Research and analysis

Menopause and workplace productivity

Published 20 August 2024

Rapid projects support government departments to understand the scientific evidence underpinning a policy area by convening academic, industry and government experts at a single roundtable. These summary meeting notes seek to provide accessible science advice for policymakers. They represent the combined views of roundtable participants and are not statements of government policy.

What evidence is there on the relationship between access to/uptake of individual health interventions for menopause and workplace productivity?

Meeting notes from a roundtable chaired by Dr Sue Mann, National Clinical Director for Women’s Health, facilitated by the Government Office for Science.

23 May 2024, 2:30pm-4pm

Key points 

• There is some evidence that early and severe menopause directly affects productivity and/or reduces time in employment, e.g. through reduced hours, increased sick leave or early retirement.  

• Healthcare and workplace measures both play a role in mitigating the impacts of menopause-related symptoms at work.  

• There is a shortage of evidence on the relationship between hormone replacement therapy (HRT) and productivity. The relationship is hard to assess due to factors including variations in HRT availability, variations in individual response to treatment and difficulties in measuring individual productivity.   

• There is a lack of research on the impacts of workplace interventions, such as occupational health or digital apps, on productivity.  

• There is some evidence to suggest the negative effects of menopause on productivity are concentrated among women with lower incomes, lower levels of education and among those working in the private sector. Reasons for this are not yet understood.   

• A better understanding of the relationship between menopause and productivity requires a mixed methods approach. There are opportunities to link primary care and survey datasets with labour market data.

Measures for workplace productivity 

1. There are multiple ways of measuring aspects of employment that impact productivity and may relate to the effects of menopause. These include:  

• self-reporting of productivity (both quantitative and qualitative), such as direct measurements (e.g. surveys or interviews asking specific questions related to productivity)  and indirect measurements (e.g. surveys or interviews asking how comfortable women feel discussing their symptoms in the workplace, job satisfaction, and wellbeing)

• absence (number of illness-related absences) 

• presenteeism (when an employee is at work despite being unwell; often hard to measure except through self-reporting)

• proximate metrics on total time in employment over a lifetime (e.g. in full- or part-time employment)

• employee retention (or turnover of employees who leave an organisation citing menopausal symptoms as a cause)

• aspects of worker performance such as sales or value added

• aspects of cognition related to performance, such as information processing and reaction times.

Correlation between menopause symptoms and productivity

2. There is credible evidence that identifies causal impacts of early and severe menopause affecting productivity and/or reducing time in employment (e.g. reduced hours, increased sick leave, early retirement) (Bryson, et al., 2022; Evandrou, et al., 2021; Whiteley, et al., 2013).   

3. Productivity loss related to menopause is not attributable to symptoms alone. Many women report that the symptoms of menopause themselves do not cause workplace productivity problems, but their treatment by others as a result of their symptoms does (Griffiths, et al., 2017).   

• Discrimination can lead to poor job satisfaction and feelings of unfairness, which can lower productivity or cause women to leave work. However, women may not report such issues as the cause of their departure (Atkinson, et al., 2021).   

4. Not all symptoms have the same impacts. Women experience physical menopause symptoms differently from psychological symptoms; it is important not to refer to ‘menopausal symptoms’ as a generality.   

• One study found that more severe physical menopause symptoms were related to poorer job performance, whereas more severe psychological symptoms were related to poorer retention. The study also found that the use of personal coping strategies was effective for mitigating the effects of physical symptoms (Steffan & Potočnik, 2023).  

• Vasomotor symptoms (hot flashes) tend not to be associated with lower employment rates, whereas psychological symptoms due to menopause do affect employment (Bryson, et al., 2022). For each additional psychological symptom, the adverse effect on employment rates increases.    

5. The impacts of menopause on workplace performance may not always be observable. Some studies suggest that productivity actually increases as symptoms worsen, in part due to women compensating by working unpaid outside working hours (Potočnik, et al., 2023; Bryson, et al., 2022).   

6. There is some research to suggest the negative effects of menopause on productivity are concentrated among women with lower incomes (D’Angelo, et al., 2022), lower levels of education and among those working in the private sector (Conti, et al., 2024). Reasons for this are not yet understood.   

