It's time to talk about the M word

By Joseph A. Bell, Deborah Garlick and Claire Stevens

©Juanmonino/E+/Getty Images Plus

Key points

• Women going through the menopause are the fastest-growing workforce demographic, with menopause affecting three in four women.

• For too long, women have been embarrassed to talk about a natural process which may be significantly impacting on their personal and professional lives.

• A loss of these key, experienced members of the team would be detrimental to the profession when simple changes can be made to improve experiences.

• Small changes, reducing the taboo and allowing discussion can improve working conditions and help menopausal women.

What is menopause?

'The British Medical Association found a strong pattern of highly experienced women leaving general practice partnerships, ending their positions as clinical leaders and directors and leaving medicine early because they were struggling to cope with menopause symptoms with no support from management or peers'.¹ Menopause is a biological transition that happens over many years, defined as when a woman has not had a period for 12 months.² This transition can be broken down into three stages: perimenopause (the time leading up to menopause); menopause; and post-menopause.

During the menopause transition, the balance of hormones in a woman's body can change, which can result in a wide range of symptoms, both physical and psychological.³ Menopause is usually a natural part of ageing that typically occurs between 45-55 years of age but it can occur much earlier, either naturally or as a result of surgery or illness.

During this time, hormones (including oestrogen, progesterone and testosterone) can change dramatically and decline, resulting in a woman experiencing symptoms.²

The statistics

• The average age for a woman to reach menopause in the UK is 51. It can be earlier than this due to surgery, illness or a natural early menopause

• Three out of four women experience symptoms and one in four has serious symptoms

• Around eight in ten menopausal women are in work

• Around 1 in 100 women experience the menopause before 40 years of age

• According to the Office of National Statistics, menopausal women are the fastest-growing workforce demographic.

The symptoms

The top five symptoms that women found bothered them the most, according to the survey with the Trades Union Congress, various universities and 'Henpicked: menopause in the workplace' (2018), were:

• Fatigue

• Hot flushes

• Difficulty focusing or concentrating

• Anxiety and worry

• Insomnia

• Problems with memory recall.

Other symptoms reported for menopause included:⁴

• Unpredictable/heavy periods

• Headaches

• Tiredness

• Lack of energy

• Sweating

• Depression

• Mood swings

• Irritability

• Aches and pains

• Dry eyes and dry skin.

How does menopause affect the dental workforce?

Not only are 76.9% of the dental team women,⁵ but 35% of dental care professionals (DCPs) and 43% of dentists are currently within the age range that can be affected by menopause;⁶ hence, a large proportion of the dental workforce is going to be affected.

Aspects of work which women cited as making menopause symptoms worse were high temperature, poor ventilation, humidity, no access to a quiet or restful space and noise. Long hours, short and changing deadlines, high workloads and dealing with customers, patients and clients can also make symptoms worse.³ All of these can apply to working within the dental profession. Additionally, the COVID-19 pandemic has resulted in the introduction of increased levels of personal protective equipment for aerosol-generating procedures (AGPs). A high number of the dental profession has found that this creates extremely uncomfortable working conditions, even without experiencing menopausal symptoms.

Moreover, dentistry relies on good teamwork, skills, knowledge and understanding for best patient care. With a high proportion of the dental workforce being women, the effects of menopausal symptoms can affect patient care and also staff morale. It is therefore imperative we have a good understanding of what we can do to help. By removing the taboo of menopause and allowing for open discussions, we can create a huge change by improving the working experience of those affected and by improving staff satisfaction and patient care in the wider team.

Menopause-friendly working conditions are important for the dental team. Co-author of The government report on menopause, Dr Andrea Davies, stated 'menopause and work - it's a two-way street.' The report found that work is good for menopausal women as it can provide fulfilment and improved self-esteem, sense of identity and social needs. However, working environments with lack of temperature control, cramped conditions, some uniforms and stress can also make menopause symptoms worse.⁴

The matter has been raised within medicine, with a survey of over 2,000 respondents by the British Medical Association finding significant failings in care for women experiencing the menopause. The survey found 93% of respondents said that their menopause symptoms had affected their working lives but 38% said they were unable to make the changes they needed to their working pattern to cope with symptoms. Almost half said they did not feel comfortable discussing their symptoms. Disappointingly, a significant number said that they would be 'laughed at or ridiculed' by both managers and peers if they spoke about the menopause. Only 16% of respondents had discussed their menopause symptoms with their manager.⁷

With a high proportion of the dental workforce being women, the effects of menopausal symptoms can affect patient care and also staff morale

All women experience menopause differently. Brewis et al. (2017), found that almost half of women don't seek medical advice and the majority of women don't feel comfortable talking about menopause with their managers.⁴ This could be due to the negative perception of menopause and potential embarrassment to talk about it. Moreover, it could be due to lack of accurate knowledge and women not being aware that what they are experiencing is due to fluctuating hormones during the menopause.⁴

