NHS Fife acknowledges and agrees with the importance of regular and timely review of policy statements and aims to review policies within the timescales set out.
New policies will be subject to a review date of no more than 1 year from the date of first issue.
Reviewed policies will have a review date set that is relevant to the content (advised by the author) but will be no longer than 3 years.
If a policy is past its review date then the content will remain extant until such time as the policy review is complete and the new version published, or there are national policy or legislative changes.
- Symptoms of Menopause
- Menopause Policy Statement
- Supporting Staff – Staff and line management responsibilities
NHS Fife is committed to providing an inclusive and supportive working environment for all staff.
This policy is intended to support staff who are experiencing symptoms associated with the menopause or the perimenopause (the transition phase which can last years either side of the menopause). The menopause itself is defined as having occurred when someone has not had a period for twelve consecutive months (for people reaching menopause naturally and not, for example, using hormonal contraception). However, some people can also have menopause induced as a result of surgery or medical treatments, such as chemotherapy or pelvic radiation therapy. Not everyone will experience symptoms during the perimenopause but offering support to those who do should help improve their experience at work. These natural symptoms are associated with a lack of oestrogen but can have adverse impact.
This policy is aimed to help all those who are perimenopausal or menopausal but the term ‘menopause’ will be used throughout this document.
A significant proportion of staff working for NHS Fife are in the age range of 40 - 60, when symptoms are most likely to occur. Evidence shows that some people may not feel comfortable discussing menopause related health problems, and the potential impact these can have on their work, with their managers.
Staff within NHS Fife should be made to feel that the menopause is not an issue that needs to be hidden; they should be assured of being able to talk about it openly without any hesitancy or fear of embarrassment. However, it should be noted that there is no obligation for staff to disclose that they are experiencing the menopause but that if they do, they can be confident that they will be listened to, understood and supported.
This policy is intended to help improve the experience of staff working within NHS Fife but does not form part of an employee’s contract of employment. The policy may be revised by NHS Fife from time to time.
Monitoring and evaluation of this policy will sit with the NHS Fife Area Partnership Forum.
The aims of this policy are to:
- support staff experiencing the menopause, and help them to minimise the impact it can have on them while at work
- create an environment where staff can feel confident enough to raise issues about their symptoms and ask for adjustments at work
- ensure all staff know and understand what the menopause is and have access to a policy where help and support available within NHS Fife is clearly defined, and
- inform staff and managers about the potential symptoms of menopause, what the potential consequences can be and how staff can and should be supported where required.
NHS Fife is committed to the promotion of equality, diversity and human rights. This policy is intended to support both staff and the organisation.
It is important to recognise, that for many reasons, individual experiences of the menopause may differ greatly. A person’s experience and perception of the menopause may differ because of one or more of the relevant protected characteristics named in the Equality Act 2010, namely, age, disability, trans status (gender reassignment), marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex or sexual orientation.
Should you feel that you do not receive the intended benefits of this policy, because of one of the relevant protected characteristics named in the Equality Act 2010, please discuss this with your line manager in the first instance. If you are unable to resolve any issues you may have with your line manager, you can contact a colleague from the Occupational Health & Wellbeing service for confidential advice. Ultimately, it is management that can help and support any changes to the work/ workplace that might be suggested, so speaking to management is an important first step.
Menopause is defined as a biological stage in a person’s life that occurs when they stop menstruating, and is a natural part of ageing. Normally it is defined as having occurred when someone has not had a period for twelve consecutive months. The average age for a person to reach menopause is 51, however, it can be earlier or later than this due to surgery, illness or other reasons. Around 1 in 100 people experience the menopause before 40 years of age. This is known as premature menopause or premature ovarian insufficiency.
Peri-menopause is the time leading up to menopause when someone may experience changes, such as irregular periods or other menopausal symptoms. This
can be years around the menopause. References to menopause throughout the policy should be assumed to also include people experiencing the peri-menopause.
Post-menopause is the time after menopause has occurred. During this stage, menopausal symptoms, can start to ease for many people although this can take many years.
Staff experiencing the menopause - Throughout the policy, gender neutral terms are used to describe staff who may experience the menopause. It is recognised that not everyone experiencing the menopause will identify or express themselves as a woman. People who are non-binary, trans or intersex, and who may not identify as a woman, may also experience menopausal symptoms. This policy therefore applies to anyone experiencing the menopause, regardless of their gender expression or identity.
