We’re in the midst of a cultural awakening around menopause. For far too long, this life stage has been, at best, ignored, and, at worst, stigmatized by the health-care industry (which has mostly failed to educate its doctors on the 34 symptoms of menopause) and cultural narratives suggesting that people in menopause should navigate it in silence. Now, as new standards of care, product innovations, and support communities give long overdue recognition to this phase of life, employer perceptions of menopause are in dire need of a catch-up. By failing to acknowledge menopause as a biological reality and support employees who are going through it, the workplace remains a largely menopause-unfriendly sphere.

Perhaps the most common and most damaging reality about menopause in the workplace is just how little attention is paid to it. Many employers assume that menopause only affects folks who’ve already “aged” out of the workforce and is therefore a non-issue for them, when, in reality, menopause often occurs at the very height of a person’s career; in fact, the average age of a menopausal person is 51, and the average age of a female CEO is between 51 and 53, says Catherine Balsam-Schwaber, CEO of menopause-care line Kindra. As a result, having to manage menopause (without employer support) is actually a common cause of premature workplace departure.

In a recent survey of 2,500 working people experiencing menopause conducted by menopause telehealth company Gennev, 45 percent reported taking a menopause-related sick day, and one in four reported leaving their job due to menopause. “We found that it was either because they were just really over not feeling well at work, or relatedly, because they felt that their performance started to plateau or drop,” says Jill Angelo, Gennev’s founder and CEO. And by offering minimal or no support to actively prevent that from happening, many employers are essentially pushing menopausal people out the door.

When you consider the fact that all people who menstruate will reach this stage of life (a number slated to hit 1.1 billion by 2025), and many will experience the disruptive symptoms of perimenopause years beforehand, as early as their mid-30s, the potential for menopause to have massive workplace consequences becomes even clearer—as does the onus on employers to step up in support.

Menopause can affect folks in the workplace, both physically and mentally

Any number of menopause symptoms can have a ripple effect on how someone feels or performs at work, but using results from the recent Gennev survey, Angelo calls out three of the biggest workplace disrupters: “Number one is the inability to get good sleep, which tends to cause a lot of fatigue. Number two is hot flashes, perhaps occurring in the middle of an important meeting. And number three is brain fog or lacking clarity of thought, which can really get in the way of productivity,” she says.

When you roll them together, these symptoms also tend to exacerbate each other. “For example, let’s say, a person is experiencing forgetfulness,” says Leah Millheiser, MD, NCMP, chief medical officer at menopause telehealth company Evernow. “And maybe they’re tired because of insomnia, which worsens that forgetfulness. Or, being concerned about forgetting something causes anxiety, which is another symptom of menopause. And that prompts a hot flash, which throws them off because they’re worried about coworkers judging them or assuming they’re not a strong member of the team.”

“People often minimize or dismiss their struggles and experiences [with menopause] to avoid career penalties.” —Monica Mo, PhD, founder and CEO of WellSeek

The resulting snowball effect shows just how deeply menopause can infiltrate a working person’s life at a moment’s notice. And yet, despite the impact of symptoms, the lingering stigma of menopause keeps many folks from discussing it.

“People often minimize or dismiss their struggles and experiences to avoid career penalties, or being viewed as ‘incompetent’ and having a perceived deficit that may affect future opportunities,” says Monica Mo, PhD, founder and CEO of WellSeek, a community organization for women’s mental health at work. “The mainstream work culture over-glorifying the ‘hustle’ pushes women to compromise their own well-being for the sake of productivity.” And that’s a recipe for higher risks of stress, burnout, and early resignation, she adds—all of which are already on the rise among folks who identify as women in the midst of the pandemic.

At the same time, this silence on menopause contributes to a lack of awareness overall, which can even lead to some folks not recognizing their own menopause symptoms. “My friend who runs a biotech company found herself having the sweats in the middle of board meetings, and it didn’t even occur to her what might be happening to her body,” says Alicia Jackson, PhD, founder and CEO of Evernow. “It took dinner with a group of friends for her to realize it was likely menopause.”

