Menopausal vasomotor symptoms are associated with poor self-assessed work ability

A qualitative study of work and early menopause: 'On-the job' experiences and career trajectories

OBJECTIVES

Early menopause or premature ovarian insufficiency (POI), menopause occurring before age 45 and 40 years respectively, occur at the age when most women are establishing or consolidating their careers. Studies of older postmenopausal women indicate an adverse bidirectional relationship between menopause and work. However, data are lacking regarding the work experiences of women with early menopause or POI. We explored the experiences of women with early menopause or POI in relation to work.

STUDY DESIGN

Using maximum variation sampling, 30 women (median age 44 years and 38 years at menopause diagnosis) of diverse backgrounds and menopause causes (16/30 iatrogenic) participated in qualitative interviews to explore experiences of early menopause/POI in the context of their overall lives, work and career. Dual thematic (themes identified across interviews) and thematic narrative (themes identified within individual interviews) analysis was done using NVivo 12 software.

MAIN OUTCOME MEASURES

Themes related to work experiences and influencing factors.

RESULTS

Two major themes were identified: 'on-the-job' experiences (work performance, bodily presentation and disclosure) and career trajectories (intact and altered). Factors impacting the interaction between work and early menopause/POI included: career (type of work, environment, working conditions), personal (age, socio-economic background, family arrangements, migration history) and menopause experience (spontaneous versus iatrogenic, treatment complexity).

CONCLUSIONS

Early menopause/POI has multiple impacts on women's work experiences and career trajectories. As with older postmenopausal women, career and personal factors influence younger women's work experience. However, this research highlights differences associated with menopause occurring at an earlier, often unexpected age compared with menopause at the usual age.

Scale development and validation of perimenopausal women disability index in the workplace

BACKGROUND

Menopausal disorders include obscure symptomatology that greatly reduce work productivity among female workers. Quantifying the impact of menopause-related symptoms on work productivity is very difficult because no such guidelines exist to date. We aimed to develop a scale of overall health status for working women in the perimenopausal period.

METHODS

In September, 2021, we conducted an Internet web survey which included 3,645 female workers aged 45-56 years in perimenopausal period. We asked the participants to answer 76 items relevant to menopausal symptomatology, that were created for this study and performed exploratory and confirmatory factor analyses for the scale development. Cronbach's alpha, receiver operating characteristic analysis, and logistic regression analysis were used to verify the developed scale.

RESULTS

Approximately 85% participants did not have menstruation or disrupted cycles. Explanatory factor analysis using the maximum likelihood method and Promax rotation identified 21 items with a four-factor structure: psychological symptoms (8 items, α = 0.96); physiological symptoms (6 items, alpha = 0.87); sleep difficulty (4 items, alpha = 0.92); human relationship (3 items, alpha = 0.92). Confirmatory factor analyses found excellent model fit for the four-factor model (RMSR = 0.079; TLI = 0.929; CFI = 0.938). Criterion and concurrent validity were confirmed with high correlation coefficients between each of the four factors, previously validated menopausal symptom questionnaire, and Copenhagen Burnout Inventory scales, respectively (all ps < 0.0001). The developed scale was able to predict absenteeism with 78% sensitivity, 58% specificity, and an AUC of 0.727 (95%CI: 0.696-0.757). Higher scores of each factor as well as total score of the scale were more likely to be associated with work absence experience due to menopause-related symptoms even after adjusting for Copenhagen Burnout Inventory subscales (all ps < 0.0001).

CONCLUSION

We found that the developed scale has high validity and reliability and could be a significant indicator of absenteeism for working women in perimenopausal period.

Dysmenorrhea, Workability, and Absenteeism in Australian Women

Background: This study determined the prevalence of bothersome menstrual symptoms and their association with workability in naturally menstruating women not using hormonal contraception. Materials and Methods: A representative sample of community-dwelling Australian women aged 18-39 years selected from two large national electronic databases responded to a survey on general health. This study focuses on self-reported dysmenorrhea and menstrual bleeding and their association with workability and absenteeism in working women, assessed by the Workability Index. Results: Of 3,555 women, 1,573 (44.2% [95% CI: 42.6%-45.9%]) reported moderate to severe dysmenorrhea and 774 (21.8% [95% CI: 20.4%-23.2%]) reported heavy to very heavy bleeding. Women with dysmenorrhea were 50% more likely to report poorer work performance and twice as likely to report more days of sick leave in the past year (absenteeism) than other women. Conclusions: Despite the availability of safe and effective management options, Australian working women aged 18-39 years continue to experience bothersome dysmenorrhea and menstrual bleeding. Dysmenorrhea is associated with increased absenteeism and poorer workability. Therefore, awareness needs to be raised among women and health care providers of ways to manage dysmenorrhea and heavy bleeding and the unmet need for intervention in the community, respectively.

Perimenopause: Symptoms, work ability and health among 4010 Dutch workers

OBJECTIVE

In this study we examined the associations between menopausal symptoms and work ability and health among a general population of Dutch female workers.

STUDY DESIGN

This nationwide cross-sectional study was a follow-up of the Netherlands Working Conditions Survey 2020. In 2021, 4010 Dutch female employees aged 40-67 years completed an online survey on a variety of topics, including menopausal symptoms, work ability and health.

METHODS

Linear and logistic regression analyses were performed to investigate the association between the degree of menopausal symptoms with work ability, self-rated health and emotional exhaustion, after adjustment for potential confounders.