Symptoms of the menopause
How long menopausal symptoms can last can vary greatly: on average they will last for around 4 years after a person stops having periods, although some people can experience them for much longer.
Not everyone will notice or experience a symptom but research shows that approximately 75% of people do experience some symptoms, of which 25% could be classed as severe.
Symptoms can manifest both physically and psychologically, including but not limited to:
- mood changes
- memory and concentration loss
- panic attacks
- heavy or light periods
- no or infrequent periods
- loss of confidence
- sleep difficulties
- hot flushes or excessive sweating
- joint and muscle stiffness, and
- out of character behaviour, for example uncharacteristic emotional
Some staff may not initially realise that they are experiencing the menopause and may try to ignore, or even misdiagnose their own symptoms. If you have any concerns about changes to your health or wellbeing, seek medical advice from your GP.
Menopause Policy Statement
NHS Fife aims to provide a safe environment where all employees are treated fairly, with dignity, and respect. NHS Fife seeks to create an environment where staff feel confident enough to raise issues relating to the menopause.
NHS Fife will seek to support staff who choose to disclose that they are experiencing the menopause. Support will include the consideration of reasonable adjustments to help reduce the potential impact menopausal symptoms can have on staff while they are at work.
NHS Fife will respect each staff member’s individual experience of the menopause. And, NHS Fife will take a proactive stance to promote a greater understanding of the menopause, and seek to eradicate any exclusionary or discriminatory practices.
Discussions with line managers will be handled sensitively and confidentially, with advice from the Occupational Health & Wellbeing service being available as appropriate. NHS Fife will provide appropriate information and support to staff affected by the menopause.
NHS Fife is committed to ensuring that conditions in the workplace do not make menopausal symptoms worse and that appropriate reasonable adjustments are fairly considered.
Staff experiencing the menopause
Staff experiencing the menopause should:
- be aware that NHS Fife aims to ensure they feel comfortable to discuss this with their line manager or with Occupational Health & Wellbeing if preferable
- be aware that NHS Fife will seek to support staff by considering making suitable reasonable adjustments
Disclosing that you are experiencing the menopause
If you would like to disclose that you are experiencing the menopause, and discuss what support might be available to you, you can arrange to speak to your line manager in the first instance. If you are unable to speak to your line manager, you can self-refer to colleagues from Occupational Health & Wellbeing.
With your consent, whoever you speak to should make a record of the conversation, using Appendix 1, noting any potential issues or adjustments that you may discuss. The information you share will be strictly confidential and not shared beyond your line manager or the relevant staff within Occupational Health & Wellbeing.
Please note there is no obligation for employees to disclose that they are experiencing the menopause.
If you have previously disclosed that you are experiencing menopausal symptoms and had reasonable adjustments agreed, you should notify your manager, or the Occupational Health & Wellbeing service as appropriate, when your symptoms are controlled or have stopped or changed. This will help you to consider if any adjustments put in place remain appropriate. It is important to note that symptoms can sometimes reoccur after they have seemingly stopped for a period of time. In this instance, you may wish to inform your manager of the reoccurrence of symptoms and discuss what support you might require.
The role of line managers in supporting staff experiencing the menopause is crucial. Staff can experience the menopause in a multitude of ways. Some staff may not need any assistance or require any additional support. Some staff may have much more severe symptoms and could require additional support at work to help them cope with the impact of their symptoms in the workplace. Each situation is different and there is no standard approach to supporting staff experiencing the menopause.
If a member of staff wishes to speak about their symptoms, or just to talk about how they are feeling, please ensure that you listen and respond appropriately, using the guidance within this policy.
As with any health-related condition, sympathetic and appropriate support from managers is crucial in order to provide employees with the support that they need.
