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Opinions shared by members of Menopause ChitChat are for discussion purposes only and not intended as a substitute for professional medical advice. This forum does not replace the need for you to visit with your doctor. Click here for more information on community guidelines and policies.

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Your own experience of your menopause will be very different to other women's. You may not be finding it a pleasurable or positive experience.

Having menopausal symptoms can really affect your life in a detrimental way. Not enough women talk about their menopause and there is still much uncertainty about what the menopause means and how it can be managed. I hope this website helps to empower you with necessary information to make informed decisions regarding any treatment you may take to help turn your menopause into a positive experience that does not negatively impact your life.

To get you started, click on the picture below to watch a video with lots of information about the menopause, HRT and the alternatives.

What would you like to see?

Newson Health works to improve women's and healthcare professionals' understanding of the menopause. No pharmaceutical companies contribute to the cost of providing this education nor has any input into or control over the content of our work, all of which expresses our independent views.

The information provided on menopausedoctor.co.uk is designed to support, not to replace, the relationship that exists between a patient/site visitor and his/her physician. Our website does not host any form of advertisement.

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Home | My Menopause Doctor Louise Newson

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Your own experience of your menopause will be very different to other women's. You may not be finding it a pleasurable or positive experience. Having menopausal symptoms can really affect your life in a detrimental way. Not enough women talk about their menopause and there is still much uncertainty about what the menopause means and how it can be managed.

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Menopause Understanding and Supporting women

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The Promise of Transformation and Healing

Menopause
Research into the physiological changes taking place in perimenopausal woman is revealing that, in addition to the hormonal shift that means an end to childbearing, our bodies-and, specifically, our nervous systems-are being, quite literally, rewired. There is much, much more to this midlife transformation than "raging hormones."

It's as simple as this: our brains are changing. A woman's thoughts, her ability to focus, and the amount of fuel going to the intuitive centers in the temporal lobes of her brain all are plugged into, and affected by, the circuits being rewired.

After working with thousands of women who have gone through this process, as well as experiencing it myself, I can say with great assurance that menopause is an exciting developmental stage-one that, when participated in consciously, holds enormous promise for transforming and healing our bodies, minds, and spirits at the deepest levels.

As a woman in midlife today, I am part of a growing population that is an unprecedented 48.5 million strong in the United States alone. This group is no longer invisible and silent, but a force to be reckoned with-educated, vocal, sophisticated in our knowledge of medical science, and determined to take control of our own health.

Think about it: more than 48 million women, all undergoing the same sort of circuitry update at the same time. By virtue of our sheer numbers, as well as our social and economic influence, we are powerful-and potentially dangerous to any institution built upon the status quo. Baby boom women (those born between 1946 and 1964) are now the most affluent and influential group in the world.

It's clear that the world is changing, willingly or otherwise, right along with us. And in many instances, it's changing for the better. It's no accident that the current movement of psychospiritual healing is composed largely of women in their thirties, forties, fifties, and sixties. We are awakening en masse and beginning to deliver a much-needed message of health, hope, and healing to the world.

My personal experience, now shared by millions of others, tells me that the perimenopausal lifting of the hormonal veil-the monthly cycle of reproductive hormones that tends to keep us focused on the needs and feelings of others-can be both liberating and unsettling. The midlife rate of marital separation, divorce, and vocational change confirms this. I, for one, had always envisioned myself married to the same man for life, the two of us growing old together. This ideal had always been one of my most cherished dreams.

At midlife I, like thousands of others, had to give up my fantasies of how I thought my life would be. I had to face, head-on, the old adage about how hard it is to lose what you never really had. It means giving up all your illusions, and it is very difficult. But for me the issue was larger than where and with whom I would grow old. It was a warning, coming from deep within my spirit, that said, "Grow... or die." Those were my choices. I chose to grow.

For most women, identity and self-esteem are generated by our associations and relationships. This is true even for women who hold high-powered jobs and for women who have chosen not to marry. Men, by contrast, usually get most of their identity and self-esteem from the outer world-the job, the income, the accomplishments, the accolades. For both genders, this pattern often changes at midlife. Women begin to direct more of their energies toward the world outside of home and family, which may suddenly appear as a great, inviting, untapped resource for exploration, creative expression, and self-esteem. Meanwhile, men of the same age-who may be undergoing a midlife crisis of their own-are often feeling world-weary; they're ready to retire, curl up, and escape the battles of the workplace. They may feel their priorities shifting inward, toward home, hearth, and family.

The woman in menopause, who is becoming the queen of herself, finds herself at a crossroads of life, torn between the old way she has always known and a new way she has just begun to dream of. A voice from the old way (in many cases it's her husband's voice) begs her to stay in place-"Grow old with me, the best is yet to be."

But from the new path another voice beckons, imploring her to explore aspects of herself that have been dormant during her years of caring for others and focusing on their needs. She's preparing to give birth to herself, and as many women already know, the birth process cannot be halted without consequences. Caring for others and pursuing unexplored personal passions are not necessarily mutually exclusive choices, but our culture makes them seem so, always supporting the former at the expense of the latter.

This is part of what makes the midlife transformation so much of a challenge-as I know only too well. Throughout most of human history, the vast majority of women died before menopause. The average life expectancy for a woman in 1900 was only forty. For those who survived, menopause was experienced as a signpost of an imminent and inevitable physical decline. But today, with a woman's life expectancy at eighty-four years, it is reasonable to expect that she will not only live thirty to forty years beyond menopause, but be vibrant, sharp, and influential as well.

The menopause you will experience is not your mother's (or grandmother's) menopause. Women of the World War II generation, whose female role models tended to be like June Cleaver on Leave It to Beaver, had an entirely different social and political environment in which to make their transition. Menopause (like menstruation, for that matter) was not discussed in public.

Today this is no longer true. As we break this silence we are also breaking cultural barriers, so that we can enter this new life phase with eyes wide open-in the company of more than 48 million kinswomen, all undergoing the same transformation at the same time. And, as you'll soon discover, the changes taking place in midlife women are akin to the power plant on a high-speed train, whisking the evolution of our entire society along on fast-forward, to places that have yet to be mapped. Whether you climb aboard this fast-moving train or step aside and let it pass will play a major role in how far you go and how you feel along the way.

Ultimately, I've found this journey bracing, exciting, and health-enhancing. And I'm certainly not alone. A 1998 Gallup survey, presented at the annual meeting of the North American Menopause Society, showed that more than half of American women between the ages of fifty and sixty-five felt happiest and most fulfilled at this stage of life. Compared to when they were in their twenties, thirties, and forties, they felt their lives had improved in many ways, including family life, interests, friendships, and their relationship with their spouse or partner. In other words, the conventional view of menopause as a scary transition heralding "the beginning of the end" couldn't be further from the truth.

So no matter what is happening in your life right now, take heart. Please join me-and the millions of others who have come before and will come after-as we transform and improve our lives, and ultimately our culture, through understanding, applying, and living the wisdom-and joy-of menopause and beyond.

Learn More - Additional Resources

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The Wisdom of Menopause | Christiane Northrup, M.D.

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The woman in menopause, who is becoming the queen of herself, finds herself at a crossroads of life, torn between the old way she has always known and a new way she has just begun to dream of.

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Workplaces should start catering for the menopause in a comparable way to pregnancy, according to one of Britain's leading women's health experts.

Myra Hunter, emeritus professor of clinical health psychology at King's College London said that menopausal symptoms remained a "taboo issue" in many workplaces and, while policies to support pregnant women are now standard, there is still little awareness of the impact that the menopause can have on women who are often at the peak of their career.

"Often there's a will to address this among managers, but they just don't know how to talk about it," said Hunter. "Women want it to be raised if appropriate. They don't want to be treated as ill, they just want some understanding and awareness of it."

The call comes as Hunter and colleagues publish the results of one of the first major studies looking at how symptoms such as hot flushes affect women at work. The study, which tracked 124 female employees in the public and private sectors, found that such symptoms could have a significant impact, but that following a simple programme of cognitive behavioural therapy, delivered via a self-help booklet, hugely reduced the degree to which women felt their symptoms were problematic.

The menopause occurs at the age of 51 years, on average, and the way women experience this transition can vary a lot. About 80% of women experience some hot flushes and night sweats and for 20 to 30% these symptoms are severe enough to have a significant impact on quality of life. Some women also report tiredness, "brain fog", mood swings and loss of confidence. For some women, the transition period lasts just a few years and in others it can last a decade.

There is no strong evidence that the menopause causes women to leave jobs in large numbers or that it has a negative impact on professional performance. "The evidence we've got from surveys, it's subjective, but it suggests that women might over-compensate," said Hunter.

