It took Sarah Cooke a while to work out what the problem was. Same old stress at work, same high workload typical for NHS senior managers. But where she had always coped – thrived, even – now she was struggling.
Three years on and with her NHS career at an abrupt and unsupported end, Sarah can finally acknowledge what was at the root of her disintegration: the menopause.
If it had been possible to discuss the menopause at her workplace, things might have been different. If she had had support during the two years she went through the symptoms of menopause, she might not have forfeited her job and pension rights, and taken a £20,000 a year salary drop to join a new employer. And the NHS might not have lost a talented and committed senior manager. Something has to change.
“I really did not understand what was happening to me,” says Sarah. “My memory was gone, my concentration was gone and I had hideous sleep patterns. My head felt like a fuzz in the mornings and I was having hot flushes.” Some male colleagues seemed to think this was hilarious, she adds.
“At first I thought it was stress and I just wasn’t coping so I downgraded to a less senior job,” she recalls. “But that didn’t help. I felt a lot of self-doubt as I tried to work out what was happening to me and why I couldn’t function. I felt a failure.”
A supportive GP referred her to a gynaecologist who diagnosed her as perimenopausal – in other words, actively going through the changes that lead to the menopause when periods stop. But rather than put her work problems down to this, Sarah was determined to believe she was suffering from stress and kept changing jobs in a bid to find a solution. Rather than take time off, as recommended by her GP and consultant, she battled on.
Lack of support
To cut a long story short, Sarah eventually involved MiP, but by then it was too late. Occupational health proved unhelpful and when she was threatened with redundancy when she eventually went off sick, Sarah left the NHS for a lower paid, less senior job.
Sarah details the shortcomings in her case. “There was no one-to-one support and no risk assessment was carried out. There was no proper work plan agreed. And I didn’t involve the union soon enough.”
She adds: “The combination of menopause and stress at work is a lethal one for your mental health and it’s a combination that carries a lot of stigma. We need more awareness of the symptoms of menopause and how this can affect women at work, and we need more support for women and more empathy.”
No giggling, thanks
There’s a strong chance that quite a lot of readers will have switched off by now. Who wants to read about the menopause? I mean, it’s just embarrassing, isn’t it?
Actually no, say MiP national officers Jo Spear and Claire Pullar. It’s a natural part of women’s lives but one that can affect them significantly at work. We need to talk about it more – and without the giggling in the corner, thank you very much.
The TUC and UNISON both recognise that the menopause is an occupational health issue. The TUC’s briefing on the issue says: “Employers have been slow to recognise that women of menopausal age may need special consideration and for too long it has simply been seen as a private matter. As a result it is very rarely discussed and many managers will have no awareness of the issues involved. This means many women feel that they have to hide their symptoms and will be less likely to ask for the adjustments that may help them.”
The menopause affects all women, usually between the ages of 45 and 55 and typically lasting for two to five years while hormones change and periods stop. While every woman’s experience is different, symptoms can include:
- Hot flushes
- Sleep disturbance
- Lack of energy
- Anxiety attacks
- Frequent urinary tract infections
- Heavy periods and clots
- Dry skin and vaginal dryness
All of these can have an impact on women at work. Just think about offices with no temperature control or long meetings when it’s hard to excuse yourself to visit the toilet. Think about the embarrassment of hot flushes or the anxiety of not knowing when you might bleed through your clothes. That’s why MiP has taken it up as a national issue and will be offering training and advice for local reps.
Stigmatising a natural process
“It’s a natural process and it’s natural to support people who are going through this,” says Pullar. “Yet I come across women who say they want to give up work because of their menopausal symptoms and because their line manager won’t support them.”
Jo Spear says the stigma surrounding the “change in life” means many woman can’t be open about what they’re experiencing. “They go off sick but they’re not open about the real reasons. This triggers performance management and capability reviews,” she explains. Women are regularly penalised for several short periods of absence when these absences should be recorded as part of an ongoing issue.
This, says Spear, is totally inappropriate. When a woman is going through menopausal symptoms, reasonable adjustments at work should be possible.
Too often, that’s not the case. “As much as we would like to be able to sit down with employers and talk about reasonable adjustments, the first thing they are going to say is that this is not a disability. And it’s not. But there are simple things employers can do to treat people fairly,” Spear adds.
UNISON has published a guide for safety reps which sets out employers’ responsibility to take into account the difficulties that women may experience during the menopause. According to the guidance: “The Health and Safety at Work Act requires employers to ensure the health, safety and welfare of their employees, and they are required to do risk assessments under the Management Regulations which should include any specific risks to menopausal women. They also have a duty not to discriminate under the 2010 Equalities Act.”
An issue for everyone
Both Spear and Pullar are heartened by what they hear from MiP reps who, they say, are very interested in finding out more about the menopause and how they can support members. Taking up individual cases and using UNISON’s checklist for employers is important, says Spear. So is simply raising the issue of the menopause and creating a space where it’s possible to talk about it.
“This is not a women’s issue,” she says. “If you’re a male manager, you’re going to have to deal with it. If you’re a woman, you’re going to have to go through it. Women should not have to suffer in silence. Talk to your line manager, talk to your health and wellbeing lead, talk to your union rep about what they are doing to support menopausal women.”
But what of Sarah? The salary hit has been hard, but she says she is happier now than she has been in a long time. Where once she would have been planning her route to chief executive, now she’s planning retirement and a camper van trip around Europe.
“Now I have come through this, I have been able to see what really matters in life,” she says. For Sarah, the “change of life” turned out to be exactly that.
Find out more about the support available to women on the Menopause Matters website. If menopausal symptoms are affecting your work and you’re not getting the support you need, talk to your MiP national officer.
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