological issues such as mood disturbances, anxiety and/or depression, memory loss, panic attacks, loss of confidence and reduced concentration
hot flushes (brief and sudden surges of heat usually felt in the face, neck and chest)
sleep disturbance that can make people feel tired and irritable
night sweats (hot flushes that happen during the night)
irregular periods and/or periods can become light or heavy
muscle and joint stiffness, aches and pains
recurrent urinary tract infections (UTIs) including cystitis
headaches
weight gain
palpitations (heartbeats that become more noticeable)
skin changes (dryness, acne, general itchiness)
reduced sex drive.

Remember, everyone is different. Symptoms can fluctuate and be felt to varying degrees.

Discuss appropriate adjustments

Simple changes to someone’s role or working environment can help ensure the menopause does not become a barrier to performance.

Certain aspects of a job or the workplace can represent a barrier for someone experiencing menopausal symptoms. As a manager, you have a responsibility to consider and put in place reasonable adjustments to alleviate or remove these barriers wherever possible, so that women experiencing symptoms can carry on performing in their role.

Start by having a confidential, two-way conversation with the individual concerned, to identify the specific issues that person is experiencing. Consider involving relevant experts where appropriate, such as an occupational health practitioner, to help identify appropriate adjustments that could be put in place to ease the impact of their symptoms on their work. Record any specific needs (and agreed adjustments) and review these at least annually. Symptoms of the menopause can fluctuate over time, so make sure you have regular discussions with the person concerned to ensure that the support still meets their needs.

Adjustments should always be tailored to an individual’s specific needs.

What kind of adjustments could help?

Adjustments can be physical, such as providing a fan, but they can also involve changes such as offering a more flexible working arrangement. The menopause affects people in different ways, but there are some practical steps you can take to make adjustments to support women experiencing the menopause at work and help to minimise some of the most common symptoms.

What are the common symptoms and adjustments to consider for each?

Sleep disruption and/or night sweats

Recognise someone may take more short-term absence if they’ve had a difficult night.
Consider a change to shift patterns or the ability to swap shifts on a temporary basis.
Offer a flexible working arrangement, for example a later start and finish time.
Ensure employees know they can work from home on an ad hoc basis if they’ve had a rough night.

Hot flushes and/or daytime sweats

Look at ways to cool the working environment, for example provide a fan, move a desk close to a window or adjust the air conditioning.
Provide easy access to cold drinking water and washrooms.
Adapt uniforms to improve comfort.
Limit the time wearing personal protective equipment (PPE) such as face masks (subject to any COVID-secure measures required).

Heavy or irregular periods

Provide easy access to washroom and toilet facilities.
Allow for more frequent breaks to go to the toilet.
Be understanding about someone working from home if they have very heavy bleeding.
Make sanitary products available in washrooms.
Make it easy to request extra uniforms if needed.

Headaches and fatigue

Consider a temporary adjustment to someone’s work duties.
Provide a quiet area to work.
Provide access to a rest room.
Offer easy access to drinking water.
Allow regular breaks and opportunities to take medication.

Muscular aches, and bone and joint pain

Make any necessary temporary adjustments through review of risk assessments and work schedules.
Allow someone to move around or stay mobile, if that helps.

Psychological issues (for example loss of confidence, poor concentration, anxiety, and so on)

Encourage employees to discuss concerns at one-to-one meetings with you and/or occupational health.
Discuss possible adjustments to tasks and duties that are proving a challenge.
Address work-related stress by carrying out a stress risk assessment recommended by the HSE.
Signpost to an employee assistance programme or counselling services if available.
Identify a supportive colleague to talk to away from the office or work area, such as a wellbeing champion.
Allow time, when needed, to have some quiet time or undertake relaxation or mindfulness activities.
Provide access to a quiet space to work or the opportunity to work from home.
Have agreed protected time to catch up with work.
Discuss whether it would be helpful for the employee to see their GP, if they haven’t already.

Other examples of adjustments include:

Provide private areas for women to rest, recover or make a telephone call to access personal or professional support.
Ensure working time arrangements are flexible enough to meet the needs of menopausal women. For example, they may need more breaks during the day, or may need to leave work suddenly if their symptoms become severe.
Facilitate a comfortable working environment wherever possible – including adequate drinking water supplies, temperature-controlled areas, and access to toilets and showers or washing facilities.

Remember that menopause symptoms can fluctuate, so take a flexible approach and check in regularly with the individual.

This relates closely to the behaviour area Building and sustaining relationships. Exercise 5 offers advice on how to develop these behaviours. Involving relevant experts relates to the ‘seeking appropriate support’ aspect of the behaviour area Handling conflict and people management issues. Exercise 3 offers advice on how to develop these behaviours.

How can I manage proactively and positively if someone’s performance is affected by the menopause?

Managing performance

If someone’s performance is suffering, it’s important to help them address the root cause. In some cases, menopausal symptoms can be so serious that they affect a person’s performance at work. In this situation, it’s in everyone’s interest (yours, your employer’s and the employee’s) to discuss potential adjustments that could help the individual perform to their full potential. Where there are suspected or known health issues, these should be explored, prior to any formal processes for underperformance. Performance management should not just be a one-off annual appraisal meeting. It is most effective when it’s proactive, informal and based on regular and constructive feedback and discussion. This helps to build trust-based relationships and two-way dialogue, making it easier to address any underlying health issues. If you don’t address the root causes of poor performance, any solutions are unlikely to fully resolve the issue – and problems can spiral into sickness absence.

How do I manage health issues affecting performance?

Have regular, informal catch-ups with employees.
Approach performance conversations supportively and positively.
Take any health issues fully into account where there is underperformance on the part of an individual.
Identify any extra support or coaching the person may benefit from.
Set reasonable timescales for improvements.

Check out the CIPD’s resources on performance management for more information.

How to approach a sensitive conversation

Avoid interruptions – switch off phones, ensure colleagues can’t walk in and interrupt.
Ask simple, open, non-judgmental questions.
Avoid judgmental or patronising responses.
Speak calmly.
Maintain good eye contact.
Listen actively and carefully.
Encourage the employee to talk.
Give the employee ample opportunity to explain the situation in their own words.
Show empathy and understanding.
Be prepared for some silences and be patient.
Focus on the person, not the problem.
Avoid making assumptions or being prescriptive.

This checklist has been adapted from the CIPD and Mind’s People Managers’ Guide to Mental Health.

This relates to the behaviour area Providing knowledge, clarity and guidance. Exercise 4 offers advice on how to develop these behaviours. It also relates to the behaviour area Being open, fair and consistent. Exercise 1 offers advice on how to develop these behaviours.