The trial recruited 124 women who were struggling with their symptoms (the women experienced 56 flushes on average each week). Half the women were provided with a self-help booklet that provided guidance on how to cope with work stress, how to discuss the menopause at work and which challenged negative stereotypes associated with the menopause, such as "being past it".

The booklet also set women cognitive behavioural therapy (CBT) exercises, in which they were asked to write down the thoughts they have during hot flushes, for instance, and then challenge these beliefs.

"If a woman has a hot flush half the anxiety is about how people see her," said Hunter. "There's embarrassment and anxiety about being joked about and a big concept is hiding symptoms in fear of being ridiculed."

"Really, we shouldn't feel like that and when women verbalise it, it does appear ridiculous," she added.

Women who were given the booklet reported a noticeable reduction in both their symptoms and how problematic they were. When they were followed up after five months, the number of hot flushes they experienced was reduced by one third, they reported better quality sleep and viewed their symptoms more neutrally. In interviews after the trial, 82% said the intervention had reduced the impact of their symptoms and 37% had spoken about their menopause to their line manager.

Kathy Abernethy, chair of the British Menopause Society and a specialist nurse, welcomed the work, saying that a social shift was underway with people generally becoming more open about discussing the menopause.

This trend, she said, has been partly driven by celebrities who "have decided that it's not something embarrassing to talk about". Far more women in their 50s are also in work than in the past. According to the Department for Work and Pensions, the proportion of women aged 50 to 64 with jobs has risen by more than 50% in the past 30 years.

"Women simply want to know workplaces are taking it seriously," Abernethy added. "Awareness is a key thing. If managers are aware of the menopause it means the whole thing becomes a non-issue, like pregnancy."

Tina Weaver, CEO of the charity Wellbeing of Women, which funded the research, said the study offered practical and accessible interventions to help women. "It's alarming so many women suffer from these debilitating symptoms and feel so unsupported during the menopause that they drop out of the work force," she said. "This natural process has been overlooked and considered a taboo for too long."

The findings are published in the journal Menopause.

'Some days I felt like I needed a badge saying "Stand clear: menopausal woman approaching!"'

Angela Bonnett, 57, had a successful career in finance and by her early 50s was a senior project manager at a well-known financial institution in the City. "I'd spent 30 years being an excellent performer at the top of my tree," she said.

Five years ago, she entered the menopause and found professional skills that she'd come to take for granted - her razor sharp memory and a cool disposition - suddenly foundering. "I felt all those things were falling away," Bonnett said.

She experienced hot flushes in meetings, night sweats that disturbed her sleep, sudden mood swings, problems concentrating and irritation. "Everything that you've ever read about the menopause seemed to happen to some degree," she said. "Some days I felt like I needed a badge saying 'Stand clear: menopausal woman approaching!'"

In work, she noticed herself making careless mistakes, struggling to recall names or conversations she'd had a day earlier - "things that were just alien to me".

She took detailed notes to prompt her memory and worked harder to compensate for tiredness. She began wearing layered clothes so she could "quickly disrobe" when she was hit by a hot flush in a meeting and took to carrying a fan she had picked up on holiday in Spain.

"Initially I had some reservations that people would know why I'm doing this," she said. "But in the end I thought, either I'm going to explode or I need to cool down."

As a rule, Bonnett did not share personal problems at work. "I prefer to keep the two separate," she said. And the menopause felt like a particularly personal experience. "Whether you want someone to know your periods have stopped - it's quite core to who you are."

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Bonnett said that having support at work made dealing with the menopause easier. Photograph: Murdo Macleod for the Guardian

However, when she found herself snapping at a colleague - a reaction that was completely out of character - she decided she needed to raise the issue with her manager.

"Previously I'd been quite sensitive in situations at work, but from nowhere there would come a really sharp, nasty response to people that made the whole room gasp," she recalled.

The lack of an established protocol made raising the issue at work feel potentially awkward. Eventually she emailed her line manager, a man in his mid-30s, with a newspaper article in which a high level lawyer described the challenges she'd faced at work due to menopausal symptoms. "This allowed me to introduce the subject using outside information and explain what I was going through," she said.

Bonnett says her boss was not unwilling to help, he was simply oblivious. "It was an education for him. He said 'I had no idea you were going through this'. I said 'It's because I've been working extra hard to make sure I carry on performing'."

Once aware of her situation, Bonnett's manager was understanding and reassured her that she should feel free to come in late or leave earlier, if she needed to. The message was: whatever you need to do to cope, that's fine.

"Just having that reassurance made it a lot easier," Bonnett said. "I didn't need to do any of those things, but knowing he knew was sufficient and removed a lot of the anxiety."
Topics

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Workplaces 'should cater for menopause as they do for pregnancy'

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Workplaces should start catering for the menopause in a comparable way to pregnancy, according to one of Britain's leading women's health experts.

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Women usually experience the menopause between 45 and 55, with 51 being the average age. Since the employment rate in the UK has grown substantially for women aged between 50 and 64, and 80% of women experience menopausal symptoms, it's not surprising that the menopause can have a significant effect on a woman's working life.
Symptom trouble
The symptoms most likely to affect working women are hot flushes, night sweats (leading to insomnia) and a lack of concentration. This can lead to difficulties in making decisions. Other important symptoms affecting work are joint pains, frequent urination, period problems, mood swings, irritability, anxiety and depression.

Carole Davies, occupational health advisor, says: "Mood swings and irritability aren't always understood by colleagues." Maria Goldby, senior occupational advisor, says: "We often have employees referred to us who are suffering with hot flushes and night sweats. Hot flushes often affect them at work. Night sweats causing fatigue the next day and hot flushes can lead to changes in their confidence and a lack of concentration. We see them to discuss what options may help them, including telling them to see their GP and contacting The Menopause Exchange for advice. We give overall support."
Stress effects
Stress at work can make some menopausal symptoms worse. The effects of this can be increased by having to make decisions about how to cope with the menopause and taking extra time off work to consult a doctor. Some women who take time off work won't attribute it to the menopause when giving a reason for their absence (unlike if they suffered, for example, from asthma, diabetes or arthritis).

Older working women may feel that they're in competition with younger colleagues. This can lead to a loss of self-esteem. "Increasingly, women are working to a later age and need to look their best in the workplace," says dermatologist Dr Sam Bunting.

The menopause comes at a time when social changes may also be taking place in a woman's life. Some of these changes may affect the menopausal symptoms. In addition, women may belong to the sandwich generation, having to juggle elderly relatives, children and even grandchildren. Because they work, more coping mechanisms come into play.
Menopause at work
In 2010, Professor Amanda Griffiths, deputy director of the Institute of Work, Health and Organisations, University of Nottingham, completed a research study for the British Occupational Health Research Foundation, looking at the experiences of more than 900 working women. The report found that the menopause is treated as a taboo subject in many workplaces, and more needs to be done to support women. However, some women were very appreciative of the help they had received from their colleagues and managers.

The workplace can affect a woman's experience of the menopause in several ways. Issues that need to be addressed include:

sharing offices

being able to position a desk near a window that can be opened

sitting away from a radiator

having adjustable temperature and humidity controls in the room

being able to use electric fans

having a lack of ventilation in the work environment

having access to cold drinking water

needing regular or frequent toilet breaks, which may cause problems if working to set targets and deadlines

wearing synthetic uniforms that cause increased sweating.

Workplaces vary, and the situation in an office will differ from that in schools, hospitals, the police, fire brigade etc. Shift work can cause additional problems.

Interventions may reduce absenteeism and maximise productivity, reduce stigma and embarrassment when women are in the company of colleagues, managers and clients, improve job satisfaction and wellbeing and make the workplace environment as comfortable as possible for menopausal women.
Help at work
The workplace needs to be proactive in helping menopausal women cope with their symptoms. For example, impartial information should be available to all female employees. Some workplaces will employ an occupational health advisor, who can speak to women in confidence and offer one-to-one advice. For this reason, occupational health nurses need to ensure that they have up-to-date and impartial information on all aspects of the menopause. Then they will be able to provide answers to some of the questions that employees may ask and help women make well-informed decisions.

If there is no occupational health department, women may find it difficult to speak to their line manager (especially someone who is male and younger than them). If this is the case, it may be more appropriate to go to the human resources department, a welfare officer or health and safety advisors.