Managers within NHS Fife should:
- read and understand our Menopause Policy and supporting guidance
- help staff experiencing the menopause to feel supported, and to be effective in their role
- ensure staff are aware of sources of help and support, internally within NHS Fife and from external sources (see Appendices 2 and 3)
- be prepared to have open discussions with staff and treat the conversation sensitively and professionally (see Appendix 1)
- seek consent from staff members to share information with the Occupational Health & Wellbeing service
- be aware of sources of support both for themselves or for staff requesting any reasonable adjustments
- be understanding and make fair decisions, in line with this policy, with respect to requests for reasonable adjustments
- make a record of conversations with staff or actions taken to support staff, after taking advice from Occupational Health as appropriate
- ensure an ongoing dialogue and review arrangements regularly to check that any reasonable adjustments agreed remain appropriate and adequate
- seek advice from the Occupational Health & Wellbeing service if there are any issues relating to support or reasonable adjustments that are not resolved
Effective management of team members with menopausal symptoms can help you to improve team morale, retain valuable skills and talent, and reduce sickness absence.
Good people management is fundamental to supporting employee health and well-being, spotting early signs of ill health or distress, and initiating early conversations about what support might be available.
It is important for managers to recognise that other people can be indirectly affected by the menopause, for example if a person’s partner is experiencing insomnia and night sweats, they may also experience disrupted sleep and fatigue. If an employee’s partner experiences significant physical or psychological symptoms they may be concerned for their wellbeing and feel increased levels of stress. In some cases, staff can experience relationship problems or difficulties at home during this time. These issues can have an impact on staff in the workplace and managers should be understanding and supportive of staff members in these circumstances.
It is also important to recognise that some staff members may not want to discuss the menopause. Any conversations should be kept strictly confidential, and information should only be shared with the Occupational Health & Wellbeing service (via the management referral process) when consent has been provided by the staff member concerned.
The onus is on managers to raise concerns with staff about the menopause if they feel it is impacting on work, even if the staff member does not raise the issue with the manager themselves.
Staff should consider seeking medical advice from their GP in the first instance.
Staff should not feel that they simply have to ‘put up’ with menopausal symptoms as a part of life (although there are some people who, because of previous illness cannot be prescribed the usual medication - such as hormone replacement - that can help to diminish menopausal symptoms and will usually have to ‘put up’ with symptoms). The effects and effectiveness of treatments, including non-medical options, can be discussed with a GP. GPs may also discuss lifestyle and how symptoms can be managed through changes that may help improve individuals longer term health.
Specialist menopause services, which people can self-refer to if they wish, are available in within NHS Fife.
You may wish to learn more about the menopause yourself. Links to more information about the menopause can be found in Appendix 3.
Make a list of your symptoms
Make a list of the symptoms, both physical and mental, you have experienced in the timeframe associated with your periods stopping, noting that not all symptoms are necessarily always as a result of the menopause. Note how you are feeling and any changes that have occurred. If you have an idea about any preferences for treatment, take a note of this before discussing it with your GP. Similarly, if you think of any reasonable adjustments that might support you at work, note this and discuss it with your line manager in the first instance.
Talking to your line manager about the menopause
Ask for a discussion in a location that offers you a level of privacy that you are comfortable with and ensure that enough time is allocated for you to explain your situation.
You may wish to write down any issues you want to raise beforehand. If you do, bring this to the meeting along with any thoughts or suggestions about reasonable adjustments from your discussion with your GP and/or your own research before the discussion.
If necessary ask for someone to accompany you to help you focus on the issues you need to raise and explain this to your line manager beforehand.
If you would prefer to speak to someone from the Occupational Health & Wellbeing service in the first instance, you can contact them to arrange a ‘self-referral’ appointment. If you require adjustments to help you improve your experience at work then the Occupational Health & Wellbeing service will most likely have to liaise with your line manager to consider this and a management referral may ultimately be required or suggested.
You can contact the Occupational Health & Wellbeing service via email at:firstname.lastname@example.org or tel: 01592 729401 (or ext 29401)
The NICE Guideline on the diagnosis and management of the menopause can provide further information and guidance on the menopause.
The following are examples of what might be considered to be a reasonable adjustment but should not be considered to be adjustments that will be automatically made. Similarly, this list is not exhaustive and other adjustments might be considered. What is reasonable in the circumstances for each member of staff should be discussed and agreed between a staff member and their line manager, with advice from Occupational Health & Wellbeing as necessary.
Examples of adjustments that might be considered to support staff experiencing menopausal symptoms could include the following.