Existing research on individual healthcare interventions for menopause and productivity outcomes

7. The available economic and psychological literature on the relationship between individual healthcare interventions for the treatment of menopausal symptoms and workplace productivity is sparse and conflicting.   

8. Regarding HRT for alleviating menopausal symptoms:   

• there is a shortage of evidence on the relationship between access to, and uptake of, HRT and productivity. Differences in doctors’ prescribing behaviours, the type of HRT prescribed, the availability of HRT by location and difficulty of measuring individual productivity make this relationship methodologically challenging to assess

• some research indicates HRT use has an economically significant impact on the employment of women aged 40-55 (Daysal, et al., 2011). Other research found the effects of early menopause and severe menopause symptoms on productivity were similar for women receiving and not receiving HRT (Bryson, et al., 2022).   

9. Digital health interventions, such as AI chatbots and apps, are showing promise in helping women and their employers better combine work and menopause challenges, but require further testing (SHAW, 2022).    

10. Barriers to individual women engaging with occupational health (OH) include lack of availability, women not knowing they are (peri)menopausal, women not seeing menopause as worthy of OH support, and concerns over gendered ageism.  

11. One trial found that women who received self-help cognitive behavioural therapy (CBT) had significant improvements in their experience of menopause symptoms and had reduced impairment at work compared to the control group (Hardy, et al., 2018).

12. Some research suggests interventions are more beneficial at an organisational level, because some problems around dealing with symptoms of menopause are workplace-wide issues (Griffiths, et al., 2017).  

13. A study linking primary and secondary healthcare records to employment and other administrative data in Sweden and Norway is researching menopause symptoms and HRT’s causal impacts on women’s economic lives and careers (Conti, et al., 2024).  There are data challenges in the UK system that make this type of study more difficult.  

14. The English Longitudinal Study of Ageing (ELSA) may be able to provide data on this topic as it contains self-reports of menopause onset age, HRT take-up, and wage and employment data (ELSA, 2024).   

15. Raising awareness is important in terms of helping women in the workplace gain access to support. However, not all women would welcome this due to concerns about stereotyping, cultural differences in menopause experience, stigmatisation and discrimination (Steffan & Loretto, 2024; Griffiths, et al., 2013).

Methodological challenges

16. Measuring productivity at an individual and quantitative level is challenging, as most workplaces cannot allocate output per worker measurements without incurring substantial costs.   

17. Most productivity data are from self-reported job performance. Self-perception has limitations, and some measurements are easier to quantify than others (e.g. absence).   

18. There are challenges in isolating menopause-related symptoms from other health conditions and other life stresses (work stress, elder care and financial precarity).   

19. There are challenges in identifying appropriate interventions to test (e.g. randomised trials, longitudinal studies), and then in deploying those interventions in such a way as to capture their causal impacts. The way interventions are implemented is important, and process evaluations should also be included in experiment design (e.g. Hardy, 2019).   

20. There are also problems with the external validity of studies, specifically the ability to extrapolate from results to wider populations.  

21. Most data focuses on women with severe menopausal symptoms, since these women engage most with healthcare services and workplace initiatives.   

22. It is hard to compare data between countries, as care pathways and medical training on menopause are so variable.

Evidence gaps

23. There is a lack of heterogenous data in this area of research, as well as:   

• a lack of longitudinal data  

• a lack of data on non-white women  

• data gaps on the experiences of neurodivergent menopausal women. This is increasingly important as more women of menopausal age are being diagnosed or self-diagnosed as neurodivergent. They may not be able to take HRT alongside other medications and/or may not have the same type of social support needs

• a lack of interdisciplinary research (e.g. studies co-designed by organisational scholars and clinical experts).

24. It is important to combine data sources that identify the occurrence and timing of menopause in women representative of the general population with administrative data on labour market outcomes. There currently exists no such dataset for the UK.   

25. The Office for National Statistics (ONS) holds a linked dataset for investigation of labour market outcomes related to health using Hospital Episode Statistics (HES) and is hoping to link primary care and survey data with labour data.  

26. Throughout the sparse literature on this topic, there is variability in the metrics used. It would be useful to establish key metrics and ways of measuring these objectively.

Attendees 

Sue Mann (Chair, National Clinical Director for Women’s Health), Alex Bryson (UCL), Belinda Steffan (University of Edinburgh), Charlotte Bermingham (ONS), Claire Hardy (Lancaster University), Gabriella Conti (UCL), Krystal Wilkinson (Manchester Metropolitan University), Lucy Chappell (DHSC), Michele Battisti (University of Glasgow).