Health and safety representatives and managers need to know about all of the health implications of the menopause. Employers should include the menopause in a health and safety policy and in risk assessments because they need to make sure that the working conditions don't worsen a woman's symptoms.
Women helping themselves
Women can raise awareness at work to reduce the stigma of the menopause and make sure that work colleagues know about the menopause and, for example, what hot flushes are.
Get help from The Menopause Exchange
Norma Goldman has a pharmacy degree and is a qualified health promotion specialist. She presents talks on the menopause to employees in the workplace, organisations, companies and groups of women. She also presents podcasts and has spoken at exhibitions and conferences. Norma's in-depth knowledge has helped 1000s of women enjoy a more comfortable menopause.

The presentations are suitable for women at or approaching the menopause, those who have had a premature menopause/hysterectomy or those interested in midlife and post-menopausal health. The information includes general information on the menopause and menopausal symptoms, current guidelines on the use of HRT and other ways of coping with symptoms, including self-help lifestyle measures, health promotion advice including nutrition and exercise, prescribed medicine alternatives to HRT and complementary therapies and medicines. Norma also presents seminars on the menopause to healthcare professionals.

The Menopause Exchange is completely independent and the information given is impartial and practical. For more information or testimonials of previous presentations in the workplace, call Norma at The Menopause Exchange on 020 8420 7245 or email her at norma@menopause-exchange.co.uk.
About the author
Norma Goldman (B.Pharm MRPharmsS. MSc.) has a pharmacy degree and an MSc degree in health promotion. She is the founder and director of The Menopause Exchange.
Created March 2017 Copyright © The Menopause Exchange 2017
Tags: employees, health & safety, line manager, menopausal symptoms, menopause at work, menopause presentations, nurses, occupational health advisor, risk assessments, stress, talks, The Menopause Exchange, workplaces

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menopause articles & questions and answers

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THE MENOPAUSE AT WORK " The Menopause Exchange

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Women usually experience the menopause between 45 and 55, with 51 being the average age. Since the employment rate in the UK has grown substantially for women aged between 50 and 64, and 80% of women experience menopausal symptoms, it's not surprising that the menopause can have a significant effect on a woman's working life.

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For healthcare professionals The British Menopause Society (BMS) is the specialist authority for menopause and post reproductive health in the UK. Established in 1989, the BMS educates, informs and guides healthcare professionals, working in both primary and secondary care, on menopause and all aspects of post reproductive health.

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Menopause counsellor and founder of Menopause Support, Diane Danzebrink has written some handy resources including a menopause symptom checker, several guides to help you get the best out of your doctor's appointment, and guidance for men who want to understand more about the menopause . For your convenience, they are presented here in both Word or PDF formats for easy downloading and printing.

Introducing our fabulous Menopause Posters

We're absolutely thrilled to introduce our fabulous menopause posters. A few months ago a request went out asking if a member of the private Facebook community might design a poster for us, and designer Bonnie Fitts kindly volunteered. You'll find her at https://www.bonniefittsartndesign.com/

We think you'll agree that she has done the most amazing job and we are so very grateful for her generosity in designing these for us.

We would love you to share them on your social media and print them and put them up anywhere that will allow you to; workplaces, community spaces, gyms, hairdressers, shops, waiting rooms, the possibilities are endless and we really need your help to spread the word. Thank you.

The posters can be downloaded as .PDF files Caucasian, Asian or Afro-Caribbea n.

Some key questions about menopause for Health Secretary Matt Hancock

The campaign has sent letters to Prime Minister Boris Johnson and Health Secretary Matt Hancock with some key questions about menopause care, and we will share their replies. If you would like to support us by writing yourself to the health secretary, perhaps with a copy to your own MP, here's a template letter you can use as a start.

A chance to contact your MP

Download as a PDF

Hi everyone, the start of a new Parliament would seem like an opportune time to contact all our MPs to ask what they are doing about the HRT shortage and the wider campaign issues. If we all did it thousands of letters and emails would arrive in MP's offices over the next few days.

I have written a template letter and have left a gap for you to include details of your own experience whether with HRT, your GP or in the workplace etc. Don't forget to include your full name and address too.

You can find contact details for your local MP here https://members.parliament.uk/ When you get a reply please do share it in the private FB group The Menopause Support Network or email to hello@menopausesupport.co.uk

Frequently asked questions about HRT and menopause

We answer twenty frequently-asked questions on this hot topic.

Download as a PDF

FAQs about Oestrogen and Progesterone

How to apply oestrogen gel, how much to use, when to take it and a host of other questions answered.

Download as a PDF

Preparing for your Smear Test

These are some useful tips which may encourage you to attend your appointment and make it easier and more comfortable to have your smear test.

Download as a PDF.

Understanding Vaginal Atrophy or G.S.M

Vaginal ATROPHY, which is officially known as Genitourinary Syndrome of Menopause (G.S.M) is a common symptom of menopause affecting about 70% of women yet only 7% will ask for help from their GP, unfortunately many decide to self-treat, this is not recommended . Huge thanks to Jane Lewis author of Me & My Menopausal Vagina for writing this for us .
Download in PDF

The Psychological Impact Of Menopause

Anyone who has experienced pre- menstrual syndrome will be well aware of the emotional rollercoaster that fluctuating hormones can cause during the reproductive years but many women are simply not prepared for the variety and intensity of those symptoms which affect some women at menopause.

Try our Menopause Symptom Checker

Download in PDF

If you think you may be suffering from symptoms of perimenopause, then try our simple symptom checker. Put a tick by any of the symptoms that apply to you, then print off and take with you to your doctor's appointment.

The NICE guidelines on menopause state blood hormone tests alone are not indicated to diagnose menopause in a woman over 45 years of age, experiencing menopause symptoms.

Ten Things your Doctor should know about Menopause

Women, their partners and their families cannot afford to keep waiting for GP education to improve; too many women are experiencing poor short and long term physical and mental health due to a woeful lack of professional knowledge. Having campaigned now for several years for better care and support for women it is clear that things are not changing quickly enough so we must take control and educate ourselves and encourage others to do the same. To that end I have compiled this guide.

Getting the most out of your doctor's appointment

So you have decided that it's time to visit your doctor to discuss the seemingly unrelated mixed bag of symptoms you have been trying to cope with. I hope this guide will help you when planning your visit to your doctor to discuss menopause.

Understanding Menopause for Partners

Read the original blog or Download in Word or PDF

I counsel women every day of every week who don't understand what's happening to them at menopause, so if women don't understand what chance do their partners have? I hope that this guide will help.

Menopause is the new Black

Read the original blog or Download in Word or PDF

Sadly, desperate women will go to desperate measures to relieve their menopause symptoms and as is so often the case this presents an ideal opportunity for those seeking to exploit the situation not for the health and well-being of those women but purely for financial gain.

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Menopause counsellor and founder of Menopause Support, Diane Danzebrink has written some handy resources including a menopause symptom checker, several guides to help you get the best out of your doctor's appointment, and guidance for men who want to understand more about the menopause .

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The Menopause - Woman's Hour - BBC Radio 4

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A series exploring its impact on women's work and relationships, and potential treatments

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Menopause Exchange for unbiased, independent information and advice

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Welcome to The Menopause Exchange for unbiased information on the menopause.

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Are You Too Embarrassed To Go To The Doctor? Hormones, reproductive organs, puberty, childbirth, menopause and increasingly cancers. Women in the UK are not doing themselves any favours. The good news is, generally speaking, women [...]

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Are You Too Embarrassed To Go To The Doctor? Hormones, reproductive organs, puberty, childbirth, menopause and increasingly cancers. Women in the UK are not doing themselves any favours. The good news is, generally speaking, women [...]

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Women’s Health Concern | Confidential Advice, Reassurance and Education

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Women’s Health Concern (WHC) aims to advise, reassure and educate women of all ages about their health, wellbeing and lifestyle concerns.

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Featured

Sophie Cox

Senior Comms and Marketing Officer, Mental Health at Work

As you probably know, the Mental Health at Work Commitment is a simple framework to support employers in making a positive change around mental health. It builds on what we already know actually works: based on the  Thriving at Work  standards, pulling from the pledges and standards that are already out there, and using up-to-date research from UK employers and mental health experts.

Launched in 2019, we've seen almost 3,000 employers sign up - which means that over 5 million people at work are actively being supported with their mental health.

Read article

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Paying attention to mental health in the workplace has never been more important. Mental Health at Work is here to help you find what you need.

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shutterstock.

Menopause, when periods stop for good, is a normal stage in every woman's reproductive life. The symptoms usually begin in a woman's forties, with the average age of menopause itself being 51. Experiences differ from woman to woman. Some report sailing through transition, others are pleased to no longer menstruate or be able to fall pregnant, or just embrace getting older.

Symptoms also vary. Some are probably familiar - like unpredictable periods or heavy bleeding, hot flushes, night sweats, poor sleep and emotional outbursts. Others are less well known, including growth or loss of body hair, clumsiness, pins and needles and moments of forgetfulness or poor concentration. About 25% of women have very debilitating symptoms.