- Considering some degree of temperature control, such as a desk fan or moving a person to a cooler area of the office or away from a heat source
- Offering easy access to cool drinking water
- Agreeing the need to sometimes move away from a desk to manage a hot flush, allowing a person to go to the coolest point (which may be outside), the toilet or quiet room as necessary
- Ensure that meeting rooms are not occupied beyond the suggested capacity and that ‘time out’ of a meeting may be required.
Heavy / Light periods
- Supporting access to washroom facilities both when office based and when off site on visits / meetings/ inspections. This may mean preparation in advance to check available facilities
- Consideration of allowing a person to work from home when leaving the house and travelling is not feasible due to heavy
- Providing quiet areas and touchdown areas as appropriate
- Considering the provision of noise reducing headphones to wear in open offices
- Allowing time to take
- Consider flexible working / agile working if necessary /change of work
- Consider offering a ‘buddy’ or someone else to talk to
- Consider allowing a person some time to help them refocus on their work
- Support an individual to seek support from their GP
- Offer the Occupational Health – telephone number - tel: 01592 729401 (or ext 29401).
Loss of Confidence
- Offer regular one to one discussions with line managers
- Consider protected time to catch up with
- Help with establishing if there is a pattern and considering adjustments if concentration is better or worse at certain times of the day
- Review workload with line manager
- Support to make lists of work tasks
- Offer quiet space and try to minimise when others will disrupt staff when they need to concentrate
- Consideration of noise reducing
Anxiety and panic attacks
- Support an individual to seek support from their GP and consider making use of support services through the Occupational Health Staff Counselling service: tel 01592 729401 (or ext 29401)
- Consider offering a quiet room or space to practice relaxation techniques and mindfulness e.g. Pause Pods
- Consider offering some time out for a person to take a short walk or speak to someone they trust who can
External sources of support and advice:
- NHS Inform
- Royal College of Obstetricians and Gynecologists
- Menopause Café
- Sandyford Menopause Clinic
- NHS Employers
- Menopause Matters
- BOHRF - Work and the Menopause: A Guide for Managers (Download the British Occupational Health Research Foundation (BOHRF) guide for managers here.)
- TUC - Supporting women through the menopause: Guidance for Union representatives (This guidance document includes the section 'What can employers do?' (pg.8-9). Download it here.)
- The Faculty of Occupational Medicine (FOM) - Guidance on menopause and the workplace (Includes guidance for managers/employers, and guidance for women. Download here.)
- Business in the Community (BITC) - The business case for reporting your gender pay gap (The benefits of reporting and closing your gender pay gap for business, the economy and society. Download here.)
- Department for Education - The effects of menopause transition on women's economic participation in the UK (This 2017 research report contains information for employers, including 'How can employers better support women experiencing the menopause transition?' (pg.49-61). Download here.)
- Acas menopause at work guidance (Visit the Acas website to view the new menopause at work guidance. Download the factsheet for managers here. Menopause at work infographic available here, stats/facts here.)
- The Journal of Physiology, Exercise training reduces the acute physiological severity of post-menopausal hot flushes
- The Journal of The North American Menopause Society, Exercise training reduces the frequency of menopausal hot flushes by improving thermoregulatory control
- NICE guideline (2015), Menopause: diagnosis and management
- NICE quality standard (2017), Menopause
- Royal College of Nursing (RCN), The menopause and work: guidance for RCN representatives
- TUC, Supporting working women through the menopause: Guidance for Union representatives
- The Last Taboo - Managing the Menopause in the Workplace
- The Department for Education, The effects of menopause transition on women's economic participation in the UK (Research report, July 2017)
- Primary Care Women's Health Forum (PCWHF), HRT Myths Uncovered page 1 and page 2
- British Menopause Society (BMS) Fact Sheet, Information for GPs and other healthcare professionals, for women and for media
- Faculty of Occupational Medicine (FOM), Health and Work Menopause Focus infographic
- The British Menopause Society
- Daisy Network
- Royal College of Nursing - Women's health: menopause
- Royal College of Obstetricians & Gynaecologists - Women's health information hub
- Women's Health Concern (WHC)
Internal sources of support and advice:
- Confidential Contacts
- Occupational Health & Wellbeing Service
- Staff Self-Referral Service
- Dr Steven Monaghan, Consultant Gynaecologist – weekly telephone clinic
- Lynn Sutherland, Lead Menopause Nurse
- FHSCP Supporting the Menopause in the Workplace: Supporting the Menopause in the Workplace