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“No one ever talks to you about menopause,” says Carlotta Berry, an electrical and computer engineer at Rose-Hulman Institute of Technology in Terre Haute, Indiana. But a few years ago, it hit Berry “like a steam truck”. She got brain fog, she grew irritable and cranky, and her hair fell out, twice. What she came to call her ‘private summers’ — the dreaded hot flushes — would arrive at inconvenient times, such as during lectures.

“I’d be up there teaching, feeling like I’m about to pass out and looking out at this sea of white young men,” recalls Berry, now 51. With no older female colleagues to turn to in her department, she was left to navigate the discomfort alone at work. “You are in a predominantly male career. Who are you going to talk to? You kind of suffer in silence,” she says.

Berry’s story isn’t rare. But it’s rarely told. Half of the world’s population can expect to experience menopause — a drop in reproductive hormones and the cessation of menstrual bleeding. Although the timing can vary by decades, the process usually occurs between 45 and 55 years of age. And with more women starting science careers, it follows that many are likely to experience this transition at key career stages. Yet, most workplaces don’t see menopause — and the mental and physical changes that accompany it — as something they have to support. And many women are reluctant to speak out for fear it might lead to them being labelled as problematic.

University workplaces are no exception. Whereas employers have become better at understanding and catering for the pressures of child-rearing, the needs of menopausal women are often overlooked. Menopause occurs at a time when women are likely to be assuming leadership positions in their teams or fields. Scientists face the added challenge that “universities can be very patriarchal places, and that is particularly still true in the hard sciences”, says Jo Brewis, a management- and organization-studies researcher at the Open University in Milton Keynes, UK, and an expert on menopause and the workplace. But universities ignore menopause at their peril. Failing to support staff through this stage of life puts institutions at risk of losing the expertise of senior women, and they could even be sued for discrimination, Brewis warns.

Employers already have many tools to accommodate staff — but employees and supervisors must first get to a point where menopause is demystified and destigmatized before discussions around solutions are likely to improve. “These aren’t easy conversations to have, but everything starts with education,” she says.

Managing menopause at work

Technically, menopause occurs 12 months after a person’s final period. But the word is often used to refer to the mental and physical changes leading up to, and following, this event. This includes perimenopause, when the amount of oestrogen produced by the ovaries begins to drop. Perimenopause can last for several years, and often involves irregular or heavier periods, hot flushes, and cognitive and mood changes.

Individual experiences vary greatly. Menopause is a natural stage of life for those with ovaries and a uterus, which includes anyone who menstruates, such as some transgender men and non-binary people. It is also more common than either pregnancy or motherhood. Some people experience ‘sudden’ menopause after having surgery to remove their ovaries. And some drugs, including tamoxifen, which is used to treat breast cancer, can push people into menopause.

Menopausal symptoms such as hot flushes, dry skin, weight changes, depression and sexual discomfort can remain for years. The drop in oestrogen also increases the risk of some health conditions, including osteoporosis and heart disease. These physical changes, together with changes in cognition and memory, can materialize at a time when researchers are hitting the pinnacle of their careers, with packed schedules and plates full of responsibilities.

When 58-year-old Elena Sanchez-Heras, a cell biologist at University College London, entered perimenopause a decade ago, it almost drove her to quit her job. Her periods had always involved low moods followed by painful stomach and back cramps, she says. She took over-the-counter pain drugs such as paracetamol and ibuprofen to cope when work required her to stand for hours at the bench in a cold laboratory. But as she entered perimenopause, the pain in her lower back became so bad, she recalls thinking: “This is killing me.”

Carlotta Berry posing for a portrait with some programmable vehicles

Menopause hit electrical and computer engineer Carlotta Berry “like a steam truck”, and now she counsels younger colleagues experiencing it.Credit: Haley Rose Photography

Menopause is increasingly featuring in the UK media and being spoken about by celebrities and other prominent people. Her university now has a menopause guidance document and a menopause network, but at the time, Sanchez-Heras wasn’t aware of any institutional policies that would support people in her situation. And the idea of speaking to her bosses — all male at the time — about her pain and discomfort was unthinkable. She worried that they might not understand what she was going through or, even worse, think of her as a troublemaker. She ended up suffering in silence, taking precious leave days to stay at home in bed when the pain and low moods were unbearable. “On the days I was really down, I was thinking, this is not the career for me,” she says.

