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Issue 143 Spring 2022

Endocrinologist > Spring 2022 > Features


MENOPAUSE: SPEAKING AN UNSPOKEN TRUTH

ANNICE MUKHERJEE | Features



Menopause, like puberty and childbirth, is a physiological stage of reproductive health. However, negative stereotypes, lack of positive representation and confusion about where to access support make this a complex issue for women today, especially within the workplace.

We know that approximately three out of four women experience menopausal symptoms, and more openness is needed. For approximately 25% of women, symptoms will be bothersome enough to impact their daily life.1

BREAKING THE TABOO

Media interest in menopause has sky-rocketed in recent years. Davina McCall’s 2021 Channel 4 television documentary ‘Sex, Myths and the Menopause’ raised awareness on a broad scale about issues surrounding menopause. Today, many women seek health information from media and social media platforms, and menopause is a growing commercial industry. Increasing awareness regarding menopause-associated health concerns and high adoption of women’s health apps indicate that women are increasingly a commercial target for the ‘menopause industry’.

There has also been considerable recent political interest. A parliamentary Private Members’ bill reading in October 2021 resulted in Government action to cut the cost of repeat hormone replacement therapy (HRT) prescriptions and a new Menopause Taskforce to improve support for women experiencing menopause symptoms, with implications in the workplace.

MENOPAUSE IN THE WORKPLACE

'Today, many women seek health information from media and social media platforms, and menopause is a growing commercial industry.'

Women over 50 are the fastest-growing employee demographic in the UK workforce, with over 3.5 million such women in employment.2 They offer a wealth of experience and skills.

However, 60% of 45–55-year-old women who are experiencing menopause symptoms say it impacts negatively upon them at work.3 So, it is unsurprising that menopause is becoming an increasingly important concern in UK workplaces. It deserves an open conversation, but menopause remains taboo at work. As such, menopause today is a personal journey and societal concern.

Over the last six years, the publication of several national guidelines concerning menopause in the workplace has aimed to redress the balance. Guidance has been provided by the Faculty of Occupational Medicine, the conciliation service ACAS, UNISON and the Chartered Institute of Personnel and Development, among others.

Menopause symptoms can be diverse, but usually settle over time. Support in the workplace aims to optimise productivity, facilitate retention and career progression for women in midlife, and help achieve gender balance in leadership roles.

In July 2021, a study highlighted the lack of gender parity amongst leadership roles in medicine.4 The British Medical Association (BMA) circulated a menopause survey to its members in 2019. It found that the majority of respondents in this demographic were not receiving any support from their employer. The results highlighted the need for cultural change in workplaces and made recommendations to facilitate flexible working, workplace adjustments and well-being support to help break the taboo.5

With increased awareness, some companies are starting to take action to support employees suffering from menopausal symptoms and to create menopause-friendly working environments.

Big brands such as Vodafone, the UK broadcaster Channel 4, HSBC and the car sales website Auto Trader have adopted menopause at work policies, including paid leave and menopause training. Such policies are currently considered good practice but are not mandated. Training for managers, fostering a culture of openness, identifying menopause-related difficulties early and referring for occupational health support where disruptive symptoms persist are strategies recommended to reduce any negative impact of menopause on workforce logistics going forward.

MANAGING MENOPAUSAL SYMPTOMS

The use of HRT during menopause has an established role in managing symptoms. Research into the risk–benefit ratio for HRT during the last two decades shows that risks are linked to age, co-morbidities, duration of treatment, type, dose and route of delivery. Reduced risks are associated with micronised progesterone and dydrogesterone for endometrial protection in women with an intact uterus, compared with other progestogens, and a favourable risk profile is observed with the use of transdermal oestrogen alone in hysterectomised women. Risk stratification can minimise previously documented cardiovascular, thromboembolic and breast cancer risks, and identify those unsuitable for hormone therapy.

'Big brands such as Vodafone, the UK broadcaster Channel 4, HSBC and the car sales website Auto Trader have adopted menopause at work policies, including paid leave and menopause training. Such policies are currently considered good practice but are not mandated.'

For those unable to use hormone therapy due to risk factors or co-morbidities, lifestyle strategies and several natural and non-hormone pharmacological therapies are available that women often find helpful. A novel neurokinin-3 receptor (NK3R) antagonist is in the pipeline, which significantly reduces menopausal flushing and other symptoms, with a good safety profile. It does not affect serum oestrogen levels and therefore may be suitable for women who are intolerant of or cannot use HRT safely. Pioneering work by Whaljit Dhillo and colleagues at Imperial College London resulted in the seminal paper on NK3R antagonists in 2017.6 Since then, several research groups have reproduced these results. Japanese-owned Astellas Pharma may be first to the mass market with Fesolinetant, which is expected to be licensed in 2022/2023.7

For all women, lifestyle approaches and an individualised, tailored approach to pharmacological intervention are critical for successful menopause health outcomes and workplace productivity.8

Annice Mukherjee
Consultant Endocrinologist, Manchester, UK and authors of The Complete Guide to the Menopause.8

References

  1. British Menopause Society 2021 www.thebms.org.uk/2021/08/the-british-menopause-society-response-to-the-department-of-health-and-social-cares-call-for-evidence-to-help-inform-the-development-of-the-governments-womens-health-strateg.
  2. Royal College of Obstetricians & Gynaecologists 2019 Better for Women www.rcog.org.uk/globalassets/documents/news/campaigns-and-opinions/better-for-women/better-for-women-full-report.pdf.
  3. NHS Employers 2021 Menopause and the Workplace www.nhsemployers.org/articles/menopause-and-workplace.
  4. Salem V et al. 2021 Lancet Diabetes & Endocrinology 9 556–559.
  5. BMA 2020 Challenging the Culture on Menopause for Working Doctors www.bma.org.uk/media/2913/bma-challenging-the-culture-on-menopause-for-working-doctors-report-aug-2020.pdf
  6. Prague JK et al. 2017 Lancet 389 1809–1820.
  7. Astellas Pharma 2021 News Release https://newsroom.astellas.us/2021-09-22-Astellas-to-Present-Fezolinetant-12-Week-Findings-from-Phase-3-SKYLIGHT-2-TM-Trial-in-Oral-Session-at-The-North-American-Menopause-Society-2021-Annual-Meeting.
  8. Mukherjee A 2021 The Complete Guide to the Menopause London: Vermilion.




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