IN FOCUS : Tackling MENOPAUSE Time for policy and education Tackling MENOPAUSE

Problems related to menopause, a natural phase in a woman’s life, impinge on productivity at the workplace, apart from raising questions pertaining to her rights to special privileges, because of the inevitable biological changes she undergoes during the period.  

According to an article published recently in the ‘Nature’ journal, menopause experiences in workplaces globally suggested an underestimated drain on productivity and mental health.A 2021 report by the London-based Fawcett Society found that over half of women and transgender men experiencing menopause said their symptoms made them less likely to want to apply for a promotion.

In Australia, a survey of menopausal women working in health care and universities discovered that many felt guilty about their perceived underperformance. A  US study published in ‘Menopause’ in 2015 estimated that women experiencing hot flushes and night sweats had up to 60% more lost workdays than do their asymptomatic colleagues.

Amid a growing body of evidence that menopause hampers career growth of women, the Government of India mentioned in the Lok Sabha in July 2022 that firm research was needed to draft a menopause policy. “At present, there is no menopause policy for women employees. Besides consultations with stakeholders and experts, firm research findings on the physical and mental stress faced by women employees because of menopause are required,” Union Women and Child Development Minister Smriti Irani told Parliament. The Pioneer’s Amartya Smaran looks at the gamut of issues concerning menopause in the country, where time is ripe for experts to draft a menopause policy.

The cessation of menstrual cycles at the end of a woman’s reproductive period is termed menopause. The average age of menopause in women is 52 years, though its onset among women aged anywhere between 45 and 55 is common. According to the World Health Organization, menopause is one point in a continuum of life stages for women and marks the end of their reproductive years. After menopause, a woman cannot become pregnant, except in rare cases when specialized fertility treatments are used.

The transition period before full menopause is called perimenopause and postmenopause is the period after it. Globally, the mean average age of menopause in women is 51 years; while in India, menopause sets in for women at 46.2 years. It was observed that a woman with a life expectancy rate of 70.95 in India spends a third of her life in the postmenopausal period.

By 2030, the number of Indian women aged 50 years and above is expected to reach a staggering 168 million. This means the population of women experiencing the condition will rise significantly over the next seven years.The occurrence of menopause peaks after the age of 41 years and gradually the prevalence rate touches 65% in women aged between 48 years and 49 years.

With the increasing level of employment among women in India, a vast majority of women who fall under the prescribed age bracket of 45-55 undergo mild to severe menopausal symptoms. Studies have noted that severe symptoms of menopause such as hot flushes, fatigue, anxiety, palpitations, and heavy sweating could significantly hinder a person’s performance at work.

The stereotypical view of women being irrational and emotionally unstable as a result of menopausal symptoms could stop an individual from realizing their full potential at work. Another report stated that around 25-30% of women find menopausal symptoms bothersome at workplaces. Striking a different note, women who work reported to have dealt with the symptoms a lot more efficiently when compared to those who don’t. Women in ‘white collar’ jobs experience significantly fewer psychological symptoms than menopausal women in lower-paid and manual jobs.

A survey conducted in the UK found that one in three women miss out on work due to menopause. Research points out that women feel demotivated to apply for more complex roles and take a step back from seeking promotion in their careers. As per the University College London Social Research Institute, the months spent at work are reduced by about 9% at the onset of menopause before the age of 45.

Unlike India, the UK has a dedicated holistic menopause policy to spread awareness in the workplace. According to GOV.UK, all stages of the menopause transition are referenced as a priority issue in Government’s public policy agenda on work, diversity, and inclusion. With champion support work coaches in place, older job seekers in the U.K. receive adequate support in order to better understand and deal with the problems that are caused by menopause.

Elaborating on the topic from a scientific standpoint, Dr. Avula Lakshmi Nethra — MBBS, MS-OBGYN, says: “It is necessary to begin with a fundamental comprehension of menopause. All people, regardless of age or gender, should be taught to recognize the spectrum of symptoms. To embrace the process as normal, to encourage and uplift women throughout this time, and to help them feel confident in their bodies and their abilities.”