RESULTS

Almost one-fifth of participants were in the perimenopause (n = 743). Of these women, 80 % experienced menopausal symptoms: 27.5 % 'often' and 52.5 % 'sometimes'. Experiencing menopausal symptoms was associated with lower work ability, poorer self-rated health, and more emotional exhaustion. These associations were most pronounced among perimenopausal women 'often' experiencing symptoms.

CONCLUSIONS

Menopausal symptoms threaten the sustainable employability of female workers. Interventions and guidelines are needed to support women, employers and (occupational) health professionals.

Increasing climacteric symptoms in untreated perimenopausal Finnish women: a 10-year cohort study

OBJECTIVE

This study aimed to examine changes over a 10-year period in experiencing climacteric symptoms and their associations with sociodemographic and health-related background factors in a birth cohort of Finnish women who have never used menopausal hormone therapy (MHT).

METHODS

This nationwide population-based follow-up study consists of 1491 women who during the follow-up period moved from the age group 42-46 years to the age group 52-56 years. The experience of climacteric symptoms was assessed by 12 symptoms commonly associated with the climacterium. The data were analyzed using statistical techniques.

RESULTS

Both the intensity, expressed as a symptom score of four symptoms associated with a decrease in estrogen production (sweating, hot flushes, vaginal dryness, sleeping problems), and the prevalence of the five most common symptoms (sweating, hot flushes, sleeping problems, lack of sexual desire, depressive symptoms) increased clearly during the follow-up period. The examined sociodemographic and health-related variables did not explain the changes in experiencing the symptoms.

CONCLUSIONS

The results of this study can be considered in primary and occupational health care and in gynecological settings when working with symptomatic women or women with hidden climacteric problems and carrying out health promotion and counseling for them.

Impact of menopausal symptoms on work and careers: a cross-sectional study

BACKGROUND

Women over 50 years are one of the fastest-growing employment groups. Menopausal symptoms can adversely impact quality of life, work performance and attendance; however, few studies look at the impact of individual menopausal symptoms on work and career development.

AIMS

To measure the prevalence of menopausal symptoms in employees in a healthcare setting, to assess the impact of individual symptoms on work, attendance and career development and to explore perceptions about workplace supports.

METHODS

In this cross-sectional study of Irish hospital workers, menopausal employees were asked about the frequency of 10 menopausal symptoms and the extent to which each symptom impacted them at work. Impacts on performance, attendance and career development were assessed, along with the benefits of workplace support.

RESULTS

Responses from 407 women showed that the most common menopausal symptoms affecting employees greater than 50% of the time while at work were fatigue (54%), difficulty sleeping (47%), poor concentration (44%) and poor memory (40%). Work performance was impacted for 65% of respondents and 18% had taken sick leave. There was a significant association between symptom severity at work and reduced work performance, career development decisions and attendance. Manager awareness about menopause (29%) and flexible working times (29%) were selected as the most important workplace supports.

CONCLUSIONS

Female employees are negatively impacted by menopausal symptoms while at work, particularly by psychological and neurocognitive symptoms which were associated with reduced work performance, attendance and career decisions. Manager awareness and flexible schedules were considered the most beneficial workplace supports.

Menopause-Biology, consequences, supportive care, and therapeutic options

Menopause is the cessation of ovarian function, with loss of reproductive hormone production and irreversible loss of fertility. It is a natural part of reproductive aging. The physiology of the menopause is complex and incompletely understood. Globally, menopause occurs around the age of 49 years, with geographic and ethnic variation. The hormonal changes of the menopause transition may result in both symptoms and long-term systemic effects, predominantly adverse effects on cardiometabolic and musculoskeletal health. The most effective treatment for bothersome menopausal symptoms is evidence-based, menopausal hormone therapy (MHT), which reduces bone loss and may have cardiometabolic benefits. Evidence-based non-hormonal interventions are also available for symptom relief. Treatment should be individualized with shared decision-making. Most MHT regimens are not regulator approved for perimenopausal women. Studies that include perimenopausal women are needed to determine the efficacy and safety of treatment options. Further research is crucial to improve menopause care, along with research to guide policy and clinical practice.

Unveiling the Role of the Work Environment in the Quality of Life of Menopausal Physicians and Nurses

BACKGROUND

There is a lack of scientific evidence regarding the specific challenges faced by menopausal medical professionals in different work settings. This study aims to investigate the relationship between work environment and the menopausal quality of life (QoL) in physicians and nurses.

METHODS

This survey was conducted using the Menopausal Quality of Life Questionnaire (MENQOL) with a sample of 35 menopausal physicians and 95 nurses employed in health facilities in Astana and Kyzylorda cities, Kazakhstan.

RESULTS

Physicians reported a higher frequency of menopausal symptoms compared to nurses. The difference was statistically significant (p < 0.05) for symptoms such as decreased productivity (60.00% vs. 38.20%), flatulence or gas pains (71.43% vs. 48.39%), weight gain (79.41% vs. 61.80%), changes in skin appearance (79.59% vs. 50.00%), and changes in sexual desire (58.82% vs. 33.70%). Physicians with managerial duties had a significantly higher occurrence of vasomotor symptoms compared to non-managerial physicians (mean 3.35 ± 2.14 vs. 1.69 ± 0.89) and also had a higher mean psychological score (mean 3.26 ± 1.28 vs. 2.29 ± 1.19).

CONCLUSIONS

These findings reflect differences between the menopause effects related to work environment for doctors and nurses, and shed light on the specific challenges faced by them during menopause. In addition, it is important to consider socio-demographic and workplace-related factors in investigating their impact on the QoL.

Evaluation of a workplace educational intervention on menopause: A quasi-experimental study

OBJECTIVE

To evaluate the effects of a workplace educational intervention on menopause on self-efficacy regarding working during the climacteric.

