Menopause, as an issue, lies at the intersection of gender, sex, reproduction, ageing, public health and economy, affecting millions of individuals worldwide. For many, menopausal transition can be associated with unpleasant symptoms and physical/psychological changes that negatively impact quality of life and have implications for long term health. Some may face discrimination and exclusion at social and economic levels at this stage of life.

There has been a significant recent focus in the media on menopause and the difficulties of living through the menopausal transition for some individuals, with its impact on quality of life and work productivity. This presents an opportunity to create more awareness of menopause-related health and quality of life. However, more work needs to be done to address inequalities that exist in relation to access to evidence-based healthcare, as well as workplace and social support for women across various sociocultural backgrounds and for transgender, non-binary and gender- fluid individuals.

AN UNMET NEED FOR EDUCATION

The prospect of going through the menopause provokes anxiety and uncertainty for many individuals. There remains a lack of educational framework or resources that can help prepare them for what is to come. Many individuals under 40 years of age have limited education regarding the menopause.

That limited education for women and their general practitioners is causing perimenopausal women to go through this stage in their lives without knowledge and appropriate medical care is a case in point.^1,2 Instead of looking at this time in one’s life as a new and natural phase, many menstruating individuals get redefined in terms of loss of fertility, loss of femininity, an altered role in the family and a change in societal status.

ADDRESSING INEQUALITIES

Currently, in UK law, menopause is not a specific protected characteristic under the Equality Act 2010 which protects workers against discrimination. However, as per the Health and Safety at Work Act 1974, an employer must, where reasonably practical, ensure everyone’s health, safety, and welfare at work. Employers are encouraged to have workplace policies in place that support staff affected by menopause.

There are several factors that play a role in health inequalities related to menopause. First, the majority of global research and clinical care infrastructure remains focused on women’s well-being in relation to reproductive health concerns and unique requirements of adolescent and fertile women. There is a need for more research funding and investment of clinical resources in healthcare related to perimenopause and menopause.

Furthermore, there are biological variations in age at menopause and severity of menopausal symptoms across ethnicities. Studies show that women of colour tend to enter perimenopause and menopause at earlier ages than their white peers, have longer transition periods, and experience more intense hot flashes and vaginal symptoms.³ Current healthcare systems do not sufficiently address menopause-related issues that are specific to different ethnicities, and there remain barriers related to language, access to information and cultural taboos in seeking health advice. Research on menopause is also largely focused on the white population. These factors underpin the need to improve participation from other ethnicities as well as transgender individuals.

SOCIETAL ISSUES

Societal attitudes and sociocultural perceptions can affect how individuals perceive and manage their menopausal symptoms, and these can vary significantly.

For instance, in some rural villages in India, Iran and Africa, where fertility and having large families are highly valued, women may fear, as they reach menopause, that their husbands might abandon them for younger women and that they might face exclusion.⁴

There has been an evident shift in women’s participation and contribution to the global economy. This also means that a growing number of women aged 45 years and older participate in the labour market, making menopause an integral part of working individuals’ lives. However, despite their significant economic contribution, a parallel trend has been the impact on an individual’s career projection in the menopausal years, with significant menopause-related productivity losses and negative experiences in the workplace due to menopause.⁵

Importantly, menopause is not experienced exclusively by women; rather, trans men, trans women and non-binary and gender-fluid individuals also experience menopause. However, hitherto, menopause literature is largely framed around the experiences of cisgender women, with transgender individuals receiving little or no guidance about what happens when they reach the age when women typically go through menopause.

In one study, transgender women expressed uncertainty regarding clinical management approaches at and beyond the menopausal age, as well as for those beginning hormone replacement therapy at this age. This ambiguity reflects the lack of consensus on hormone therapy management within healthcare provision and the lack of empirical evidence relating to long term effects after the age of 50.⁶

CHANGING THE NARRATIVE

It seems pertinent to change the negative narrative around the menopause, to one which is not tied to ageist and sexist stereotypes. Greater menopause awareness among all individuals will help tackle negative notions around menopause and help build constructive responses towards transitioning human physiology. Such awareness can be achieved by means of an educational curriculum starting from school, public health awareness campaigns, workshops, programmes, literature in different languages, involvement of ethnic/transgender groups and workplace policies.

Workplace menopause policies and support for individuals experiencing difficulties during menopause will ensure help for the quickest growing workforce demographic. The ability to retain these workers would greatly benefit the employee, employer and economy.

The current gaps in the discourse around menopause necessitate awareness and education for all individuals, particularly medical professionals and menstruating individuals themselves, so that equitable and inclusive healthcare becomes a reality.

DISCLAIMER
The term ‘individuals’ is used to identify all who experience menstruation as well as menopause.

NALINI KAUSHIK
Founder, BleedEqual, and India Managing Director, DevUp Global Consulting Pvt Ltd, New Delhi, India

VIKRAM TALAULIKAR
Associate Specialist in Reproductive Medicine, University College London Hospital, and Honorary Associate Professor in Women’s Health, University College London; British Menopause Society certified Menopause Specialist

REFERENCES

1. Munn C et al. 2022 Women’s Health doi: 10.1177/17455057221139660.
2. Harper JC et al. 2022 Women’s Health doi: 10.1177/17455057221106890.
3. Avis NE et al. 2018 Obstetrics & Gynecology Clinics of North America 45 629–640.
4. Hall L et al. 2007 Journal of Holistic Nursing 25 106–118.
5. CIPD 2019 Majority of Working Women Experiencing the Menopause say it has a Negative Impact on them at Work.
6. Mohamed S & Hunter MS 2018 International Journal of Transgender Health 20 98–107.