Giving us a rundown on the different menopause stages that occur in an individual, Dr. Avula Lakshmi Nethra explains: “The late reproductive stage occurs when the hormonal shifts begin before noticeable changes in monthly cycle, and they lead to a decline in ovarian reserve (the number of follicles still present in the ovaries). A woman undergoes early menopausal transition when she experiences more than seven days of difference in cycle length of consecutive menstrual cycles. However, for many women who do not track their menstrual cycles closely, a skipped menstrual period is the obvious first sign. Though the duration of this stage is variable, women who enter the menopausal transition at a younger age tend to have a longer duration of the early and total transition.”

She adds: “Late menopause transition begins after a woman has gone without menstruation for 60 days or longer and often lasts between one and three years. It is noteworthy that, each woman’s cycle is unique, and she may show signs of anovulatory or ovulatory phases at different times.The late menopausal transition may include ovulatory cycles that are of normal duration and may appear hormonally normal, suggesting that fertile windows may exist until the final menstrual month. And, retroactively, a woman is considered to have attained the early postmenopausal stage once 12 months have passed since her last menstrual period. At this point, the ovarian reserve is extremely diminished. Stress, obesity, smoking, and alcohol usage, as well as health conditions including thyroid dysfunction, diabetes, and especially mental illnesses, can all alter any of the menopause stages.”

Asked about the potential health conditions that might arise during the menopause period, Dr. Nethra concludes: “Recognising that all women go through menopause as a normal part of their physiology is the first step in solving the problems that develop during this time. Remember that the procedure is further complicated by co-morbidities and age-related disorders. As a result, before treating menopausal symptoms, it is vital to check in with patients who have been diagnosed with illnesses such as diabetes, obesity, cardiovascular disease, or mental health disorders.”

Although there is no such thing as a menopause policy in place, there are a number of programs such as maternity leave, miscarriage leave, paternity leave, flexible work arrangements and programs, and harassment and discrimination policies that support the well-being of women at the workplace.

“Menopause is a big transition. Symptoms can range from just physical changes of hot flushes, iron deficiency, joint pains, urinary incontinence, low sex drive and irregular periods, to mental strains such as anxiety, bouts of low confidence, and depression,” says Devidutta Dash, who is the founder & CEO of Lemme Be, GenZ Inclusive Period Care.

“The list of symptoms is endless and quite unique to the person facing it.  However, most women, especially women in leadership roles, recognise the changes that come with menopause and eventually adapt to manage their symptoms better.They donot let their biological changes hinder their career prospects and their ambition. But with the changing demographic in the workplace and with more women persevering through these changes, it is time we build a better environment and positive ecosystem so that everyone feels included, as well as accepted.”

Chipping in on why there needs to be a robust policy that boasts a menopause-friendly atmosphere at the workplace, Devidutta says: “We need to build a supportive and inclusive workplace not just for menopausal women, but also for trans and non-binary people going through menopause so that they can continue to have fulfilling and successful careers.

The most effective change towards building an inclusive workplace would be increasing awareness and normalizing the conversation amongst colleagues, family members and friends. Additionally, creating a support system (buddy system) for their emotional support and offering flexible working hours would vastly benefit them in this period.”

“In recent years, many organisations have made tremendous efforts to encourage the equality and well-being of women in the workplace,” says Sakshi Pal, HR Head at Techwave. “As part of these efforts, several programs are being implemented to improve women’s representation in leadership roles, work-life balance, and health and wellness policies.”

She continues: “The social stigma associated with menopause has historically made many women uncomfortable discussing the topic or seeking support. Women are increasingly accepting menopause as a normal and natural part of life. In an effort to raise awareness of menopause and ensure good health during menopause, we are conducting webinars to provide information about the physical and emotional changes associated with menopause, understand the symptoms, and determine the appropriate treatment. Furthermore, we have provided a platform where professional women can share their knowledge and answer questions, and women with similar experiences can connect.