When we consider that most women in the UK now work outside of the home, and that employment rates among women over 50 have increased dramatically over the last three decades, it is obvious menopause is an important workplace issue. This is for three main reasons.

The first is corporate social responsibility - the need to ensure that mid-life women have the highest possible quality of working life, and are able to work for as long as they choose, unimpeded by menopause-related difficulties. The second is the law - workplace discrimination based on gender or age is illegal under the Equality Act and BT were the subject of the first successful employment tribunal in 2012. Here direct sex discrimination and unfair dismissal were proven after the plaintiff was dismissed for under-performance, despite providing a medical note documenting that her poor concentration was due to menopause transition.

The third reason is economic. As demonstrated in the BT tribunal, menopause symptoms can affect performance at work. They can also contribute to higher sickness absence. If a woman has to leave work because of her symptoms, replacing her costs an average of £30,000. So there are important cost savings to be made here, as well as retaining expertise and experience.

Different treatment

And yet, as many women experience, menopause is not on most employers' agendas. In fact, very few menopause-specific health and well-being policies exist in UK organisations. Little training or information about the menopause is provided for managers or any other employees. There is also evidence that mid-life women feel they are treated differently - perhaps even harassed or ridiculed - by others at work, whether they are actually menopausal or not.

The analogy we draw is to pregnancy and maternity. Imagine a woman in her early 30s telling her manager she is pregnant, and saying she wants to take maternity leave at a certain point and return to work when the baby is three months old. Nothing unusual there.

Now imagine the same woman, 15 years later, telling the same manager she is experiencing severe menopausal hot flushes and night sweats and wants to work from home when these symptoms are especially bothersome. The evidence suggests that, even if this woman felt able to disclose her symptoms (and many, many mid-life women workers do not), she is likely to meet with bafflement, at best.

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There is a range of advice available for employers on menopause as a workplace issue. Some of the best guidance we have found is provided by Business in the Community, a responsible business network run by the Prince of Wales. There are also pioneers like retailer Marks and Spencer and the Nottinghamshire Police Service, who have provision in place already. Others, like the water company Severn Trent and the University of Leicester (where three of us work), are developing this provision, supported by consultants from Henpicked, a social network for women over the age of 40.

It is important to emphasise that support mechanisms can cost very little - like allowing women to wear uniforms made of natural fibres or to work in an office with natural light, providing USB fans or supplies of cold drinking water and sanitary protection.

Other approaches, including specialist occupational health support, may cost more, but individual women will only need them for a short period of time. Flexible working, which can as we suggest above help women to cope during menopause transition, is something every UK worker has the right to request anyway.

To be clear, we are not advocating for "special treatment" for mid-life women workers. That is, not unless risk assessments during pregnancy and maternity leave represent special treatment. Neither are we suggesting that men don't have mid-life experiences which could prove equally challenging to manage at work.

Instead, we think it's important to normalise women's experiences of the menopause so mid-life women can raise it at work without worrying about being judged or stereotyped; and to impress on employers how important it is that this demographically pressing phenomenon is no longer ignored.

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Three reasons employers need to recognise the menopause at work

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Menopause, when periods stop for good, is a normal stage in every woman's reproductive life. The symptoms usually begin in a woman's forties, with the average age of menopause itself being 51. Experiences differ from woman to woman. Some report sailing through transition, others are pleased to no longer menstruate or be able to fall pregnant, or just embrace getting older.

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A.Vogel Menopause Health Hub offers information and answers to women looking for help to get them through their menopause

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Menopause expert Eileen Durward offers information on how to find out if it is the menopause, what to expect and advice on how to treat the symptoms.

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Menopause Matters, menopausal symptoms, remedies, advice

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Menopause and treatment options. An independent, clinician-led site aiming to provide accurate information about the menopause.

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If you are like many women over 50, you may be living from the neck up. In this video, I tell you how to balance your 2nd chakra to stimulate creativity in all forms. You will learn about your body's subtle energy system and how you can connect your physical, emotional and vibrational body. I share many tips and exercises, including chants, that you can use to heal pelvic pain and awaken your dormant sexuality.

At 4:49 - Learn how you can open your second chakra to increase your creative energy

At 5:45 - Find out how to tap into your vaginal pulse

At 7:04 - Discover exercises you can do to strengthen your pelvic floor muscles

At 10:29 - Hear many more ways to balance your second chakra.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women's health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.

Video

In this video, I tell you how you can avoid a hysterectomy at midlife. And, if you have already had one, I share how you can regain your creative pelvic energy.

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Vital Life Force | Christiane Northrup, M.D.

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If you are like many women over 50, you may be living from the neck up. In this video, I tell you how to balance your 2nd chakra to stimulate creativity in all forms. You will learn about your body's subtle energy system and how you can connect your physical, emotional and vibrational ...

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If you're interested in reading more on ideas presented in the article below, I suggest reading Diastasis Recti. If you'd like movement instruction via video, start with Nutritious Movement for a Healthy Pelvis.

Kara Thom, author of See Mom Run, and an expert on Keeping Fit during pregnancy and motherhood ( sounds easy) interviewed me on the exciting mechanics of the Pelvic Floor (PF). I love the Pelvic Floor (kinda creepy, right?) And, as Kara reports, my position on the Kegel as a pelvic floor-weakening exercise is 180° from wide-spread belief, but, what can I say? Science is not based on public opinion.

The PF muscles run between the sacrum (the triangular bone at the base of the spine) and the pubic bone (the bottom-front of the pelvis). Ideally you want the PF to be long, supple, and taut, to generate long-term forces that hold up your organs, as well as have enough motor skill to open and close your bathroom muscles as needed. When the PF is too tight, it can pull the sacrum out of alignment, bringing it forward, into the bowl of the pelvis. Bye-Bye strong PF muscles, Hello Pelvic Floor Hammock. Hammocks are for vacation and have not promoted the notion of long-term force generation for some time.

The gluteal muscles (your butt!) keep the PF in check, preventing the sacrum from collapsing and provide leverage for the PF to contract. The secret to perfect pelvic floor tone is supple and strong glutes and PF muscles - not one stronger than the other.

Oh, and P.S. This goes for you too, Dudes. You have a pelvic floor too, and although your organs won't prolapse or peek out of your vagina (vagina. vagina. vagina. Anyone uncomfortable?), they will settle down onto your prostate. For your prostate, this is about as comfortable as being trapped underneath a large bookcase.

The squatting exercise progression from You Don't Know Squat ( click here to view) should be done a few times a day, even in a modified form, until the tension in the knees, hips, back, and feet allow you to settle in. Then, keep doing this bathroom squat on a "regular" basis. Get it?

To read Kara's interview and my follow up click here: http://mamasweat.blogspot.com/2010/05/pelvic-floor-party-kegels-are-not.html

Follow up questions: http://mamasweat.blogspot.com/2010/05/pelvic-floor-encore.html

Are you still interested in learning more on this?

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If you're interested in reading more on ideas presented in the article below, I suggest reading Diastasis Recti. If you'd like movement instruction via video, start with Nutritious Movement for a Healthy Pelvis. Kara Thom, author of See Mom Run, and an expert on Keeping Fit during pregnancy and motherhood ( sounds easy) interviewed me on the exciting mechanics of the Pelvic Floor (PF).

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Most working women over 50 used to be at the tail end of their careers, heading towards retirement and easing out of the fast lane.

Now, a record-breaking 3.5m older women are in employment - many starting new careers and setting up businesses in mid-life, in response to the raised pension age, a lengthening lifespan, and an optimism inspired by new opportunities. According to the Department for Work and Pensions, the proportion of women aged 50 to 64 with jobs has risen by more than 50 per cent in the past 30 years.

Yet the new workplace still retains one old pitfall - the effect, for some women, of working through the menopause. Indeed, a recent survey by the charity Wellbeing of Women with ITV's Tonight programme found that half of those quizzed said symptoms made their work life worse. A quarter said that they had considered leaving their jobs altogether because of the menopause.

And even though some organisations are rising to the challenge - it was revealed last month that staff at West Midlands Police and West Midlands Fire and Rescue Service are being offered monthly classes by a GP, Louise Newson, who dubs herself the 'Menopause Doctor', to try to halt a flood of older women leaving the services and to 'destigmatise' the issue - many say they are ignored by occupational health and find co-workers difficult and unsympathetic.