METHODS

Quasi-experimental design, with one intervention and one control group. Women aged 40 to 67, working in one of the two participating departments of a large municipality in the Netherlands, were recruited to participate in the study. The allocation of participants to intervention or control group was done at the departmental level. The main component of the multifaceted intervention consisted of educational workshops on menopause and work. The primary outcome was score on the Self-Efficacy to Manage Symptoms Scale. Secondary outcomes were scores on other self-efficacy scales, knowledge about the menopausal transition, menopausal symptoms, beliefs and behaviours and work-related variables. Differences between groups were analysed with Pearson's chi-square, Student's t-test or Mann-Whitney U. Analysis of covariance (ANCOVA) was used to correct for baseline and potential confounders.

RESULTS

Data from 54 women were analysed, 25 in the intervention group and 29 in the control group. After 12 weeks of follow-up, the mean score on the Self-Efficacy to Manage Symptoms Scale was higher in the intervention group than in the control group: 6.52 (SD 1.45) versus 5.84 (SD 1.51), respectively, adjusted mean difference 0.75 (95 % CI 0.03-1.46, p = 0.040). The educational intervention increased self-reported knowledge (scored on the range 1-10) (adjusted mean difference 0.7, 95 % CI 0.26-1.15, p = 0.002) and resulted in a lower level of presenteeism (i.e., less impaired work performance) due to menopausal symptoms, measured by the Dutch Stanford Presenteeism Scale (adjusted mean difference 2.15, 95 % CI 0.13-4.18, p = 0.038), compared to the control group.

CONCLUSIONS

This educational workplace intervention study shows promising positive effects on self-efficacy regarding working during the climacteric, knowledge about the menopausal transition and presenteeism due to menopausal symptoms. This is especially true for women already experiencing menopausal symptoms, while premenopausal women were harder to engage in the intervention. A larger study, with longer follow-up, preferably a randomized controlled trial, is needed to investigate the clinical relevance of these findings.

Quality of life in menopausal women in the workplace - a systematic review

Menopausal women are a large and economically relevant group in the workforce. Yet their quality of life (QoL) and needs in the workplace have been neglected. Thus, the aim of this systematic review was to provide an overview of QoL of menopausal women in the workplace. Systematic literature searches were executed, yielding 1211 references. After abstract screening, 156 articles remained for full-text screening. Finally, 12 articles fulfilled the inclusion criteria and were included in this review. Age, educational level, type of work, working environment (e.g. crowding, confined spaces, noise, workstation design), permanent place of residency, mental factors (e.g. stress level, workload, work pattern), comorbidities, menopausal symptoms, time since menopause and physical activity have repeatedly been shown to affect QoL in the workplace in menopausal women. Low-threshold access to medical and psychological support as well as individual adaptation of the workplace environment are, among others, retrieved recommendations for employers from these findings. Further raising of awareness of special needs of menopausal working women as well as further systematic research programs are needed.

Impact of Menopausal Symptoms on Work: Findings from Women in the Health and Employment after Fifty (HEAF) Study

Women make up a growing proportion of the workforce and therefore many women experience menopause while in paid employment. We explored the prevalence of menopausal symptoms, the relationship between symptoms and coping with work and the risk factors associated with struggling at work during the menopause. The Health and Employment After Fifty (HEAF) community-based cohort of people aged 50-64 years was incepted 2013-2014 to study health and work. In 2019, female participants were asked to complete a questionnaire about their menopausal symptoms, and effect of those symptoms on their ability to cope at work. 409 women were eligible for inclusion. The commonest symptoms were vasomotor (91.7%); trouble sleeping (68.2%); psychological (63.6%) and urinary (49.1%). The prevalence of reporting symptoms was similar no matter which type of occupation women were performing at the time. Around one-third of women reported moderate/severe difficulties coping at work because of menopausal symptoms. Risk factors for difficulties coping at work included: financial deprivation, poorer self-rated health, depression, and adverse psychosocial occupational factors but not physical demands. More awareness is needed amongst employers in all sectors but women with financial difficulties and those with jobs in which they feel insecure, unappreciated, or dissatisfied are at greatest risk.

Menopausal Voice-Related Work Limitation Scale (MenoVWL): Development and Validation

OBJECTIVES

Menopause has been reported to affect the voice of female professional voice users (FPVUs). The present study aims at the development and validation of a scale to measure self-perceived menopausal voice-related limitation to work in FPVUs, henceforth the Menopausal Voice-Related Work Limitation Scale (MenoVWL).

METHODS

Items were drawn from previous studies on impacts of sex steroid hormones on voice, available validated scales, and in-depth interviews with post-menopausal FPVUs. A preliminary version with 16 items was evaluated by a panel of 15 voice experts. The resulting revised version was filled in online, together with questions on current endocrinological reproductive status and related symptoms, history of amenorrhea, professional occupation, and demographic information. Responses concerning only professional voice users were selected and inclusive and exclusive criteria were applied for correct allocation of participants into pre- and post-menopausal stages within a restrict age range;192 responses were subject to factorial analysis for MenoVWL validation. Cronbach's alpha measured internal reliability. The scale was tested by comparing MenoVWL scores between pre- and post-menopausal FPVUs (98 and 94, respectively).

RESULTS

Thirteen items were retained from the expert panel evaluation. Items presented a high Content Validity Index (.94 out of 1) and high Item Acceptance Ratio (86.25 %). Both exploratory and confirmatory factorial analysis rendered one dimension scale with an excellent internal consistency (Cronbach's alpha = .9). The results of a Mann-Whitney test showed a higher MenoVWL score for post- as compared to pre-menopausal FPVUs (Z = - 2.818; P = .005).