Being able to go or stay at home on bad days without using up her leave would have helped Sanchez-Heras a lot. It might also have paved the way for conversations with her bosses. Having a more diverse management group would help, too, Sanchez-Heras says. She found it much easier to speak about personal challenges once the team gained a female leader.

Sorely needed support

There’s not much information on menopause experiences in workplaces around the world. But what there is suggests an underestimated drain on productivity and mental health. A US study published in Menopause in 2015 estimated that women experiencing hot flushes and night sweats have up to 60% more lost workdays than do their asymptomatic colleagues1. A 2021 report by the Fawcett Society, a gender-equality advocacy organization in London, found that more than half of women and transgender men experiencing menopause said their symptoms had made them less likely to want to apply for a promotion2.

In Australia, where women make up 57% of the higher-education workforce and 78% of the health and social-care sector, a survey last year of menopausal women working in health care and universities discovered that many felt guilty about their perceived underperformance3. Many of the respondents also said they wished to cut down on their working hours to improve their health and work–life balance. And a 2019 UK survey of 1,400 women experiencing menopause symptoms found that nearly two-thirds were less able to concentrate at work, more than half experienced more stress and nearly one-third took sick leave because of symptoms (see go.nature.com/3lrkjxc).

Brewis has found that many women working in science, technology, engineering and mathematics (STEM), are reluctant to discuss menopause with their bosses and colleagues. She suspects they fear it becoming another source of bias against women. “Anything that affects your ability to process information, your decision making, your focus — that’s not a good look for an academic,” she says.

She would know. Her own menopause symptoms have made it difficult for her to concentrate, with spells of forgetfulness. She recalls her embarrassment sitting down next to a colleague at a conference, only to draw a complete blank on her name. “We had a very warm professional relationship. And I could not remember her name.”

So, what can academic and private-sector scientific workplaces do to help staff navigate this time? Brewis, who has written guidelines for UK higher-education institutions on how and why they should support staff during their menopause journeys (see go.nature.com/3yuf5r7), says the most important thing is to raise awareness of what menopause is, and isn’t (see ‘Menopause resources’). “Menopause is still quite widely misunderstood,” she says. “There’s this assumption that suddenly you are a flushing, incapable mess.”

On a practical level, universities can educate managers about appropriate adjustments to accommodate menopause symptoms. For example, they can offer flexible working arrangements to allow time off for people who need to go to medical appointments, or to work from home when symptoms are at their worst. Giving staff more control over their working environment can also help, Brewis says. For example, having access to natural light and climate control can help to alleviate symptoms. Providing quiet rooms can dampen noise that might exacerbate concentration difficulties. Such accommodations, and others, including access to a private space to rest or deal with symptoms, would also support pregnant and breastfeeding researchers, disabled researchers and those dealing with chronic illness.

Of course, there are also many things individuals can do to alleviate their symptoms. For her hot flushes, Berry found comfort in wearing a portable, rechargeable fan that looked like a set of chunky headphones around her neck. She could use it discreetly while teaching and during lab sessions.

There are also medical remedies, the most well-known of which, hormone replacement therapy (HRT) is effective for many women. HRT supplements the body with the hormones that dwindle during menopause, and can relieve symptoms such as hot flushes, irritability and night sweats. Twenty years ago, many doctors were scared away from HRT by a flawed, but headline-grabbing study that linked it to increased risks of breast cancer and heart disease4. Follow-up studies5 narrowed down those who may be at risk to smaller subsets of people — such as some people with a family history of breast cancer, or those taking HRT for longer periods of time — but public-health messaging has not kept up.

“Hormone therapy is effective and safe for the majority of women, and it’s the most effective treatment by far,” says Stephanie Faubion, medical director of the North American Menopause Society, which is headquartered in Pepper Pike, Ohio, However, although many people can take HRT safely, it is not a panacea.

Researchers now think there is a “window of opportunity” in the ten or so years following the onset of perimenopause, during which HRT can be effective and low risk for most women6.

There are alternatives to HRT, including antidepressants for low moods and gabapentin, a pain medication that has modest effects in treating hot flushes.

Improving dialogue

The United Kingdom has led the English-speaking world in raising awareness about menopause in the workplace. Such conversations are gathering steam in non-Anglophone countries, too. Registered nurse and health-care researcher Lena Rindner has studied menopause in the workplace in Sweden, a country with a reputation for strong gender-equality norms.