Beverley Sunderland, managing director of Crossland Employment Solicitors, says: "One of the main issues for menopausal women is that difficulty sleeping, hot flushes at night, lack of concentration, memory loss and hormone imbalance can have a real effect on their working life. They start to miss targets, make mistakes and situations which they would have dealt with easily become more difficult - they become less tolerant, more emotional and in a lot of cases, anxious. This can be misunderstood by fellow workers - perhaps attracting allegations of bullying. It might also lead to poor performance and possible conduct issues."

Diane Danzebrink, 50, a counsellor and coach from Buckinghamshire, found menopause left her unable to work for four months due to extreme anxiety. "My onset was sudden, following a hysterectomy," she says. "But the first flushes were bearable and I could manage with herbal remedies."

But by December 2013, three months after her operation (for endometriosis), Danzebrink felt low. She said: "I become withdrawn, felt hopeless, worthless - I couldn't see a future. I couldn't bear any pressure; I had sleepless nights, palpitations, and huge anxiety. I couldn't even bear to be alone at home. I couldn't work."

Her husband Martin had to take over the running of the couple's internet business in addition to his own work as an equine dental technician, as well as looking after the house.

"It got very dark," admits Ms Danzebrink. "My confidence had collapsed."

It was only after her GP prescribed plant based bio-identical oestrogen that her symptoms began to lift. "It was such a weight off my shoulders," she says. "I could begin to think about work again."

For some, menopause is plainer sailing. Deborah Garlick, founder of Henpicked.net, a community website aimed at women post 40, says about 25 per cent will find it makes little difference to their lives. "At the opposite end," she says, "another 25 per cent are struggling with severe symptoms, concerned that others might not be sympathetic."

She recalls one woman telling of being ridiculed as she tried to get a severe hot flush under control. "There wouldn't have been a joke made if it had been stress or mental health- related."

Garlick says: "The important thing is that we need to start taking it seriously because the average age for menopause is 51, women work to 68, and we live to 82 - a third of our lives is now post-menopausal."

Prof Mary Ann Lumsden, vice president of the Royal College of Obstetrics and Gynaecologists, is pleased the issue is being raised. "All women will become menopausal in time - for some, as in pregnancy, it can cause a bit of upheaval in their lives, and that is normal. They are not mad or ill, it's just a stage in life."

Helping the conversation along are public figures like 55-year-old Carol Vorderman, who prior to entering the I'm A Celebrity jungle admitted she only felt able to get back to work after she being prescribe HRT in the form of oestrogen gel to help the symptoms.

What needs to change in the workplace to help menopausal women?

It's about the right kind of support, argues Sue Fish, Chief Constable of Nottinghamshire. "It's common sense, looking after the wellbeing of your workforce," she says, pointing out a recent menopause seminar was oversubscribed. "A lot of male colleagues say it is helping them to understand what is happening at home as well as in the workplace. The younger ones are learning what's happening to their mum."

Senior women shouldn't be afraid to lead on the issue. Fish points out too that unlike most pregnancies, menopause happens when women are at the peak of their careers. "It becomes important not only how you manage it personally, but also how you model it for others."

Her own symptoms included hot flushes and "not sleeping well, which makes the pressure and intensity of the job I do even harder. Identifying the problem behind my insomnia with my GP was halfway to solving it."

Credit: Andrew Fox for The Telegraph

The push to change the menopause workplace culture came from Prof Dame Sally Davies, the Chief Medical Officer, who broached the issue 12 months ago. As a result, the Faculty of Occupational Medicine at the Royal College of Physicians produced guidelines last week which include training for employees and managers, a review of workplace temperature and ventilation, flexible working hours or shift changes, and access to cold drinking water in all work situations. Additional suggestions include flexibility over uniforms, as well as the provision of changing facilities.

"But how far should reasonable adjustments go?" asks Sunderland. "Should targets be reduced to reflect the effects of the menopause; should employers suggest to women of a certain age that they go to occupational health for support - perhaps a course of HRT? The problem is that if a male manager tries to broach the subject with a female employee, not only is it a difficult and personal discussion, but she may feel singled out for being a woman."

And do women want to be singled out as needing special treatment, at a time in life when many feel gender limitations are behind them?

"I am aware there are a lot of professional women don't want to appear weak by acknowledging the menopause," Prof Lumsden says. "For them, the idea of asking for help is not the way forward."

Nina Finbow, a web entrepeneur, says, "I have friends in senior roles who have had to attend meetings with closed windows where they were almost expiring from heat and drenched in perspiration, fearing that wet patches might appear - but this does not prevent them from continuing to work effectively. I am all for breaking down myths and misconceptions but I feel strongly about not making special allowances.

"There is a danger of making too much of it, causing a male backlash," she warns. "There are enough jokes about women's 'time of the month'."

Garlick sees information as the root of balanced support: "Educating men (and women) about the side effects of menopause can be done. I did a presentation on menopause at the Institute of Directors, and guys admitted to me they found it a mystery.

"They told me they can't spot women in menopause so can't have a good conversation. 'And how would we even start,' said one. 'It would be so embarrassing for me - and what if I got it wrong?'."

He has a point.

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How to handle menopause in the workplace

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Most working women over 50 used to be at the tail end of their careers, heading towards retirement and easing out of the fast lane. Now, a record-breaking 3.5m older women are in employment - many starting new careers and setting up businesses in mid-life, in response to the raised pension age, a lengthening lifespan, and an optimism inspired by new opportunities.

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7 Keys to Balance Hormones & Manage Menopause

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Hormone replacement therapy (HRT), possibly the most controversial medicine ever invented, will not kill you. That was the conclusion this week of a big, respectable study in the United States that was one of the first to flag up the risk of breast cancer. Women who took the tablets to alleviate the hot flushes and night sweats that assail them, prevent them sleeping and can make life intolerable were no more likely to be dead 18 years later than women who did not.

That's good news and it was loudly celebrated. Gynaecologists who have been frustrated and dismayed by the bad press HRT has had, leaving them groping in the dark for something else to give the distressed woman in the consulting room who doesn't want hormones, said this is proof of its safety. The risks are low. Women must be told about them, but they should not be deterred by any thought that HRT could shorten their life.

And yet. The long-term results from the Women's Health Initiative study are about mortality. In one way they don't change a thing. HRT still increases the chances that a woman will get breast cancer and ovarian cancer and possibly heart disease and stroke in those over 60 - she just won't die as a result. Treatment is better these days. But that woman sobbing in the doctor's consulting room, waking up in bed soaked with sweat, trying to get through a meeting at work with heat pounding her body and afraid everybody must be noticing her flushed face, still has a difficult decision to make.

HRT works. It can be like magic for women who feel their life is wrecked. Mariella Frostrup said she got her life back and hit out at "the shroud of secrecy and shame" around the menopause that prevents women getting the relief of HRT. Woman's Hour presenter Jenni Murray, however, who developed breast cancer after ten years of HRT following an early menopause, said she would never have taken it if she had known then what she knows now.

Most women go through the menopause between the ages of 45 and 55, although for some it happens prematurely and others are thrown into it by cancer treatment to stop the body producing oestrogen, as the hormone feeds breast and ovarian cancers.

The first oestrogen pill was introduced in 1942, and HRT became available to women in the UK in 1965, without the sort of trials that would be done today to look at the side-effects. The rationale was clear: the pills replaced the oestrogen women were losing. The sales pitch was paternalistic and played on women's fears of ageing. Without any evidence, the suggestion was planted that HRT would restore both vigour and beauty. "When a woman develops hot flashes, sweats, wrinkles on her face, she is quite concerned that she is losing her youth - that she may indeed be losing her husband," said a drugmaker's promotional film in 1972. New York gynaecologist Robert Wilson, who had links to the manufacturers, published a book called Feminine Forever, calling women who did not take hormones "castrates".

The science came later and caused much dismay. The Women's Health Initiative (WHI) was a huge study of nearly 162,000 women launched in 1991. The UK-based Million Women Study began in 1996. Both found an increased rate of breast and ovarian cancer. Thousands of women stopped taking HRT. Thousands more were anxious about starting it.

The pendulum has recently swung back the other way, with guidance from Nice, the National Institute for Health and Clinical Excellence, in November 2015. Millions of women should no longer have to suffer in silence, it said. An estimated 1.5 million women in the UK - 85% of all those going through menopause - suffer common symptoms such as hot flushes, insomnia and night sweats. Yet they don't always get the help they need to manage the symptoms. HRT worked, Nice said, and should be considered. And now the WHI study has published its long-term findings showing women do not die from taking it.

"Data showing that mortality overall is not increased in all age groups is a very reassuring finding," said Haitham Hamoda, consultant gynaecologist at Kings College Hospital and spokesman for the Royal College of Obstetricians and Gynaecologists. Hamoda is also on the medical advisory council of the British Menopause Society which has lobbied for HRT and disputed the risk findings in the past.

