In 2019, Mara’s weekly performance review meetings grew intolerable; she would sit in a cramped conference room with her supervisors only to be told that she wasn’t performing well enough. “I felt like a child,” says Mara, who is 48, lives in Hampshire and works as a public servant. “They would tell me off. They’d say: ‘You won’t meet this deadline, will you? You didn’t put a paragraph in this document.’”
A year earlier, Mara had had a hysterectomy, to alleviate her endometriosis. Afterwards, in surgically induced menopause, she began to experience debilitating brain fog, anxiety and depression. “I was drowning,” she says. “I was overwhelmed. I couldn’t see or think.” Doctors prescribed antidepressants and oestrogen gel, but nothing helped. Mara could barely function at work. “I couldn’t retain anything,” she says. “I had no memory. I couldn’t see or think clearly enough to do my work. I had no confidence at all. I thought I was useless.”
Mara told her supervisors she had depression and anxiety, and submitted a doctor’s note, but they put her on a first warning. At the time she didn’t realise her depression was linked to the menopause - all she knew was that she needed help. (In the autumn of 2019, a specialist explained that her symptoms were caused by the menopause, and provided her with a doctor’s note explaining this to her employers, but they continued to monitor her performance, as they’d done previously.)
Every week, she had to attend a meeting with her supervisors, where they’d tell her that, once again, she had failed to meet the standard expected. By the summer of 2019, Mara couldn’t cope any more.
That weekend, she spent a sunny afternoon with her husband and son at a local fair. The following day, she woke up and drove to a nearby motorway bridge. She sat on a patch of grass and ignored the fact her phone was vibrating with texts from her concerned husband. Instead, she spent a few hours assessing what she felt, then, were her options. “It wasn’t that I wanted to die,” she says. “I needed to die. Work wasn’t ever going to stop doing what they were doing to me. And I was so ashamed to be so incompetent at my job.”
She stood up and approached the bridge, feeling completely empty. She peered over the side, then realised, to her dismay, that the bridge wasn’t high enough. “I thought,” she says, “if I jump, I will survive. And there was no way I wanted to survive. And that is the only reason I am alive today. Because it wasn’t high enough.”
Mara’s story is an extreme example of the devastating impact the menopause can have on women’s jobs – and their mental and physical health. “It’s really difficult to collect data on how many women may be leaving the workplace due to the menopause,” says Dr Vanessa Beck, an expert in work and organisation at the University of Bristol, “because it’s not something people tend to talk about in exit interviews.” Even if women were asked about the menopause when leaving companies, Beck isn’t sure it would help. “I’m not convinced that women would disclose,” she says. “There’s a lot of shame.”
Some data does exist, however. A 2019 survey from Bupa and the Chartered Institute of Personnel and Development (CIPD) found that 59% of working women aged 45 to 55 who were experiencing the menopause reported that it had a negative impact on them at work, with the most common issues including a reduced ability to concentrate, and feeling more stressed and less patient with clients and colleagues. The same survey estimated that 900,000 women had so far left their jobs, due to menopausal symptoms.
Meanwhile, a survey of 1,132 women from Newson Health Menopause and Wellbeing Centre, also published in 2019, found that over 90% of respondents felt that menopausal or perimenopausal symptoms were affecting their performance at work, and one-third of women had considered reducing their working hours or even leaving their job as a result. Also, earlier this month, the Guardian reported on the growing number of women taking their employers to tribunal, claiming unfair dismissal and sex discrimination due to their experience of the menopause.
In July, the House of Commons women and equalities committee launched an inquiry into menopause and the workplace. “These are women in the prime of their lives,” says the committee’s chair, Caroline Nokes MP, “in their late 40s and 50s, who should be in senior positions ... These are the people who should be the trailblazers and role models for younger people in the workplace.”
Almost uniformly, women experiencing menopausal symptoms at work struggle to talk openly about it. Quite simply, it’s embarrassing. “There’s a stigma around it,” says Rachel Weiss, founder of The Menopause Cafe, a safe space where men and women can gather to talk about the menopause. “Being an older woman is not viewed as a positive thing in our society.”