Rindner has found that even there, menopause poses a significant mental-health challenge, especially for those who have university-level education and are in leadership positions. She says that employers are working to address the drain on productivity and loss of talent. They see older women as a valued and experienced workforce whose contributions might otherwise be lost. “This is becoming a huge thing in Sweden,” she says.

Stephanie Faubion standing at a lectern giving a presentation

Physician Stephanie Faubion says employers should be aware of available resources.Credit: Mayo Clinic Foundation

In Japan, menopause is rarely spoken about at work, says Yuko Harayama, former head of international affairs at RIKEN, a national institute for basic and applied science. However, the conversation might be changing, she says. Last year, the Japan Broadcasting Corporation (NHK) published a survey in which almost one-fifth of respondents reported that they had quit or considered quitting their jobs owing to menopause symptoms (see go.nature.com/38sf3uh). It estimates that 750,000 working women have experienced negative effects at work from menopause, a loss estimated to have cost the economy ¥420 billion (US$3.2 billion).

There have been no studies on how scientists experience menopause in Japan, Harayama says. But, she says, there’s evidence to show that Japanese women tend to avoid taking up executive positions in research, as principal investigators or directors. This might be because they prefer research to administrative tasks, Harayama says with a laugh. But, it’s not unreasonable to think that menopause could be responsible for stalling some research careers. “It’s very sad if, due to physiological things, you give up what you are doing,” Harayama says.

Many UK employers, including universities, have introduced menopause policies. The country has a Menopause Friendly Accreditation process for employers , with accredited members ranging from universities to various National Health Service trusts and pharmaceutical giants. Most university policies include statements on confidentiality for staff needing support, and set out employees’ rights to ask for flexible work arrangements to accommodate their symptoms. The policies also outline how managers should deal with such requests. It’s important that employers categorize absences due to menopause symptoms as health-related absences, rather than unexplained absences that could trigger performance reviews, Brewis adds.

Many UK universities, including those in Birmingham and Leeds, host staff-led menopause cafés — discussions at which people can network, share experiences and concerns and maybe enjoy some refreshments. They are open to anyone of any sex or age, according to a video by Rachel Weiss, who founded menopause cafés in Scotland in 2017. This makes them different from support groups, she says.

Brewis notes that a serious discussion needs to be had about how menopause affects senior academic women’s salaries. In the United Kingdom, the pay gap between women and men in higher-education institutions stands at 18% and is wider for people in their 50s than for other age groups. This feeds into the country’s retirement-pension gender gap, which stands at nearly 40%. Making it easier for women to navigate menopause symptoms at work could be one way to address this inequality, Brewis suggests.

The United States does not have the same public discussions as the United Kingdom and Australia. But many US-based women wish to see the issue discussed more openly.

“By the time I reached menopause, I had grants and publications and a tenured position,” says Nalini Nadkarni, a tree ecologist based at the University of Utah in Salt Lake City. She says she experienced mild symptoms. “However, many women do experience emotional and physical manifestations that can be a barrier to continuing productivity”, so it is a good idea to document the effects on productivity and educate scientists about them, she says.

For her part, Faubion thinks it is more important to educate employers about resources for employees dealing with menopause, than to ask them to accommodate symptoms. “I hesitate to talk about accommodations in the workplace,” she says. The more menopause is spoken about as an anomaly, rather than a natural part of life, the more it could unintentionally hold women’s careers back, she says. “I don’t think we need to view menopause as a disease or disorder.”

Faubion is not the only one concerned about the negative effects of making menopause an employer’s responsibility. In the Australian study, the survey respondents disagreed on whether employers should introduce menopause-specific policies. Some felt such policies might marginalize older female workers or paint them as ‘problems’ needing to be solved.

Ultimately, menopause symptoms are just a phase of life — and decline as people age. For many, the post-menopausal years are among the most productive and rewarding of their careers.

The cessation of her periods was an enormous liberation for Sanchez-Heras. Suddenly, the pain that had been her constant companion since she’d been a teenager was gone. “Now I can do six-hour sessions of microdissection without any trouble,” she says.

Both Sanchez-Heras and Berry now share their experiences with younger co-workers. “I still hear from my colleagues: ‘Why didn’t anyone speak about this?’ We need to remove the stigma,” says Berry.

Sanchez-Heras agrees. And she would like to see more research into menopause and other biological processes that have historically been neglected under the headline of ‘women’s health’. “The more women get into workplaces, the more they will have to battle with these things. I don’t see why we have to suffer so much.”



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