A menopause policy can benefit female employees by fostering a more inclusive workplace culture. Through acknowledging and addressing these issues, we not only demonstrate our company’s support for its employees, but we also create a more positive work environment.”

Nirmala Mocherla, HR at Nugenes Company,observes: “When there is no disparity in salary for men and women, we can proceed to discuss menopause policy.”
Seconding Nirmala’s opinion, Sakshi Pal adds,”There is a persistent issue of wage disparity between men and women in many industries and countries. It has been found in several studies that women and men are paid differently for the same job based on the type of work required and the industry they work in. Even though progress has been made in recent years on addressing this issue, there is still work to do to make sure that women and men are paid equally. Techwave is committed to closing the gender pay gap and ensuring that all employees have an equal chance to succeed in the workplace.”

In contrast to Nirmala’s and Sakshi Pal’s views, Mrudula, an assistant manager at a top IT firm, avers: “Our company supports women especially when it comes to women hygiene. Even in the case of maternity leave, based on the requirement of the individuals, our company extends the period to one year. At the time of menopause, women have too many issues to tackle as a result of the changes that happen in the body. I’ve seen cases where companies have given them the option to work from home. They also provide hygiene products related to women’s health in the workplace.

Currently, we have no policy as such for menopausal women but I feel it’s needed. If they give a one or two-month break for women who are in the menopause stage, that would be the best remedy for women to overcome the issues. I think it’s still taboo because the opposite person who’s going through the condition is not ready to discuss the matter.

To date, no one really talks about it openly. If they set a policy, the taboo around menopause will slowly fizzle away. Coming to the pay gap, no such thing exists. I’ve seen many families where a woman earns more than a man and they are paid based on their performance. The pay gap is a myth. However, there are instances where companies feel it’s not worthwhile to give a promotion to a woman because she might leave or underperform once she gets pregnant. These things should change.”

Commenting on the increasing awareness of the topic, Kiriti Acharjee, co-founder at HealthFab remarks: “Women in their lifetime must make a balance between many things. While experiencing hormonal changes in their body they handle things beautifully. In today’s world, where we talk about menstrual problems, menstrual hygiene, and maternity period; there is a lot to talk about menopause also.”

“Menopause is a natural biological process, but physically a woman has to deal with mood swings and hormonal changes,” explains the founder.“Emotional symptoms of menopause may disrupt your sleep, lower your energy or affect emotional health. Awareness about menopause is still limited and there are certain myths to be busted. A workplace environment where male and females work together is a place where we can discuss and spread awareness regarding menopause. We should work together and normalize discussion on such sensitive topics. Menopause is not only a problem for working women but housewives also need special attention when it comes to their health and wellness. Menopause, in some cases, causes depression in women. It is crucial for males to know about the phase so that they can support their partner in these hard times.”

Janani, an IT executive from the city, points out some pertinent issues. “I still feel there is a lack of awareness in our country. Forget menopause, as far as I know, companies still don’t provide proper facilities for women during their periods. How can one imagine a woman walking into a room full of people and sharing her situation? I’ve seen cases where women in menstruation as well as menopause used to come up with different reasons to take a day off fearing unfavorable consequences. A majority of them are still not okay talking about it. A sincere effort to establish a woman-centric health policy that addresses menstrual and menopausal issues would be much appreciated.”

For instance, although the situation pertaining to the topic of menstruation has improved, it is still considered taboo in India. And if we take a trip down memory lane, the natural phenomenon of menstruation was never really talked about in our society. However, the idea of discussing the matter in the open has made people more knowledgeable over the years. In the same manner, it is imperative that health experts, activists, and politicians educate people on the topic of menopause. This awareness will not only supplement women with knowledge but also help them tackle problems with ease.

Taking into consideration the likeliness of menopause hampering an individual’s growth at work, the Indian government is still seriously considering crafting a policy to raise awareness with Union Minister Smriti Irani urging experts to study the topic. Now, the onus is on the Indian government and companies to introduce policies that enable the menopausal female workforce to function with awareness and confidence.