CONCLUSIONS

MenoVWL is a comprehensive and validated scale with a known factor structure. It constitutes a health care and safety outcome self-perceived measure of value to the early detection of voice-related limitations to work in FPVUs during menopause.

Q-122 as a novel, non-hormonal, oral treatment for vasomotor symptoms in women taking tamoxifen or an aromatase inhibitor after breast cancer: a phase 2, randomised, double-blind, placebo-controlled trial

BACKGROUND

Vasomotor symptoms (hot flushes and night sweats) are experienced by more than two-thirds of women with breast cancer taking oral adjuvant endocrine therapy. Safe and effective treatments are lacking. Q-122 is a novel, non-hormonal compound that has shown promise for reducing vasomotor symptoms by modulation of oestrogen-responsive neurons in the hypothalamus. We aimed to assess the efficacy and safety of Q-122 in women with breast cancer taking oral adjuvant endocrine therapy and experiencing vasomotor symptoms.

METHODS

We conducted a multicentre, randomised, double-blind, placebo-controlled, proof-of-concept, phase 2 trial at 18 sites in Australia, New Zealand, and the USA. Eligible participants were women, aged 18-70 years, taking a stable dose of tamoxifen or an aromatase inhibitor following breast cancer and experiencing at least 50 self-reported moderate to severe vasomotor symptoms per week. Participants were randomly assigned (1:1) using an interactive web response system to oral Q-122 100 mg or identical placebo, twice daily for 28 days. Randomisation was stratified by BMI (≤30 kg/m2 or >30 kg/m2) and use of any of a selective serotonin reuptake inhibitor, selective norepinephrine reuptake inhibitor, gabapentin, or pregabalin. Q-122 and placebo capsules were identical in appearance and containers identically labelled. During the double-blind treatment and analysis phases, the participants, investigators, clinical research organisation staff, and sponsor were masked to treatment allocation. The primary outcome was the difference in the mean percentage change from baseline in the Vasomotor Symptom Severity Score of moderate and severe hot flushes and night sweats (msVMS-SS) between Q-122 and placebo after 28 days of treatment. Primary analysis was by modified intention-to-treat and safety was assessed in all participants receiving at least one dose of study drug. This study is registered at ClinicalTrials.gov, NCT03518138.

FINDINGS

Between Oct 24, 2018, and Sept 9, 2020, 243 patients were screened, 131 of whom were randomly assigned and received treatment (Q-122 n=65 and placebo n=66). Q-122 resulted in a significantly greater mean percentage change in msVMS-SS from baseline over 28 days of treatment compared with placebo (least squares mean: Q-122 -39% [95% CI -46 to -31] vs placebo -26% [-33 to -18]; p=0·018). Treatment-emergent adverse events were generally mild to moderate and similar between the two groups (treatment-related treatment-emergent adverse events in 11 [17%] of 65 patients in the Q-122 group vs nine [14%] of 66 in the placebo group); zero patients in the Q-122 group and two (3%) patients in the placebo group had serious adverse events.

INTERPRETATION

Q-122 is an effective and well tolerated non-hormonal oral treatment for vasomotor symptoms in women taking oral adjuvant endocrine therapy after breast cancer. Our results support the conduct of larger and longer studies of Q-122, with potential use extending to postmenopausal women who require an alternative to menopausal hormone therapy.

FUNDING

QUE Oncology.

Treating menopause - MHT and beyond

Every woman who lives past midlife will experience menopause, which, by definition, is complete cessation of ovarian function. This process might occur spontaneously (natural menopause) or be iatrogenic (secondary menopause), and can be further classified as 'early' if it occurs before the age of 45 years and 'premature' if it occurs before the age of 40 years. Globally, the mean age of natural menopause is 48.8 years, with remarkably little geographic variation. A woman's age at menopause influences health outcomes in later life. Early menopause is associated with a reduced risk of breast cancer, but increased risks of premature osteoporosis, cardiovascular disease and premature death. The cardinal symptoms of menopause, and adverse health sequelae, are due to loss of ovarian oestrogen production. Consequently, menopausal hormone therapy (MHT) that includes oestrogen or an oestrogenic compound ameliorates menopausal symptoms, while preventing menopause-associated bone loss and cardiometabolic changes. Importantly, comprehensive care of postmenopausal women involves lifestyle optimization (attention to nutrition and physical activity, reducing alcohol consumption and not smoking) and treating other established chronic disease risk factors. This Review offers a commentary specifically on the contemporary use of MHT and novel pharmaceutical alternatives to manage menopausal symptoms.

Menopause and work: A narrative literature review about menopause, work and health

BACKGROUND:

Menopause is part of working women’s lives. In Western countries, labour market patterns are changing rapidly: women’s labour participation has increased, the percentage of full-time working women is rising, and retirement age is increasing.

OBJECTIVE:

This narrative literature study aims to provide an insight in the state of the art in the literature about the relationship between menopause, work and health and to identify knowledge gaps as input for further research.

METHODS:

The search was conducted in PubMed, CINAHL, MEDLINE and ScienceDirect. The final set includes 36 academic articles, 27 additional articles related to the topic and 6 additional sources.

RESULTS:

Research on menopause, work and health is scarce. Results are grouped thematically as follows: Menopause and (1) a lack of recognising; (2) sickness absence and costs; (3) work ability; (4) job characteristics; (5) psychosocial and cultural factors; (6) health; (7) mental health, and (8) coping and interventions. Work ability of women with severe menopausal complaints may be negatively affected.

