Working + perimenopause can be hella hard
Working + perimenopause can be hella hard
...and now we have more big numbers to prove it
A Mayo Clinic study out this week estimates US$1.8 billion in lost work time per year due to women experiencing menopause symptoms, a number that leaps to US$26.6 billion annually when medical expenses are added. That second figure takes into account direct excess medical expenses to women, adjusting for inflation, and based on previous research looking specifically at women who had worsened Vasomotor Symptoms published in 2015 that put the annual cost at $1,346. It does not assess the cost women themselves bear related to reduced work hours, job loss, early retirement or changing jobs.
The findings were published in the journal Mayo Clinic Proceedings from research conducted over three months in 2021. Researchers asked 32,469 women ages 45-60 getting general care at the Mayo Clinic to fill out a survey; of the 5,200 who responded, 4,440 of them working. The story got tons of media attention in North America – my dad emailed from Canada to tell me it was on NBC Nightly News – and of course, most headlines focused on the dollar figure. When I posted about that top line on social media, there were a number of comments to this effect: ‘afraid this will make managers afraid to hire and retain us’.
It scares me too, and when I spoke to lead author Stephanie Faubion, medical director of the North American Menopause Society and director of the Mayo Clinic Center for Women’s Health about this on Friday, she said it ‘terrifies’ her. (Editor’s note: My plan was to share the audio with you, but in a freak, unexplained and embarrassing journalism accident, the recording of that phone call is… soundless. I’m still grieving; it was a great conversation. Here is what I remember. Onwards.)
“But it is happening,” she pointed out, adding ignoring that gets us nowhere. And as the authors of the study pointed out, there is a “a dearth of literature on the impact of menopause symptoms on work productivity” – just like most things in menopause – so this is a start.
We need to be careful: recognizing there is a problem but not becoming hysterical about it. I’m aware of the gross overestimating that’s gone on in the UK on this issue – headlines like More than 1m UK women could quit their jobs through lack of menopause support that remain in The Guardian to this day – and MenoClarity and Magnificent Midlife founder Rachel Lankester’s excellent work in calming them down greatly over at her blog The Mutton Club.
Here the authors used 2020 US Census data and mean income of the age range – $76,000 for women aged 45 to 60, which is interesting in and of itself – based on 212 estimated work days per year. They extrapolated to the 15.4 million American women in the age range working full-time. That big figure, when broken down, isn’t quite as a scary as it sounds: the calculations were done based on a mean of three missed days a year.
The top lines: 11 percent of women missed days of work and 13 percent of women reported an adverse work outcome. That means they answered ‘yes - specifically due to menopause symptoms’ to one of the following: missed days from work in the past 12 months; hours cut back at work in the last 6 months; laid off or fired from work in the past 6 months; and quit/retired/ changed jobs in the past 6 months.
The authors used the Menopause Rating Scale, which assesses 11 factors across somatic, psychological, and urogenital subsets. They acknowledge more representative research is needed, as 93 percent of respondents were White.
But as Faubion pointed out, one of the aims of the survey was to find out more about racial and ethnic differences, and it turns out higher percentages of Black and Latina women reported adverse work outcomes than White and Asian women. Also, on a ‘perhaps this is kind of an elite cohort, considering they were being treated at the Mayo Clinic’ point that I raised, she said ‘not necessarily’, but also, if anything, things probably get worse further down the socioeconomic chain.
When I asked Faubion for her take on the best approach to all this, she said a good start would be just getting the word out to more and younger women about the very existence of perimenopause and the havoc it can cause – pointing out elder millenials are now prime age at 42. Training managers about menopause and all it entails, so they can support women, is also key.
Doing more work to address lingering taboos is also necessary, with senior author Ekta Kapoor, assistant director of Mayo Clinic Women's Health, saying in a press release the it adds to the “psychological burden” women experience.
“Women often fear bias, discrimination and stigmatization, and therefore may be reluctant to disclose their menopause symptoms to their workplace managers and others,” she said. “Recognizing these concerns and creating a safe workplace environment for women to discuss their health care needs may help address this.”
Watch Stephanie Faubion talking about the study here (and if you like, imagine it’s my amazing missing audio).
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More menopause at work
• It’s worth remembering that while we might be feeling an understandable, knee-jerk fear that talking about menopause is veering us toward irrelevance, in terms of sheer numbers (not to mention wisdom, institutional understanding and memory, experience, etc, etc) the reality is that we are essential: Employers warned not to overlook psychological impact of menopause Personnel Today
• Over in New Zealand, a survey of 4,000 people conducted by Menodoctor Menopause Clinic's Dr Linda Dear found that 84 percent reported menopause symptoms impacting their work. “It also found that 14 percent of participants felt well supported at work, one in six said they thought about quitting and 12 percent did quit.” Women leaving their jobs due to menopause 1news
• Meanwhile, research conducted by the UK’s Healthcare Safety Investigation Branch after a 56-year-old National Health Service worker committed suicide, recommends the Royal College of Psychiatrists works with organizations “to identify the best way to consider menopause during mental health assessments”: Impact of menopause often overlooked when evaluating suicide risk Personnel Today
Science stuff
• AUTISM - A new three-year research project in the UK will compare menopause experiences of 500 neurodivergent and neurotypical people, ages 40 to 60, at different stages of the transition. The study, which is being conducted by psychologists Professor Julie Turner-Cobb and Dr Rachel Moseley out of Bournemouth University, aims to determine what factors impact their experiences and symptoms.