Hamoda says the breast cancer risk is not high. The WHI study puts it at one more case in 1,000. He prefers that to the observational Million Women Study, funded by Cancer Research UK, which says it is two women in 1,000. One in 1,000, Hamoda says "in medical and statistical terms is a small number. It is similar to the [breast cancer] risk of drinking a glass of wine a night." The risk of breast cancer from being overweight is four times higher.

A more recent study, from the Institute of Cancer Research in London, found last year that among the 100,000 women taking part to look at the causes of breast cancer, those on HRT had a 2.7 times higher risk than those not taking hormones. "We found risks that were slightly higher than other people had been reporting," said Dr Michael Jones of the ICR's genetics and epidemiology unit. "Part of that we think is because we have good quality data and were able to tell when women started and stopped HRT."

The risk is higher for woman taking the combined oestrogen and progesterone pill and lower for oestrogen only - but women need progesterone to protect against womb cancer unless they have had a hysterectomy.

Gynaecologists like Hamoda understand the need. "We see about 2,000 patients a year. The number of patients who come in saying it's affecting my relationship, I go to a meeting and my brain goes blank. It really affects women's lives. The average duration of symptoms is seven years but one in three go beyond that. There are no markers to show who will have the symptoms for six months and who is going to have them for 20 years," he said.

Author Jeanette Winterson described two years of mental breakdown. She, like many others, decided to seek treatment with "bioidentical" hormones rather than those the NHS provides, which their supporters claim are natural. She wrote of the "impossible choice" that women have to make, between mental and physical wreckage and flooding their bodies with synthetic hormones.

But conventional doctors say there is no difference. Women are given oestrogen in the form of estradiol on the NHS, which Hamoda says is bioidentical - identical - to that made in the female body. The progesterone that most women get is synthetic, but bioidentical micronised progesterone, made from plants, is also available on the NHS.

The advice from the NHS is that each woman should sit down with her GP and talk through the options, based on what they know of her individual risk. There are no easy answers. Women at high risk of breast or ovarian cancer or those who have had them will not be advised to take HRT. For everyone else it is something of a guessing game. The odds of cancer are low and reduced if a woman takes the pills for a shorter length of time (no help to those who have symptoms for 20 years), but the risk exists.

There is a glimmer of hope on the horizon though. Maybe more than a glimmer. In April this year, the results of a trial of a new drug were published by Imperial College London. It involved women who were having seven or more hot flushes a day; the drug cut the number of hot flushes by 73%. Oestrogen deficiency causes a chemical in the brain called neurokinin B to increase and this causes menopausal flushing - the drug blocks neurokinin B from working, eliminating menopausal flushing.

It was a small and early study carried out with taxpayer's money, funded by the Medical Research Council because the drug had already been tried and failed in other uses. But Big Pharma can now see the potential and has swooped to develop the molecule. Astellas paid $500m to buy Belgian biotech firm Ogeda, which was running a trial with similar results to Imperial's.

Professor Waljit Dhillo, an endocrinologist and one of the leaders of the trial at Imperial, said they have been inundated with emails from women wanting the drug since news emerged of the results. "They are miserable and not sleeping and it is usually at a time when women are right at the top of their career and they are drenched in sweat and can't go into meetings," he said. HRT works and is very effective, he said, but there is a huge interest in an alternative for those who cannot or will not take it. It will be a couple of years before the new drug is on the market, but if the results of further trials are as good as theirs, it is going to do very well indeed.

The alternatives

Mood swings, hot flushes, night sweats and other unpleasant symptoms of the menopause are caused by the loss of oestrogen in the body as the ovaries run out of eggs in mid-life and stop producing it. HRT replaces that oestrogen. Too much oestrogen can cause endometrial cancer so to protect the lining of the womb, combined HRT is given which contains progesterone as well.

None of the alternatives offers an instant and complete end of the symptoms. They help some women and not others. They fall into three groups: the non-drug options, medicines designed for other conditions which have been found to reduce menopausal symptoms as a side-effect and alternative therapies, which are largely untested.
Non-drug:
* Yoga. The combination of relaxation and exercise helps some women, particularly with the mood swings that the menopause can bring and also in coping with what are technically called vasomotor symptoms - in other words, the surges of heat that cause the body to sweat and the skin to flush red. Stress makes the symptoms worse.

* Cognitive behaviour therapy (CBT). Several studies have shown that CBT can help women cope and reduce the symptoms.

* Lifestyle changes and weight loss. Getting fit, taking exercise and becoming healthier helps all medical conditions. Losing weight is good for bone health, which can be impaired by the loss of oestrogen during the menopause.

* Dietary changes. Caffeine, alcohol and spicy foods have all been known to trigger sweating and flushes. Giving up smoking can also help, according to NHS Choices.
Other medicines:
* Clonidine. This is a pill to treat high blood pressure, ADHD and anxiety, but among the side effects that have been found is a (small) reduction of menopausal flushing.

* Antidepressants. These are said to help reduce hot flushes, in a lower dose than is used for depression. Venlafaxine and other drugs of the SSRI class (of which Prozac is a member) are generally prescribed.

* Gabapentin. This is a drug against epilepsy. As a side-effect, it has been found to help hot flushes in some women but may cause tiredness and other side effects.
Alternative therapies:
* A variety of herbal medicines have been found to help some women, although not in formal randomised clinical trials. Nice mentions that there is some evidence for black cohosh and isoflavones, like soy, which are derived from the bean family and are phytoestrogens. But it warns that in the different strengths and packs available, their safety is uncertain and that they can interact with conventional medicines. Evening primrose oil, angelica, ginseng and St John's Wort (effective for depression but interacts with other medicines) are all also sold in health food shops to alleviate menopausal symptoms.

* Acupuncture. A study last year found that it cut the numbers of hot flushes some women experienced, but not others.
Topics

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HRT won't kill you - but menopausal women still face a difficult decision

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Hormone replacement therapy (HRT), possibly the most controversial medicine ever invented, will not kill you. That was the conclusion this week of a big, respectable study in the United States that was one of the first to flag up the risk of breast cancer.

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This guideline covers the diagnosis and management of menopause, including in women who have premature ovarian insufficiency. The guideline aims to improve the consistency of support and information provided to women in menopause.

For information on related topics see our women's and reproductive health summary page.

In December 2019, in response to an MHRA safety alert on hormone replacement therapy (HRT) and the risk of breast cancer, we replaced the table in the recommendation on breast cancer risk with a link to the MHRA's advice on HRT risks and benefits. We will also update this recommendation as part of the planned update to the guideline.

Recommendations

The guideline includes recommendations on:

Who is it for?

Healthcare professionals who care for women in menopause.

Women in menopause, and their families and carers

Is this guideline up to date?

We checked this guideline in December 2019 and September 2021, and are updating it. The update will focus on managing urogenital atrophy, the long-term benefits and risks of hormone replacement therapy, and cognitive behavioural therapy for managing menopausal symptoms. See the guideline in development page for progress on the update.

Guideline development process
How we develop NICE guidelines
Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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This guideline covers the diagnosis and management of menopause, including in women who have premature ovarian insufficiency. The guideline aims to improve the consistency of support and information provided to women in menopause

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Even though 80% of women going through the menopause will get symptoms, such as hot flushes and night sweats (and in 25% of cases they will be severe enough to affect quality of life), few are confident talking about it. A global industry worth about US$4bn (£3.4bn) flogs books and products, but reliable information is hard to come by. So how can women distinguish fact from marketing hype - and what helps?

Kathy Abernethy, chair of the British Menopause Society, says: "Hormone replacement therapy (HRT) is absolutely the best treatment for hot flushes and sweats that affect daily life. It can also help sleep disturbance caused by night sweats and is one of several strategies to keep bones strong." Dr Mark Vanderpump, an endocrinologist (hormone specialist), agrees: "If men got hot flushes, they'd be screaming for HRT," he says. Other options include the non-hormonal drugs clonidine, venlafaxine and gabapentin, or lifestyle measures such as avoiding spicy foods, alcohol and hot places.

The risk of cancer from HRT is overstated, says Vanderpump. Cancer Research UK puts it in perspective; if 1,000 women start HRT at the age of 50 and take it for five years, there will be two extra cases of breast cancer and one extra case of ovarian cancer compared with among non-HRT users. There will also be some extra cases of heart attack and stroke, but the overall negative effects are small. Avoiding HRT could prevent 1,700 cancer cases a year, but staying a healthy weight could prevent 18,000 cancer cases and not smoking would prevent 64,500 in a year. Women need to be given information and choices, says Vanderpump. Abernethy recommends the Women's Health Concern factsheets and the website Manage My Menopause, which offers tailored advice.