It is not hard to see why many women would not want to disclose that they are menopausal or perimenopausal at work. Menopausal women are too often represented as figures of fun, to be excoriated or mocked. “I remember a senior civil servant using the term menopausal as if it was some kind of insult,” says Nokes. “You wouldn’t be able to discriminate against black or gay people in that way and use their status and who they are as an insult. But it is seen as OK when we’re talking about women of a certain age.”
Using the word as a slur can create a toxic working environment for women. “Every little mistake I made,” says Sukie Stratton, a 51-year-old insurance investigator from Gloucestershire, “people would say: ‘Oh, you must be in the menopause.’” That was during her short stint in 2019 as a trainee police officer (not for Gloucestershire police).
She realised early on that her age might be a problem. “One of my trainers came up to me,” Stratton remembers, “and said: ‘I am worried about you, because you’re in your late 40s. You won’t be able to do the night shift.’ I said: ‘Why not?’ She said: ‘Because you’ll be menopausal, won’t you? You won’t be sleeping and you’ll be tired all the time.’”
Even though Stratton did not even have menopausal symptoms, the comments were constant. When her colleagues saw her sweating in her cumbersome body armour, they would make jibes about hot flushes. If she made a minor mistake, they would assume it was memory loss. One of the final straws was when a relief sergeant referred to Stratton as a “bloody knackered menopausal woman” in front of an office full of her peers.
Stratton emailed HR, but she says they didn’t respond to her emails. One morning, she was on patrol. It was 4am, and she was sitting in the van, talking to a trusted colleague. She confided in him. He told her, candidly: “This is how it is. You will never get anywhere,” she remembers. Stratton realised he was right. All the women her age had been moved to desk jobs, or sent to rural offices with little chance of promotion. She handed in her notice.
“I felt massive disappointment,” she says. “Because I’d always wanted to join the police, and I’d held the police in high regard. I couldn’t understand why they’d dismiss someone who was capable. They seemed to think that being menopausal meant that I wasn’t up to the job.”
Not all women, of course, are driven out by such rank discrimination. Others, including Mara, leave because they feel unsupported by employers. But a third cohort of women leave because the very thought of disclosing their menopausal status to their employers is too horrifying to consider.
Cara, who is 46 and lives in Wiltshire, walked away from her job in higher education in November 2020 due to the perimenopause. “I wasn’t actively forced out,” Cara says, “but I didn’t feel like I had any choice, or options.” Cara had low mood, brain fog, muscle and joint pain. “I’d find it hard to concentrate on stuff I would be sailing through normally,” she says. Worst of all was the loss of sleep. “There would be some nights where I would get no sleep,” she says. “A good night would be four hours.”
Cara handed in her notice because she felt unable to perform at the level she had previously. “I wasn’t giving my best,” she says. “I felt isolated and embarrassed and I didn’t want to get to a point where my job did suffer, and someone would say something. I felt I wasn’t able to do the job I had done for all those years at the same level.” I ask Cara why she didn’t ask her employers for extra support. “I felt ashamed,” is the reply.
This self-enforced silence is common among the women who attend Weiss’s menopause cafes. “What we find,” she says, “is that a lot of women aren’t talking to anyone else about their menopause symptoms. They wonder if they’re going mad, or if there’s something wrong with them.” Women may feel mortified by some symptoms such as menstrual flooding (very heavy bleeding), and feel that it is easier to quit than endure the mortification of explaining to their supervisors why they can’t be more than a few metres from a toilet.
“Physically,” says Dr Helen Douglas, 49, from Glenshee in the Scottish Highlands, “I didn’t feel well enough to stand on my feet all day.” Douglas went into surgical menopause in 2013, aged 41, after a hysterectomy for endometriosis and uterine fibroids. At the time, she managed a forensic laboratory. “It was stressful,” she says. “The sort of job where you need attention to detail.”
Afterwards, Douglas’s stomach was swollen, making it impossible to get into her clothes, and she had persistent bleeding. Mentally, she wasn’t doing well. “I wasn’t sleeping,” she says. “I had anxiety and my hands would shake. Memory issues. I was short-tempered and irritable. I just wanted to tell everyone where to go.” If someone cancelled a meeting at short notice, Douglas would “internalise the anger until it led to a panic attack,” she says.