CONCLUSIONS:

Due to taboo, menopause remains unrecognised and unaddressed within an organisational context. New theoretical and methodological approaches towards research on menopause, work and health are required in order to match the variety of the work contexts world-wide.

Therapeutic potentials of genistein: New insights and perspectives

Genistein, a polyphenolic isoflavone compound found abundantly in soy or soy-based products, is widely consumed in the Asian population. Genistein has poor bioavailability, to overcome this problem many advanced nano-drug delivery carrier systems are designed to enhance its water solubility and stability. However, further research is required to develop more efficient bioavailability improvement strategies. Genistein is a phytoestrogen which has been associated with reducing the risk of cancer, cardiovascular disorders, and diabetes mellitus. This plant-based bioactive compound possesses numerous biological activities such as anti-oxidant, anti-inflammatory, anti-obesity, anti-cancer, cardioprotective, and anti-diabetic activities to treat various disease states. Genistein has been used as an active therapeutic agent in many medications. Moreover, several clinical trials are in the ongoing stage to develop more efficient treatment therapies, especially for cancer treatment. This article highlights the protective and therapeutic benefits of genistein in the treatment of different ailments, and more specifically elaborates on the anti-cancer potential of genistein regarding various types of cancers. PRACTICAL APPLICATIONS: Genistein possesses versatile biological activities, including anti-diabetic, anti-inflammatory, anti-oxidant, anti-obesity, and anti-angiogenic. The most studied activity is anti-cancer. Currently, a number of pre-clinical and clinical trials are being carried out on anti-neoplastic and cytotoxic activities of genistein to develop novel therapeutic agents with excellent anti-cancer potential for the treatment of various kinds of cancer. Moreover, many bioavailability enhancement strategies have been developed to improve the bioavailability of genistein. Genistein shows significant hypoglycemic effects alone or in combination with other anti-diabetic agents. Genistein in combination with other chemotherapeutic agents is used for the treatment of prostate, bone, colorectal, glioma, breast, and bladder cancer.

Menopause workplace policy: The way forward or backward?

Workplace policies regarding women's reproductive and menopausal health are garnering global attention. The peri- and post-menopause stages may be turbulent times for many women, with some experiencing debilitating symptoms and some none at all. While the symptoms of menopause should be recognised by employers due to their various impacts, the implementation of policies that pertain to all women can alienate older female workers by creating prejudice surrounding work capability. This piece identifies other avenues for the inclusion of menopausal symptoms through pre-existing policy and highlights the issues facing menopausal women in this current age.

Global consensus recommendations on menopause in the workplace: A European Menopause and Andropause Society (EMAS) position statement

INTRODUCTION

Worldwide, there are 657 million women aged 45-59 and around half contribute to the labor force during their menopausal years. There is a diversity of experience of menopause in the workplace. It is shaped not only by menopausal symptoms and context but also by the workplace environment. It affects quality of life, engagement, performance, motivation and relations with employers.

AIM

To provide recommendations for employers, managers, healthcare professionals and women to make the workplace environment more menopause supportive, and to improve women's wellbeing and their ability to remain in work.

MATERIALS AND METHODS

Literature review and consensus of expert opinion.

SUMMARY RECOMMENDATIONS

Workplace health and wellbeing frameworks and policies should incorporate menopausal health as part of the wider context of gender and age equality and reproductive and post-reproductive health. Workplaces should create an open, inclusive and supportive culture regarding menopause, involving, if available, occupational health professionals and human resource managers working together. Women should not be discriminated against, marginalized or dismissed because of menopausal symptoms. Health and allied health professionals should recognize that, for some women, menopausal symptoms can adversely affect the ability to work, which can lead to reduction of working hours, underemployment or unemployment, and consequently financial insecurity in later life.

Menopausal symptoms and work: a narrative review of women's experiences in casual, informal, or precarious jobs

Governments, employers, and trade unions are increasingly developing "menopause at work" policies for female staff. Many of the world's most marginalised women work, however, in more informal or insecure jobs, beyond the scope of such employment protections. This narrative review focuses upon the health impact of such casual work upon menopausal women, and specifically upon the menopausal symptoms they experience. Casual work, even in less-then-ideal conditions, is not inherently detrimental to the wellbeing of menopausal women; for many, work helps manage the social and emotional challenges of the menopause transition. Whereas women in higher status work tend to regard vasomotor symptoms as their main physical symptom, women in casual work report musculoskeletal pain as more problematic. Menopausal women in casual work describe high levels of anxiety, though tend to attribute this not to their work as much as their broader life stresses of lifelong poverty and ill-health, increasing caring responsibilities, and the intersectionally gendered ageism of the social gaze. Health and wellbeing at menopause is determined less by current working conditions than by the early life experiences (adverse childhood experiences, poor educational opportunities) predisposing women to poverty and casual work in adulthood. Approaches to supporting menopausal women in casual work must therefore also address the lifelong structural and systemic inequalities such women will have faced. In the era of COVID-19, with its devastating economic, social and health effects upon women and vulnerable groups, menopausal women in casual work are likely to face increased marginalisation and stress. Further research is need.

Relationship between number of menopausal symptoms and work performance in Japanese working women

OBJECTIVE

The presence of various menopausal symptoms could decrease work performance because symptom management strategies differ, and it is difficult to control all symptoms at work. The aim of this study was to examine the relationship between the number of menopausal symptoms experienced and work performance in working women.

METHODS

An online cross-sectional study was conducted with 599 working Japanese women aged 45 to 65 years. To represent work performance, absolute presenteeism was measured using the Japanese version of the World Health Organization and Work Performance Questionnaire short form, and menopausal symptoms were measured using the Greene Climacteric Scale. The total number of subscales on which a participant scored more than one point represented the number of menopausal symptoms.