Natural supplements

Campaigner and author Maryon Stewart advocates a diet rich in plants such as soy that contain oestrogen-like chemicals called phytoestrogens. But Abernethy says we don't know how much soy you need to eat to get the same effect as HRT. And if phytoestrogens have similar benefits to synthetic oestrogens in HRT, they may share the risks: an increased chance of blood clots and a possible increase in breast cancer.

Dietary supplements containing isoflavones (the active chemicals in phytoestrogens), herbal remedies such as black cohosh and vitamin E are all available over the counter, but there is little evidence about their effectiveness or otherwise, according to the North American Menopause Society.

Eating a varied, Mediterranean-style diet, avoiding obesity, and doing regular weight-bearing exercise will help to minimise the risk of osteoporosis, heart disease, depression and osteoarthritis. Most women don't need calcium supplements, but those at particular risk of osteoporosis should get specialist advice.

Preventing heart disease and strokes

June Davison of the British Heart Foundation says women need to be aware that their risk of heart disease and stroke increases dramatically after the menopause. Oestrogen, which has a protective effect on artery linings, falls - and other factors, such as high blood pressure, raised cholesterol and the ageing process kick in. Davison says: "Heart disease kills three times as many women as breast cancer does; it's common and certainly not a male disease. The best approach is to get a health check at your GP, optimise blood pressure, cholesterol and weight, don't smoke, eat well and exercise. We don't advise HRT to protect against heart disease; it may increase the risk of thrombosis (blood clots) if you are at increased risk and there is some evidence that heart disease is increased in the first year of HRT use. Women who want to take HRT for other reasons, such as hot flushes, and are at low risk of heart disease, can be reassured that the increased risk will be very low."

Sex drive and dry vagina

Loss of sex drive is common around the time of the menopause. Low mood, tiredness, hormonal changes and relationship problems may all play a part. It doesn't help that sex can be painful as the fall in oestrogen levels makes the vagina dry and sore. Non-hormonal vaginal moisturisers such as Replens, lubricants, and oestrogen pessaries (on prescription only) can restore vaginal moistness; the other factors may be more complex to fix.

Supplements for skin and hair

Vanderpump says women and men in midlife often experience thinning hair, rougher skin and various other age-related changes to their looks. But these are more likely to be due to genetics and environmental factors, such as sun exposure and smoking. If you eat a normal, varied diet, there is no reason to think that nutritional supplements will help hair, nails or skin. HRT doesn't turn the clock back and isn't recommended for these factors.

How can my employer help?

A government review examined 104 studies and found that the years around the menopause can have a big, usually negative, impact on women's working lives. Study co-author Professor Jo Brewis of the University of Leicester school of business says: "We need to talk about the nitty gritty of menopause without embarrassment or fear being judged." Brewis says the analogy is with pregnancy 20 years ago when women feared telling employers that they were pregnant and needed certain reasonable adjustments in the workplace. For menopausal symptoms such as hot flushes, that might include fans, open windows, adjustable air conditioning, non-synthetic uniforms and flexible working hours.

"We need to normalise the menopause, understand that it affects women differently and that many of the problems are relatively short-lived," says Brewis.

What are bioidentical hormones?

This form of HRT marketed in the private sector claims to offer hormones derived from plants that are chemically closer to the ones that occur naturally in the body. But the US Food and Drug Administration (FDA) is clear that they are no safer or more effective than standard HRT. Vanderpump says that if you find HRT helps symptoms, the exact preparation can be tailored to your specific needs; adding low-dose testosterone ( Testim) gel, for instance, may help libido - even though it is only licensed for men.

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HRT and vaginal moisturisers? Here's what really helps menopausal women

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Even though 80% of women going through the menopause will get symptoms, such as hot flushes and night sweats (and in 25% of cases they will be severe enough to affect quality of life), few are confident talking about it. A global industry worth about US$4bn (£3.4bn) flogs books and products, but reliable information is hard to come by.

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shutterstock.

Menopause, when periods stop for good, is a normal stage in every woman's reproductive life. The symptoms usually begin in a woman's forties, with the average age of menopause itself being 51. Experiences differ from woman to woman. Some report sailing through transition, others are pleased to no longer menstruate or be able to fall pregnant, or just embrace getting older.

Symptoms also vary. Some are probably familiar - like unpredictable periods or heavy bleeding, hot flushes, night sweats, poor sleep and emotional outbursts. Others are less well known, including growth or loss of body hair, clumsiness, pins and needles and moments of forgetfulness or poor concentration. About 25% of women have very debilitating symptoms.

When we consider that most women in the UK now work outside of the home, and that employment rates among women over 50 have increased dramatically over the last three decades, it is obvious menopause is an important workplace issue. This is for three main reasons.

The first is corporate social responsibility - the need to ensure that mid-life women have the highest possible quality of working life, and are able to work for as long as they choose, unimpeded by menopause-related difficulties. The second is the law - workplace discrimination based on gender or age is illegal under the Equality Act and BT were the subject of the first successful employment tribunal in 2012. Here direct sex discrimination and unfair dismissal were proven after the plaintiff was dismissed for under-performance, despite providing a medical note documenting that her poor concentration was due to menopause transition.

The third reason is economic. As demonstrated in the BT tribunal, menopause symptoms can affect performance at work. They can also contribute to higher sickness absence. If a woman has to leave work because of her symptoms, replacing her costs an average of £30,000. So there are important cost savings to be made here, as well as retaining expertise and experience.

Different treatment

And yet, as many women experience, menopause is not on most employers' agendas. In fact, very few menopause-specific health and well-being policies exist in UK organisations. Little training or information about the menopause is provided for managers or any other employees. There is also evidence that mid-life women feel they are treated differently - perhaps even harassed or ridiculed - by others at work, whether they are actually menopausal or not.

The analogy we draw is to pregnancy and maternity. Imagine a woman in her early 30s telling her manager she is pregnant, and saying she wants to take maternity leave at a certain point and return to work when the baby is three months old. Nothing unusual there.

Now imagine the same woman, 15 years later, telling the same manager she is experiencing severe menopausal hot flushes and night sweats and wants to work from home when these symptoms are especially bothersome. The evidence suggests that, even if this woman felt able to disclose her symptoms (and many, many mid-life women workers do not), she is likely to meet with bafflement, at best.

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There is a range of advice available for employers on menopause as a workplace issue. Some of the best guidance we have found is provided by Business in the Community, a responsible business network run by the Prince of Wales. There are also pioneers like retailer Marks and Spencer and the Nottinghamshire Police Service, who have provision in place already. Others, like the water company Severn Trent and the University of Leicester (where three of us work), are developing this provision, supported by consultants from Henpicked, a social network for women over the age of 40.

It is important to emphasise that support mechanisms can cost very little - like allowing women to wear uniforms made of natural fibres or to work in an office with natural light, providing USB fans or supplies of cold drinking water and sanitary protection.

Other approaches, including specialist occupational health support, may cost more, but individual women will only need them for a short period of time. Flexible working, which can as we suggest above help women to cope during menopause transition, is something every UK worker has the right to request anyway.

To be clear, we are not advocating for "special treatment" for mid-life women workers. That is, not unless risk assessments during pregnancy and maternity leave represent special treatment. Neither are we suggesting that men don't have mid-life experiences which could prove equally challenging to manage at work.

Instead, we think it's important to normalise women's experiences of the menopause so mid-life women can raise it at work without worrying about being judged or stereotyped; and to impress on employers how important it is that this demographically pressing phenomenon is no longer ignored.

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Three reasons employers need to recognise the menopause at work

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Menopause, when periods stop for good, is a normal stage in every woman's reproductive life. The symptoms usually begin in a woman's forties, with the average age of menopause itself being 51. Experiences differ from woman to woman. Some report sailing through transition, others are pleased to no longer menstruate or be able to fall pregnant, or just embrace getting older.

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When it comes to spotting the signs of menopause, you may be expecting hot flushes, irregular periods and the prospect of feeling weepy at news reports and cat food adverts. But during the perimenopause - the years running up to menopause, when your ovaries completely stop releasing eggs - there are some other signs to look out for...

1. Dry skin, hair and eyes

Have your eyes and skin been feeling dry and itchy? "During the menopause, collagen production, which is what keeps skin supple, hair soft and eyes moist, starts to decline," says Kathy Abernathy, a specialist menopause nurse and Chair Elect of the British Menopause Society. "It's worth getting a richer moisturiser or conditioner and getting over-the-counter eye drops if you're affected. You could also take omega-7 supplements (derived from sea buckthorn) as they can help ease eye dryness."