She had suffered from depression in the past, and at the time, she didn’t realise her symptoms were menopause-related. “I thought it was just a bad episode of depression again,” Douglas says. She resigned in 2014. “I couldn’t do it any more,” she says. “I’d been having recurrent thoughts of ending my life.”
Yet the outlook for women approaching the menopause in the workplace is not totally bleak. The stigma is abating. “Over the last year or so women have been much more open about it than ever before,” says Nokes. “Women like Davina McCall [who recently made a documentary on the subject for Channel 4] have spoken about their own experiences honestly.”
Nokes is willing to practise what she preaches. “I am prepared to say I think I probably am perimenopausal,” she says. “I have horrific night sweats.” She recently had to alter the bedding she uses. “I’ve got the thinnest duvet on my bed ever,” Nokes says. “But at least I’m not waking up at 3am, dripping in sweat.”
Many believe the NHS needs to improve its offering to menopausal women. “We need a multidisciplinary team to look after women after the menopause,” says Douglas. “Rather than seeing it as a gynaecological issue, women should be referred to someone who has a handle on the mental health side of things.”
Mara believes GPs could also do with better training: it was only through reading menopause support forums online that she learned about a drug called utrogestan, a form of hormone replacement therapy. “I rang my doctor,” she says, “and she prescribed it, and literally overnight I started feeling better. My husband noticed within 48 hours. He said: ‘Are you on new medication? You’ve turned nice again.’”
Another obvious solution would be menopause-friendly workplaces. Douglas advocates for companies to have specific policies around it. “It would be really helpful if there was a menopause-in-the-workplace champion,” she says, “someone women knew they could go to. Simple adjustments – switching uniforms from synthetic fibres to natural fabrics. Having free and frequent access to bathrooms, in case women are flooding.”
Some employers are ahead on this. The water company Severn Trent was the first UK employer to specifically introduce a menopause policy. The CIPD has subsequently published guidance for employers on addressing the menopause at work, while last year the Wales TUC published a toolkit.
Deborah Garlick of the training provider Menopause in the Workplace began offering menopause training to employers in 2016. “We organised our first menopause in the workplace conference,” says Garlick, “and people thought we were bonkers. But then some very large employers said, ‘Why didn’t we know this?’ And that’s how we got started.”
Part of the select committee’s forthcoming work will be to evaluate whether UK discrimination law is fit for purpose on the menopause. “Do we need to make menopause a protected characteristic, in the same way that maternity leave currently is?” asks Nokes.
Under existing law, menopausal women are protected because age, sex and disability are protected characteristics under the 2010 Equality Act. But because menopause is not specifically protected, women have to “pick the characteristic they want to take a case under,” Beck says.
Nokes says she is “open-minded” about introducing such legislation. “This is impacting 50% of the population,” Nokes says, “and it’s pushing them out of the workplace. So maybe it should be a protected characteristic.” Regardless of whether or not legislation is introduced, Beck urges employers to make adjustments for older women. “There’s the business case,” she says. “It’s costly to replace an experienced worker. But it’s about more than that – it’s the right thing to do. If you are a good employer, you should want to support your workers.”
The hope is that, with time, more enlightened employers, and government intervention if necessary, no woman should ever have to go through what Mara endured. “I was a person with value, and they were happy to destroy me and get rid of me, because of the menopause,” Mara says. Thankfully, with the help of medication, her symptoms have abated. “My energy levels are a bit low,” she says, “but I’m almost there.”
After five years out of the workforce, living on savings and focusing on her mental health, Douglas, likewise, has found a new vocation, as a writer and menopause awareness activist. “I don’t regret leaving my old job,” she says thoughtfully. “It’s taken a lot of time and work to get to a place where I am comfortable saying that. But what I do now can make a positive difference. It’s more satisfying.”
Some names have been changed.
In the UK and Ireland, Samaritans can be contacted on 116 123 or by emailing jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org.