Work and menopause: Eliminate mystique, address this health issue

Symptoms affect productivity; work conditions can worsen symptoms

As the American work force ages and women make up more and more of the labor force, occupational health nurses are giving more attention to the effects menopause may have on employees' health and productivity, as well as how working conditions might affect menopause symptoms.

Menopause is a "normal physiological event" that usually affects women starting in their 40s or 50s. A recent survey of members of the National Association for Female Executives revealed that 80% of women 35 and older who experience menopausal symptoms have had one or more symptoms interrupt their daily routines. Forty-four percent of those who experience insomnia say it has had a negative impact on their work productivity.

And while women are expected to soon make up half of the nation's work force, menopause is not a topic usually addressed in the workplace. In a setting such as a hospital, where up to three-fourths of the employee population can be female, the effects of this life change bear consideration.

Don't treat menopause like a disease

"We look at menopause like it's a normal physiological event, not an illness, and address it like other life changes and lifestyle issues," says Mary "Cricket" Barakzai, EdD, FNP-C, CNM, CNS, of the California State University, Fresno Department of Nursing. Barakzai and her colleagues offer a "Menopause or Madness" workshop for CSUF faculty and staff through the university's Life+Work+Links employee assistance and development program.

"Menopause is a normal process, like pregnancy," stresses Barakzai. "It's not a disease. So we try to offer some tips on how to handle various symptoms."

Emphasizing the normalcy of menopause and demystifying it is a major component in making women feel more at ease about menopause and making employers more open about it, which in turn can ease symptoms.

The Trades Union Congress in the UK conducted a survey in 2003 in which working women were asked about menopause and their jobs.

Somewhat predictably, the survey found that the most common symptoms experienced at work, and at times made worse by work, included hot flashes, headaches, lack of energy, sweating, anxiety, general aches and pains, dry skin and eyes, and short-term memory and concentration problems.

Significantly, despite the large numbers of women in the work force, the Trades Union Congress survey found that employers' health risk assessments did not take menopause symptoms into account as potential work issues.

Barakzai says with each generation, discussion of menopause, menses, and pregnancy becomes more open. However, she points out, there is still plenty of mystique and misconception when it comes to people's understanding of menopause.

"We try to deal with the misconceptions, such as why people have hot flashes, why someone can experience menopause even after having a hysterectomy," she says.

Despite increasing openness about women's physiological changes, occupational health professionals realize that part of the reason menopause's effects are overlooked as a work issue is because women going through menopause take great pains to appear as if nothing is wrong.

Especially in male-dominated fields, women may feel they'll be perceived as weak or unable to do the same job as their male — or younger female — counterparts. Male supervisors often don't bring the subject up for fear of a discrimination complaint.

The British survey of working women, however, highlights why employers should have a mechanism for accommodating or offering information and assistance to women experiencing menopause symptoms. Not only do the symptoms disrupt productivity at times, but working conditions can worsen the symptoms. Among the worst offenders, the survey indicates, are high temperatures in the work area, poor ventilation, inadequate or non-existent bathroom and rest facilities, and lack of access to cold drinking water.

Other factors that can exacerbate symptoms are stress, working in a fixed position for long periods, dealing with the public, managing other employees, heavy lifting, and long periods spent in front of a computer screen.

Make access to information easy, private

There is plenty of information available on menopause, its symptoms, and its health effects, and it's important to make that available to working women. Making it available privately or anonymously is likely to boost the number of people — male and female — who seek out information. Male employees can experience some side effects of a spouse's menopause (e.g., if she can't sleep, his sleep may be affected) or that of a female coworker (if symptoms are affecting her productivity), and information on menopause might reduce resulting friction.

In the CSUF wellness programs on menopause, Barakzai says there's lots of discussion about general healthy lifestyle choices, as well as discussion about what menopause actually means.

"In some cultures, it's welcome, but in general, mainstream America is a youth culture and menopause is a sign you're getting old," she says. "Whether you grieve that loss or you don't depends on your viewpoint."

Other things going on in a woman's life at the time influence that viewpoint: Are her parents getting older or in failing health? Are children leaving home? Is her overall health good or bad?

"The effect of hypoestrogenism on bones is a real hot topic now," Barakzai says. "Breaking your hip used to be a death sentence, but not anymore. Still, bone health has a serious effect on your quality of life, so there's a lot of interest in getting enough calcium, enough vitamin D, and in media reports on hormone replacement."

Offer suggestions to ease symptoms

Barakzai says women can look for triggers that cause hot flashes and other symptoms to flare up or worsen. Dressing in layers, avoiding spicy foods, and avoiding stress, when possible, are some basics.

The National Women's Health Resource Center makes the following recommendations:

Cool off hot flashes without hormone therapy

Suggest dressing in light layers that can be taken off when a hot flash starts; using a hand-held, battery-operated fan; and taking a tepid or cool shower before bedtime. For some women, alcohol or caffeine triggers hot flashes, so it can help to avoid these substances. If stress brings on hot flashes, try relaxation techniques such as deep breathing and meditation.

Weight gain at menopause common, but not inevitable

Most women gain weight, especially in their midsection, around menopause. This midlife weight gain is partly because of hormonal changes associated with menopause. However, weight gain also is associated with inadequate physical activity, and women tend to be less physically active as they grow older. Encourage female employees to reduce calorie intake and make exercise a priority.

Calcium, vitamin D key to bone, overall health

Remind women approaching menopause that adequate calcium intake — in the presence of adequate levels of vitamin D — plays a major role in reducing the incidence of osteoporosis. In addition, calcium also appears to have beneficial effects in several non-skeletal disorders, such as high blood pressure, colorectal cancer, obesity, and kidney stones. Most women who are peri- or postmenopausal should get at least 1,200-1,500 mg per day of elemental calcium, and, to ensure adequate calcium absorption, 400-800 IU per day of vitamin D. Calcium is best absorbed from whole foods or in supplement doses of 500 mg or less at a time, so 1,200- to 1,500-mg total doses should be split into two or three smaller doses.

[For more information, contact:

Mary "Cricket" Barakzai, EdD, FNP-C, CNM, CNS; Associate Professor/Graduate Coordinator, California State University, Fresno, Department of Nursing. E-mail:

National Women's Health Resource Center. 157 Broad Street, Suite 315, Red Bank, NJ 07701. Phone: (877) 986-9472. Web: Free materials available on menopause and other women's health topics.]