• HEART – An editorial in the American Journal of Medicine cited new risk factors for cardiovascular disease, and premature and surgical menopause are on it. (As I’ve written previously and the literature reflects, while our bodies were designed to compensate for hormone reduction gradually in midlife, and are able to accommodate this depending on a range of other factors, we most definitely should not be losing them all at once, and too early). There’s also an unexplained association between migraine headaches (that can accelerate in perimenopause) with aura and CVD; as well as with gestational diabetes, pre-eclampsia, delivering a child of low birth weight and preterm delivery.
Additional risk factors cited: Gout and psoriasis, ulcerative colitis, Chrohn’s and autoimmune collagen vascular diseases (including rheumatoid arthritis); trauma and adverse childhood experiences; low socioeconomic status, air pollution, long hours working a stressful job; skipping breakfast and consumption of sugary drinks.
• MIGRAINE – NAMS medical director Dr Faubion and Dr Kapoor have authored another article together, this one on the association between migraine and vasomotor symptoms. It will be published in the May issue of Mayo Clinic Proceedings.
• HOT FLASHES – Bayer is stepping back from women’s health, meaning the Mirena coil and Yasmin birth control pill will take “a back seat” (what does that even mean?) in its future drugs strategy, but they still committed to drugs in clinical trials. That includes elinzanetant, which is its Neurokinin 3 receptor (NK3R) antagonist. The non-hormonal drug (their version of Astellas Pharma’s fezonlintant, which is currently before the US Food & Drug Administration for approval) is being developed to treat vasomotor symptoms during menopause.
An ortho’s take on frozen shoulder
Recently I interviewed a kick-ass orthopedic surgeon on the other platform I run, Livehealthy; Dr Hasan Baydoun works in Abu Dhabi, but in his career has been a assistant team physician for three different major league sports teams New England Patriots, the Boston Red Sox and the Boston Bruins (among others). He also has a special interest in shoulders, so I asked him about the frozen kind (my two-part series for paid subscribers starts here), and this is what he said:
“The body creates some inflammation because it thinks there is a problem inside the shoulder. The shoulder is normally the most mobile joint of the body, but with a frozen shoulder, it becomes very tight to the point where you can’t lift it.
Luckily it self-resolves in 90 percent of cases. But the bad news is that it can involve six to 18 months of pain, and another six months to regain mobility. In around 50 percent of cases it happens in the setting of another disease, typically ones such as diabetes, Crohn's or other autoimmune conditions. The other 50 percent of cases are idiopathic.
We treat frozen shoulders with physiotherapy. If there's a lot of pain, we consider injections but it very rarely requires surgery. That should be a last resort.
It happens in men but it’s more common in women. It's linked to menopause and the hormonal imbalances that happen around that time.”
No wonder we are lost:
A new study found that 9 out of 10 women didn’t learn about menopause in school and 60 percent only started looking for information when they began experiencing symptoms.
The study was headed up by fellow MenoClarity member (and Hotflash inc podcast guest) Professor Joyce Harper at University College London and published in Post Reproductive Health. She said: "We need to ensure that all health professionals have menopause training so they can give women information on managing their symptoms and well-being. And most importantly, we should give women hope that life postmenopause can be a fruitful and exciting time."
Click, read, listen, watch + follow
• “It should be called womenopause but…” Hearing Ali Wentworth talk about her mom advising her to “get it all scooped out, like a Hallowe’en pumpkin”… (hint: it’s part of her story about going into surgical menopause) and then say she dressed up as a menopausal housewife two years ago is a very good time. There’s no shame in menopause w/Naomi Watts and Pat Duckworth (fellow MenoClarity member and British Women’s Health and Workplace Menopause Strategist) Go Ask Ali podcast
• Earlier, longer and more bothersome hot flashes; longer periods, inferior treatment and more: Black women suffer disproportionately from menopause symptoms. Awareness could help change that Sahan Journal (paywall but not if you read it fast!)
• The Organization for the Review of Care and Health Apps (ORCHA) rated Health & Her’s symptom-tracking app #1 Digitalhealth.net
• Over in period world, 40 percent of women who experience period pain work through the discomfort, according to a survey of 5,000 women in 10 countries conducted by Deloitte in late 2022. Catch the headline: Women Face Period Stigma at Work Even as Menopause Is Less Taboo Bloomberg (paywall)
• Some people listen to the urge to chuck everything in perimenopause, and they end up living in a motor home in France: Don’t Let Menopause Stop You From Being Your Fabulous Self CrunchyTales
• I have to hand it to Minnesota Women’s Press and The Edge magazine, which co-hosted a seriously well-rounded event I’d like to see more of (and just might plan myself) called Sex, Menopause, and Aging Bodies Women’s Press
• If anyone who isn’t stuck in 1994 knows that the BMI is “trash”, why do we keep using it? It’s entrenched, and it’s complicated Medscape
Editor’s Note
I would like to issue a correction on my editor’s note from last week, when I said I hadn’t had a vacation since 2019. Clearly people with memories know that last year I went on an 8-day hike on Turkey’s Lycian Way. It was challenging and life-changing, just like Thailand. Maybe I’ll forget that in a year too?
Other random confessions:
• Anyone know anything about ghost/phantom periods? I’m for sure having one. Hit reply.
• Let’s not underestimate our value to anything in this world, no matter how we are feeling or what the world might be trying to suggest. One of my favorite quotes for the last 25 years comes (as best as I can tell) from the British writer Amelia Barr, and she meant it for all of us. "No man was ever ruined from without; the final ruin comes from within, when you turn hopeless and lose courage.”
• Perimenopause pet peeve: people who play their phones too loudly in public.