RESULTS

Participants' mean age was 54.2 years, and 60.6% were postmenopausal. Their mean Greene Climacteric Scale score and mean absolute presenteeism score were 10.5 ± 10.6 and 61.7 ± 17.9, respectively. The proportions of participants who provided care for a family member, who had chronic disease, and who undertook regular exercise were significantly different among the four groups. After adjusting for other factors, absolute presenteeism was negatively correlated with the number of menopausal symptoms experienced (β = -0.13, P < 0.001).

CONCLUSIONS

Higher numbers of menopausal symptoms were correlated with lower work performance. The maintenance of health and the provision of appropriate working environments would help working women and improve work performance by reducing menopausal symptoms.

"I Get That Spirit in Me"-Mentally Empowering Workplace Health Promotion for Female Workers in Low-Paid Jobs during Menopause and Midlife

During menopause and midlife, female workers, particularly those in low-paid jobs, experience more occupational health problems than other groups of workers. Workplace interventions are often lacking, however. In the Netherlands, a workplace health promotion intervention—the work–life program (WLP)—has been developed to support female workers. Here, we tailored the WLP to the needs of female workers in low-paid jobs working at Amsterdam University Medical Center. In an exploratory mixed-methods study with a convergent design, among 56 participants, we used questionnaires before and after the intervention and semi-structured, in-depth interviews to address the following research question: What is the impact of the WLP on the women’s health and work functioning? Our quantitative data showed that menopausal symptoms improved significantly after the WLP. Our qualitative data, derived from 12 participants, showed that the WLP initiated a process of mental empowerment that initiated positive changes in four domains: behavior, physical health, mental wellbeing, and in the workplace. Taken with caution, our findings suggest that the WLP mentally empowers female workers to make choices that enhance their health and wellbeing, both at work and in their private lives, as summarized in the quote of one participant: “I get that spirit in me!”.

Effects of six month personalized endurance training on work ability in middle-aged sedentary women: a secondary analysis of a randomized controlled trial

Background

To test the effects of guided endurance training on work ability in middle-aged female hospital workers of various occupations.

Methods

We randomized 265 healthy, sedentary, middle-aged women (45–65 years) to an endurance training group (EG 210 min/week) or a wait-list control group (CG). At baseline and at 6-month follow-up, we assessed work ability (Work Ability Index [WAI]), physical activity (Freiburger activity questionnaire) and peak oxygen uptake (VO_2peak) by cardiopulmonary exercise testing. To examine the influence of baseline work ability, participants were divided into poor-moderate (WAI 1, 7–36 points, n = 83), good (WAI 2, 37–43 points, n = 136) and excellent (WAI 3, 44–49 points, n = 46) WAI subgroups.

Results

Cardiorespiratory fitness improved significantly after 6 months in the EG but not in the CG. The WAI total score increased significantly in the EG (38.3 ± 5.0 to 39.8 ± 4.9 points) but not in the CG (39.4 ± 4.7 to 39.3 ± 4.9 points), with a significant difference between groups (p < 0.01). In the EG, only the poor-moderate subgroup (WAI 1, 33.0 ± 2.9 to 36.6 ± 4.8 points, p < 0.05) increased the WAI total score, with this increase being significantly higher compared to the good (WAI 2, 40.2 ± 2.1 to, 40.4 ± 3.7 points) and excellent (WAI 3, 45.6 ± 1.5 to 45.7 ± 1.8 points) subgroup.

Conclusions

A 6-month guided exercise training intervention significantly increases cardiorespiratory fitness with concomitant improvements in work ability in middle-aged previously sedentary hospital employees. Women with low baseline work ability seem to particularly benefit from the intervention, which implies that similar interventions may be particularly beneficial for this group of individuals.

Trial registration

German Clinical Trails Register Identifier: DRKS00005159. Registered 25 September 2013.

Work ability, functional exercise capacity and prevalence of obesity in perimenopausal and postmenopausal women with non-manual employment

Objective. This study aimed to evaluate work ability and functional exercise capacity, and their correlation to each other and to obesity, in perimenopausal and postmenopausal women with non-manual employment. Materials and methods. The study included 300 women aged 44-66 years. The following measures were used: work ability index (WAI), 6-min walk test (6MWT), body mass index (BMI), waist-hip ratio (WHR) and adipose tissue accumulation. Regression models of the WAI and distance in the 6MWT were estimated. Results. The examined women obtained WAI 39.0 ± 5.0, BMI 26.2 ± 4.6, WHR 0.819 ± 0.060 and adipose tissue accumulation 30.1 ± 6.1%, on average. About 19% of women obtained a very good work ability score, 55% good, 23% medium and 3% poor. About 17% of women were obese, 39% overweight and 44% normal body mass, 29% had abdominal obesity, 19% had elevated accumulation of adipose tissue and 21% had high accumulation of adipose tissue. These results did not differ significantly between perimenopausal and postmenopausal women The postmenopausal women obtained a significantly lower functional exercise capacity score than perimenopausal women. Conclusion. Work ability correlates positively to functional exercise capacity, which correlates negatively to adipose tissue accumulation in perimenopausal women with non-manual employment, but not in postmenopausal cases.