References

Atkinson, C., Beck, V., Brewis, J., Davies, A. and Duberley, J., 2021. Menopause and the workplace: New directions in HRM research and HR practice. Human Resource Management Journal, 31(1), pp.49-64. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/1748-8583.12294   

Bryson, A., Conti, G., Hardy, R., Peycheva, D. and Sullivan, A., 2022. The consequences of early menopause and menopause symptoms for labour market participation. Social Science & Medicine, 293, p.114676. Available at: https://www.sciencedirect.com/science/article/pii/S027795362101008X   

Conti, G., Ginja, R., Persson, P. and Willage, B., 2024. The menopause” penalty. London: Institute for Fiscal Studies. Available at: https://ifs.org.uk/publications/menopause-penalty   

D’Angelo, S., Bevilacqua, G., Hammond, J., Zaballa, E., Dennison, E.M. and Walker-Bone, K., 2022. Impact of menopausal symptoms on work: findings from women in the Health and Employment after Fifty (HEAF) Study. International Journal of Environmental Research and Public Health, 20(1), p.295. Available at: https://www.mdpi.com/1660-4601/20/1/295   

Daysal, N.M. and Orsini, C., 2011. The Miracle Drug: Hormone Replacement Therapy and Labor Market Behavior of Middle-Aged Women. Available at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1996472   

English Longitudinal Study of Ageing (ELSA). 2024. Available at: https://www.elsa-project.ac.uk/   

Evandrou, M., Falkingham, J., Qin, M. and Vlachantoni, A., 2021. Menopausal transition and change in employment: Evidence from the National Child Development Study. Maturitas, 143, pp.96-104. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0378512220303868   

Griffiths, A., MacLennan, S.J. and Hassard, J., 2013. Menopause and work: an electronic survey of employees’ attitudes in the UK. Maturitas, 76(2), pp.155-159. Available at: https://www.sciencedirect.com/science/article/pii/S0378512213002235   

Griffiths, A., Hardy, C., Maclennan, S. and Hunter, M., 2017. Are individual or work-related factors associated with work outcomes in menopausal women? Maturitas, 100, p.193. Available at: https://www.maturitas.org/article/S0378-5122(17)30392-4/abstract   

Hardy, C., Griffiths, A. and Hunter, M.S., 2019. Development and evaluation of online menopause awareness training for line managers in UK organizations. Maturitas, 120, pp.83-89. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0378512218306467   

Hardy, C., Griffiths, A., Norton, S. and Hunter, M.S., 2018. Self-help cognitive behavior therapy for working women with problematic hot flushes and night sweats (MENOS@ Work): a multicenter randomized controlled trial. Menopause, 25(5), pp.508-519. Available at: https://journals.lww.com/menopausejournal/abstract/2018/05000/self_help_cognitive_behavior_therapy_for_working.9.aspx   

Potočnik, K., Steffan, B. and Zheng, S., 2023. The bright and the dark side of flexible work arrangements for managing menopause symptoms at work. In 16th Equality, Diversity and Inclusion International Conference (EDI). Available at: https://www.research.ed.ac.uk/en/publications/the-bright-and-the-dark-side-of-flexible-work-arrangements-for-ma

Steffan, B. and Potočnik, K., 2023. Thinking outside Pandora’s Box: Revealing differential effects of coping with physical and psychological menopause symptoms at work. human relations, 76(8), pp.1191-1225. Available at: https://journals.sagepub.com/doi/full/10.1177/00187267221089469  

Steffan, B. and Loretto, W., 2024. Menopause, work, and mid‐life: Challenging the ideal worker stereotype. Gender, Work & Organization. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/gwao.13136   

Supporting Healthy Ageing at Work (SHAW), 2022. Available at: https://www.shaw.business-school.ed.ac.uk/about   

Whiteley, J., DiBonaventura, M.D., Wagner, J.S., Alvir, J. and Shah, S., 2013. The impact of menopausal symptoms on quality of life, productivity, and economic outcomes. Journal of women’s health, 22(11), pp.983-990. Available at: https://www.liebertpub.com/doi/abs/10.1089/jwh.2012.3719