Menopause in the workplace experts, 'Henpicked', found that when women understand the symptoms and ways to manage them, their lives (and work) can get back to normal quickly.⁸ Alarmingly, in some cases, menopausal symptoms can lead to women leaving their jobs, with the Wellbeing of Women survey in 2016 finding one in four women consider leaving work.⁹

This highlights the issues that need to be addressed, as many women of menopausal age are vital members of the team, including dentists, nurses, practice managers and many more. There is also now a parliamentary inquiry into the workplace treatment of women going through the menopause - it will examine if legislation goes far enough to address discrimination. It's not currently law to have a menopause policy but this may soon be introduced. A loss of these key, experienced members of the team would be detrimental to the profession when simple changes can be made to improve experiences.

What can we do?

The Government's Equalities report on menopause recommends:

• Workplace training

• Raising awareness of menopause at work and introducing an array of workable solutions

• Fostering an environment in which women feel comfortable and confident talking to their managers/dentists/practice principals

• Following clear and coherent guidelines and directing women to occupational health, if necessary.

'Henpicked' have created examples of best practice for employers which we have adapted to be used by the dental team:⁸

Introducing a clear menopause policy or guidance documents

• This will inform consultants/dentists, managers and employees of the process for anyone needing support over menopausal issues.

Providing training on menopause

• For consultants/dentists/DCPs and managers to support this policy.

Taking the environment into account and considering reasonable adjustments

• Providing a desk fan

• Providing extra uniform - lightweight uniform such as scrubs are preferable. Allow for changing of uniform in the work day

• Offering flexible working and reallocating certain tasks, such as replacing staff for AGPs if uncomfortable

• Providing private rest areas

• Ensuring there is constant access to water and toilet facilities

• Providing a supply basket.

Creating an open and transparent environment

• Menopause is so often a taboo subject, with many women feeling unable to talk to managers or senior staff members about their symptoms

• By creating a working environment in which employees and dentists/managers alike feel comfortable having open discussions, organisations will be able to take steps to protect their staff and themselves.

Assessing each case on its own merits

• Every person experiences menopause differently, so it is not feasible to have a blanket set of rules.

Quotes

Lady Michelle Obama

Lady Michelle Obama recently shared her experiences of going through the menopause in the White House and having a hot flush while on Marine One, the presidential helicopter, before an event with her husband, Barack. She told listeners of her podcast 'it was like somebody put a furnace in my core and turned it on high. And then everything started melting.' Explaining her motivation for talking about her experiences, she argued 'what a woman's body is taking her through is important information. It's an important thing to talk about because half of us are going through this, but we're living like it's not happening.'¹⁰

Baroness Warsi

Baroness Warsi, Conservative member of the House of Lords, is the former Chair of the Conservative Party and Minister without Portfolio and was the first Muslim person to serve as a Cabinet Minister. She shared 'ever since the perimenopause hit three years ago, when I was 46, I've had periodic brain fog which descends without warning. Hot on its heels comes panic, followed by a hot flush, followed by sweating, followed by questioning whether I really have the right skillset for my role.'¹⁰

Davina McCall

Davina McCall revealed she hit perimenopause at 44. She didn't know who to talk to after suffering night sweats, insomnia, low mood, anxiety and brain fog: 'I was going mad. I thought I was possibly getting some sort of early onset dementia. The menopause did not even cross my mind because I was 44, I just thought it was too young, so I battled on for a year.' When she could no longer read the autocue because of tiredness through lack of sleep, she went to the GP, who said there was little that could be done. But eventually, a private gynaecologist prescribed hormone replacement therapy and she felt it turned her life around in a week. The presenter now feels 'better than I have done in years', saying 'I am working hard, I'm at the top of my game and feel like I've been reborn'.¹¹

Conclusion

The reasons for taking menopause in the workplace seriously are now well-documented.

We can play such a crucial role in supporting anyone experiencing symptoms in the dental profession, helping them understand what is happening and most importantly, what they can do to manage their symptoms and supporting them in the workplace.

For too long, women have been embarrassed to talk about a natural process which may be significantly impacting on their personal and professional lives. It's time to talk about the M word.

This article was originally published in the BDJ in Volume 232 pages 15-17, 14 January 2022. BDJ Team will feature further content on menopause in May this year.

Author contributions

Joseph A. Bell and Claire Stevens created the idea for the piece. Joseph A. Bell wrote the manuscript with help from Deborah Garlick and Claire Stevens. Deborah Garlick supplied information and resources from her involvement as part of Henpicked charity. Claire Stevens wrote the conclusion and edited the manuscript throughout.

Ethics declaration

The authors declare no conflicts of interest.