Genistein as Potential Therapeutic Candidate for Menopausal Symptoms and Other Related Diseases

Plant-derived compounds have recently attracted greater interest in the field of new therapeutic agent development. These compounds have been widely screened for their pharmacological effects. Polyphenols, such as soy-derived isoflavones, also called phytoestrogens, have been extensively studied due to their ability to inhibit carcinogenesis. These compounds are chemically similar to 17β-estradiol, and mimic the binding of estrogens to its receptors, exerting estrogenic effects in target organs. Genistein is an isoflavone derived from soy-rich products and accounts for about 60% of total isoflavones found in soybeans. Genistein has been reported to exhibit several biological effects, such as anti-tumor activity (inhibition of cell proliferation, regulation of the cell cycle, induction of apoptosis), improvement of glucose metabolism, impairment of angiogenesis in both hormone-related and hormone-unrelated cancer cells, reduction of peri-menopausal and postmenopausal hot flashes, and modulation of antioxidant effects. Additionally, epidemiological and clinical studies have reported health benefits of genistein in many chronic diseases, such as cardiovascular disease, diabetes, and osteoporosis, and aid in the amelioration of typical menopausal symptoms, such as anxiety and depression. Although the biological effects are promising, certain limitations, such as low bioavailability, biological estrogenic activity, and effects on target organs, have limited the clinical applications of genistein to some extent. Moreover, studies report that modification of its molecular structure may eliminate the biological estrogenic activity and its effects on target organs. In this review, we summarize the potential benefits of genistein on menopause symptoms and menopause-related diseases like cardiovascular, osteoporosis, obesity, diabetes, anxiety, depression, and breast cancer.

Obesity in the Workplace: Impact, Outcomes, and Recommendations

OBJECTIVE

To conduct a comprehensive literature review to develop recommendations for managing obesity among workers to improve health outcomes and to explore the impact of obesity on health costs to determine whether a case can be made for surgical interventions and insurance coverage.

METHODS

We searched PubMed from 2011 to 2016, and CINAHL, Scopus, and Cochrane Registry of Clinical Trials for interventions addressing obesity in the workplace.

RESULTS

A total of 1419 articles were screened, resulting in 275 articles being included. Several areas were identified that require more research and investigation.

CONCLUSIONS

Our findings support the use of both lifestyle modification and bariatric surgery to assist appropriate patients in losing weight.

Self-help cognitive behavior therapy for working women with problematic hot flushes and night sweats (MENOS@Work): a multicenter randomized controlled trial

OBJECTIVE

The aim of the study was to examine the efficacy of an unguided, self-help cognitive behavior therapy (SH-CBT) booklet on hot flush and night sweat (HFNS) problem rating, delivered in a work setting.

METHODS

Women aged 45 to 60 years, having 10 or more problematic HFNS a week, were recruited to a multicenter randomized controlled trial, via the occupational health/human resources departments of eight organizations. Participants were 1:1 randomized to SH-CBT or no treatment waitlist control (NTWC). The primary outcome was HFNS problem rating; secondary outcomes included HFNS frequency, work and social adjustment, sleep, mood, beliefs and behaviors, and work-related variables (absence, performance, turnover intention, and work impairment due to presenteeism). Intention-to-treat analysis was used, and between-group differences estimated using linear mixed models.

RESULTS

A total of 124 women were randomly allocated to SH-CBT (n = 60) and NTWC (n = 64). 104 (84%) were assessed for primary outcome at 6 weeks and 102 (82%) at 20 weeks. SH-CBT significantly reduced HFNS problem rating at 6 weeks (SH-CBT vs NTWC adjusted mean difference, -1.49; 95% CI, -2.11 to -0.86; P < 0.001) and at 20 weeks (-1.09; 95% CI, -1.87 to -0.31; P < 0.01). SH-CBT also significantly reduced HFNS frequency, improved work and social adjustment; sleep, menopause beliefs, HFNS beliefs/behaviors at 6 and 20 weeks; improved wellbeing and somatic symptoms and reduced work impairment due to menopause-related presenteeism at 20 weeks, compared with the NTWC. There was no difference between groups in other work-related outcomes.

CONCLUSIONS

A brief, unguided SH-CBT booklet is a potentially effective management option for working women experiencing problematic HFNS.

Climacteric women at work: What lurks behind poor occupational quality of life?

Physical and psychological changes during menopausal transition may affect various aspects of everyday functioning including women's work ability and work productivity. Presence of menopausal symptoms has been well-acknowledged to negatively affect quality of life (QOL). However, data on factors associated with occupational QOL among women at this period of life are lacking. The authors' purpose in this study was to evaluate factors affecting occupational QOL in a sample of employed mid-life women who are experiencing menopause. The authors performed a cross-sectional study among 335 employed women aged 40 to 65 years from Serbia. Socio-demographic questionnaire, Utian's Quality of Life Scale, and Beck's Depression Inventory were used in data collection. Women's average monthly household income and educational level were positively correlated, while having uterine prolapse was negatively associated with occupational QOL. Significant regression models assessing impact of gynecological illnesses and menopause-specific symptoms on occupational QOL (direct value and categories-below vs. above mean) showed that having insomnia, uterine prolapse, and genital inflammations may differentiate "good" from "poor" occupational QOL. Uterine prolapse, genital inflammation, and insomnia were associated with worse occupational QOL among working women in menopausal transition.

Menopause Symptom Management in the United Kingdom

Menopause is a complex time in a woman's life. It is an increasingly a midlife event, when health care professionals should be aiming to optimize a woman's health for the next 30 years or so. Nurses need to be able to give up-to-date information and evidence for all forms of treatment based on a background of complex and ever-changing research. This article covers the main presenting complaints and treatments, from lifestyle to hormone replacement therapy, by drawing on guidelines from national bodies.