Employers can—and should—step up to provide menopause-affirming support

While the many symptoms of menopause make it a worthy workplace concern, in and of itself, Dr. Millheiser says it’s the very normality of this life stage—and the number of people it affects—that should grab the attention of employers. “Talking about ‘symptoms’ or ‘accommodations’ for those symptoms tends to frame menopause as a disease or a disability, which, of course, it’s not,” she says. “It’s a phase of life that roughly half the population goes through, and we really haven’t done a good job of normalizing that.”

Part of that failure to discuss menopause more openly at work springs from the under-supported position that folks who identify as women have long held in the workplace. Prior to the establishment of the Women’s Bureau by the Department of Labor in 1920, wage-earning women were relegated primarily to domestic or manufacturing roles at which they were underpaid (particularly so, for women of color) and overworked, often in unsafe, unfair conditions; in that year, they made up just 20 percent of the paid workforce.

In the decades that followed, a battery of forces worked against their advancement: Cultural norms looked down upon married women continuing to work; a lack of education opportunities for women restricted them mostly to dead-end roles; until the 1963 passage of the Equal Pay Act, they could legally be paid less than male employees for the same work; and until 1978, when the Pregnancy Discrimination Act was passed, they could be let go or demoted for becoming pregnant. It wasn’t until 1993 that the Family and Medical Leave Act was passed, finally guaranteeing (still unpaid!) maternity leave to people at qualifying companies.

Though employer benefits related to fertility, pregnancy, and childbearing have continued to evolve since then, the playing field certainly cannot be level until menopause is addressed in the workplace, too—particularly given the fact that people who menstruate now make up about half of the workforce, and they’re sticking around in it for much longer.

“The challenge for us is, ‘How do we make menopause as comfortable to talk about in the workplace now as pregnancy has become?'” says Balsam-Schwaber. “We need a work environment where, if you’re in menopause, you’re able to ask for the same kinds of considerations and have the same kinds of expectations that your capabilities not be questioned.”

To achieve that broad cultural shift, the experts suggest businesses center menopause awareness through training and education. “The employee resource group (ERG) construct exists in companies around the world, and they’re meant for sharing, education, networking, and so on,” says Angelo. “A company can [support the creation of] one of these groups for folks in menopause, bring in an expert to field questions privately in advance, and conduct a virtual lunch-and-learn,” she adds. (This is a service that Gennev offers, too.)

When companies provide any sort of menopause training or seminar publicly, it also helps signal to folks experiencing it, “We hear you, and we see you,” says Balsam-Schwaber: “Programming from HR is a good place for a company to start breeding the importance of acceptance and sensitivity.”

From there, Angelo says, employers need to create a set of norms and official workplace policies that recognize the far-reaching impacts of menopause. In many cases, that can start with free-to-them adjustments—like providing the ability to work remotely (or continue doing so) or, if that’s not possible, within a well-ventilated space; adopt flexible hours; or be excused without question from a meeting to use the bathroom or grab water.

To take it a step further, companies should include menopause as its own reason for paid time off, akin to sick time or bereavement leave, says Angelo. “In offering that kind of flexibility, you’re making space for menopause care, so that an employee does not need to use their sick days or other PTO to manage symptoms.” And beyond that, the experts suggest employers provide telehealth access to menopause specialists—in the same way that many have begun to offer similar virtual services for mental health.

“One of the most exciting things happening in health care right now is the emergence of all these deep telehealth verticals, which we’re seeing employers package together,” says Dr. Jackson. “It’s like, ‘You want mental health-care, go here. You want guidance through conception, go here. You want menopause help, go here.’”

Though these types of menopause-affirming benefit packages are still in their infancy, according to Angelo, most of the companies that are beginning to offer them are doing so because of newfound encouragement from employees. “For too long, there’s been this social notion with menopause that when we get it, we have to just suck it up,” she says. “But now, there’s a generational shift as more millennials age into perimenopause and are beginning to advocate for support.”

Thanks to the pandemic, employers are also more responsive to these valid requests than ever. “Overall, there’s more empathy now for the fact that we all need support from our jobs and bosses like we do from our friends and partners,” says Balsam-Schwaber, “whether it’s during pregnancy or pregnancy loss , or when we’re dealing with mental-health issues or something happening with our family.” And going forward, there’s no reason folks experiencing menopause shouldn’t regularly be given the same due.

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