An unusual hazard of menopause in the workplace: a case report

Untreated vasomotor symptoms of the menopause can have a major impact on women at work. Recent recommendations advocate modification of the working environment, including adequate air-conditioning, to help relieve these symptoms. However, this may cause discomfort for work colleagues. We report the case of a 40-year-old woman with cold urticaria. Cold urticaria is a serious, potentially life-threatening condition. Our patient's symptoms were exacerbated when her postmenopausal work colleagues turned the air-conditioner temperature down to relieve their vasomotor symptoms.

Symptoms of menopause - global prevalence, physiology and implications

The symptoms of menopause can be distressing, particularly as they occur at a time when women have important roles in society, within the family and at the workplace. Hormonal changes that begin during the menopausal transition affect many biological systems. Accordingly, the signs and symptoms of menopause include central nervous system-related disorders; metabolic, weight, cardiovascular and musculoskeletal changes; urogenital and skin atrophy; and sexual dysfunction. The physiological basis of these manifestations is emerging as complex and related, but not limited to, oestrogen deprivation. Findings generated mainly from longitudinal population studies have shown that ethnic, geographical and individual factors affect symptom prevalence and severity. Moreover, and of great importance to clinical practice, the latest research has highlighted how certain menopausal symptoms can be associated with the onset of other disorders and might therefore serve as predictors of future health risks in postmenopausal women. The goal of this Review is to describe in a timely manner new research findings on the global prevalence and physiology of menopausal symptoms and their impact on future health.

No sweat: managing menopausal symptoms at work

INTRODUCTION

Menopause usually occurs between the ages of 45 and 55, a time when women are likely to be in the paid workforce. Most women have menopausal symptoms and these may impact on daytime function and work performance. This study examines the relationship between reproductive stage, menopausal symptoms and work, and advises how employers can best support menopausal women.

METHODS

An online and paper-based survey was completed in 2015-16 by 1092 women (22% response rate) aged 40 years plus employed in three hospitals in metropolitan Australia. Survey questions examined demographics, health and lifestyle variables, menopausal symptom reporting, and work-related variables. Reproductive stage was determined using modified STRAW +10 principal and descriptive criteria.

RESULTS

Reproductive stage was not significantly associated with work engagement, organizational commitment, job satisfaction, work limitations and perceived supervisor support. Postmenopausal women had lower intention to leave their organizations than pre- and peri-menopausal women. While sleep problems were the most commonly reported menopausal symptom by peri-menopausal women, for postmenopausal women it was joint and muscular discomfort. Only hot flushes and vaginal dryness were significantly more frequent in peri- and post, compared to pre-menopausal women. In general, women rated their work performance as high and did not feel that menopausal symptoms impaired their work ability. Most women would appreciate greater organizational support, specifically temperature control, flexible work hours and information about menopause for employees and managers.

DISCUSSION

Most women did not believe that menopausal symptoms negatively impacted on their work. Organizational changes may reduce the burden of menopausal symptoms in the workplace.

What do working menopausal women want? A qualitative investigation into women's perspectives on employer and line manager support

OBJECTIVES

To explore women's perspectives on what employers and managers should and should not do in relation to women going through the menopause.

METHODS

An online questionnaire was used to collect qualitative data in a cross-sectional study of working women. Three open-ended questions asked peri- and post-menopausal women, aged 45-65 years: (i) what they thought employers could do, or should do, to help menopausal women who may be experiencing difficult menopausal symptoms at work; (ii) how managers should behave; and (iii) how managers should not behave towards women going through the menopause.

RESULTS

137 women responded to the open questions in the survey. An inductive thematic analysis was conducted and three overarching themes emerged. Theme 1 related to employer/manager awareness, specifically to knowledge about the menopause and awareness of how the physical work environment might impact on menopausal women. Theme 2 related to employer/manager communication skills and behaviors, specifically those considered helpful and desired and those considered unhelpful and undesired. Theme 3 described employer actions, involving staff training and raising awareness, and supportive policies such as those relating to sickness absence and flexible working hours.

CONCLUSIONS

The menopause can be difficult for some women to deal with at work, partly due to the working environment. To our knowledge, this is the first study to explore women's descriptions of how they would like to be treated by employers/managers, and what would be helpful and unhelpful. The results have clear implications for communication about menopause at work and for employer-level policy and practice.

The impact of menopause on work ability in women with severe menopausal symptoms

OBJECTIVE

To measure the impact of menopause on work ability in women with severe menopausal symptoms.

STUDY DESIGN

This cross-sectional study compared the work ability of a sample of otherwise healthy employed Dutch women (n=205) with that of a sample of first-time attendees of a menopause clinic (n=60); both groups were aged 44-60 years. Self-reported questionnaire data assessing work ability (Work Ability Index; WAI) and menopausal symptoms (Greene Climacteric Scale; GCS) were used.

MAIN OUTCOME MEASURES

Logistic regression analyses were used to examine whether women with severe menopausal symptoms were more likely to have low work ability (defined as a score <37.0 points on the WAI) than were women in the reference group, after adjustment for individual and lifestyle factors.

RESULTS

Symptomatic women had significantly higher total GCS scores (mean 26.7 vs 14.2, t=10.8, P<0.001) and significantly lower WAI scores (median 32.0 vs 40.0, U=2380, P<0.001) than the reference group. They were 8.4 times more likely to report low work ability than their healthy counterparts: 76.7% versus 30.2% (OR 8.4, 95% CI 4.1-17.2).

CONCLUSIONS

Over three-quarters of symptomatic menopausal women report serious problems in dealing with the physical and mental demands of their work (recorded here as low work ability); hence these women might be at risk of prolonged sickness absence from work.