2. Joint pain

Stiff and aching joints can be another sign of menopause. "The drop in oestrogen which happens in the run up to the menopause can cause achiness," says Kathy. "You may find it's worse in the morning. Exercise that helps to maintain joint flexibility, for example Pilates or yoga, could help here."

3. Intimate dryness

While it's not exactly polite dinner party conversation, vaginal dryness is a significant problem that many women encounter during the perimenopause. "Lubricants will help to tackle this issue, but I would really recommend seeking help from your GP if it's affecting you badly," says Kathy. The doctor may prescribe vaginal oestrogen, which is inserted as a pessary, ring or cream, and helps to boost oestrogen levels and ease dryness.

4. Brain fog

Confusion, memory problems and general absent-mindedness could increase in the run up to menopause. In fact, a study by researchers from the University of Rochester in New York tested women aged 40 to 60 (a typical peri- and menopausal age bracket) and found many had problems with their 'working memory' - the ability to take in new information and manipulate it.

"It's caused by hormones changes and also the fact that you may be struggling to sleep comfortably through the night if you're having hot flushes," says Kathy. Make use of lists, phone reminders and diaries to keep on track of memory problems.

5. Acne

You thought your years of teenage spots were over, and then suddenly they reappear. Once again, it's those pesky hormones that are the culprit. "A change in the ratio of testosterone in the body causes the skin's sebaceous glands to produce excess sebum, an oily substance which blocks pores and can cause spots," says Kathy. Acne can appear along the jaw line, chest or back.

6. Anxiety and palpitations

The prospect of a hot flush can be uncomfortable, and sometimes, they can even be preceded by anxiety and heart palpitations. "You may feel a heightened sense of emotion as the flush starts, which can cause anxiety, and even occasional panic attacks if it's not recognised as such," says Kathy. It's really important to try to stay calm when you feel a flush coming, take deep breaths and sip iced water to help cool you if possible.

7. Overactive bladder

You often associate needing to pee more frequently with pregnancy, but it can also affect you during the perimenopause and menopause. "The bladder needs oestrogen to function properly, so when it starts to decrease during the menopause, it can increase the urge to go," says Kathy.

Plus, the pelvic floor muscles, which help to control the bladder, can weaken and lead to incontinence. If you feel worried or self-conscious, have smaller drinks more regularly, and consider using some discrete pads to protect underwear.

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When it comes to spotting the signs of menopause, you may be expecting hot flushes , irregular periods and the prospect of feeling weepy at news reports and cat food adverts. But during the perimenopause - the years running up to menopause, when your ovaries completely stop releasing eggs - there are some other signs to look out for...

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How to become a rooting-tooting, bad-ass, mighty powerful wise woman

The question that I'm most often asked about menopause is "How long?"
"How long will these symptoms last? When will I reach 'the other side?"
How long is a piece of menopausal string?! The length of time a woman experiences menopausal difficulties varies enormously, anywhere between a year and a decade can be considered normal. Much depends on genetics, so ask your mum and your aunties about their experience. The other factor is how easily you are able to manage change in your life? Are you kind of rigid in your self or is it easy for you to flow with what is as it emerges?

The menopausal transition is not just a change from menstruating to not menstruating, for me personally, this has been the smallest aspect of menopause. In fact, it's a mighty change from one way being, to becoming another person entirely. It's an inside job! We shed what no longer serves us so that we can emerge, phoenix-like, from the ashes of our roles, to serve the world in our own unique way (big or small) unimpeded by hang-ups or fears.

Susun Weed, who's book 'New Menopausal Years, the wise woman way' is an excellent guide to natural remedies, maps the process into three parts; premenopausal, menopausal and post-menopausal. The medical model divides the process into -

Peri-menopausal - literally 'around' menopause and

Menopause - the last bleed. But as you'll only know it's the last bleed sometime after the event, menopause is said to be at least a year after the last bleed.

This is not enough detail, we need a more detailed guide and my dear friends I have a map! It's not a linear map I must warn you, but a feminine map, so though you may find yourself cycling through different aspects of menopause in one day, you'll probably resonate with a particular chamber. This map was created by my teacher Alexandra Pope as part of her menstrual teaching ay Red School and mirrors the process.

Not yet peri-menopausal? You need to read this too! These five chambers are also present every month during your bleed-time and are a rehearsal for menopause; pay attention to the shifts now and your menopause will be much easier!

The 1st Chamber of Menopause

Separation.

You're just about coming into your power in your 40's, you know who you are and what you want, you're on your way to get it and BAM! This is where the rug gets pulled out from under your feet. You start to question...
"Does this job really matter to me anymore?" "Is my partner really my soulmate? Maybe I should go, I can't take it anymore?"
Doubts, uncertainty, confusion and raging is your new country. In 'The Wisdom of the Menopause' Christiana Northrup tells a story of 'crazy' Aunt Carole throwing the leg of lamb out the window (I think she was totally justified btw); it's a bloody struggle! All and any of the health or emotional baggage that you have not dealt with, will come and bite you on the bum. Youch!

You'll find you need way more space and time alone than before and fantasize about running away. You may actually leave but just don't burn the house down before you go.

There will be grief - over not having children, over aging, facing your mortality and all the things you wanted to do but never got around to.

Separation hurts.

A woman is separation will say...
"I hate my body, with my droopy skin and stiff hips, I'll never dance again!"
Your task in separation

Is to take time out. This will mean saying no to stuff, it's good practice because you're going to be no a lot more! Take time out to drift. Stare out of the window. Sleep. Do pretty much nothing (or that how it looks on the outside).

Self-care is key during this chamber. What does self-care mean? It will certainly include reforming your diet and honing the exercise you take, but there's much more... self-care massage, dancing, yoni steams (download your instructions here), singing.... In short doing the things that give you most pleasure.

The 2nd Chamber of Menopause

Surrender.

You still have all the joy of separation, BUT, you stop resisting and wanting to be 'normal'. Instead, you start to accept the madness, to relax and get curious. This is where the process of healing can start, with reflection and looking back at the emotional rifts in your life with kindness.

This is also the phase where as well as listening to your body, you will start to act on what you hear. So for me, like many women in their 40's, my adrenals got a little weary, actually a lot weary, and I tanked out. No energy was available for me to do anything much for about 6 months until I really heard what my body was telling me and started to act on it.

A woman in surrender will say...

"I was always doing to be a dancer but I never did it... I wonder why?"

Your task in surrender

Let go of your expectations of doing all the never-ending stuff that you feel you ought to do. Burn your to-do list.

Take more time out to rest; you know the brain fog? This is where it's inviting you, to a place of inward rest.

Search out healing practices that work for you, it may be homeopathy, therapy or massage, circles of women or nature. Choose what soothes your soul.

Potter in your jim-jams.

Say no to more stuff.

The 3rd Chamber of Menopause

Renewal

This is where things start to turn; there is a teeny tiny fragile sense of hope returning. "Maybe I... What if I.... "

Somehow, having done the healing work in the chamber of surrender, the lost parts of yourself are being gathered home. Often through menopause, it is the enthusiasms we had as a girl that come back to us along with the innocence and sense of possibility that girls have.

It is also possible that some of your energy will return at this point but DO NOT squander it, this is the energy of regeneration for you to use for yourself. Self-care is still your first priority. Non-negotiable self-love and kindness.

The woman in renewal will say

"It's not just about dancing, actually it's about teaching children to express themselves through dance, oooh, that would be fab!"

The task of renewal

Is to enjoy the sense of possibility and growth without acting on it. Think of the tender shoots in spring that must be protected from frost and hungry slugs - they need protection and kindness or they will not thrive. Your job here is simple, it is merely to receive the renewed energy. Simple eh? Except of course it's not, because as soon as we get a little more juice in our tanks, we rush off and get super-active. Self-care is STILL your first priority.

The 4th Chamber of Menopause

Vision

This chamber is a natural extension of renewal. Your energy and hope is stronger now and you are starting to see how your passion and skills can come together in the outside world.

A woman in vision will be

...scribbling down ideas about games and processes the children might move through to help them express themselves and become more confident.

A new enthusiasm comes through as the pieces of your new self reveal themselves; menopause is organizing you from the inside!

Your task in vision is to...

Enjoy the excitement of your renewed life-force and new possibilities. Think of when you buy the perfect pair of shoes, bring them home and try them on to admire them. It's not time to wear them out in the street yet. You need to admire them and wear them in at home. You can now surrender to the possibilities that arise on your horizon, still without the need to act on them in the real world. Too tender and too precious to risk those shoes outside!

Trust is key here, a trust that the universe has your back and will bring the pieces you need.

Do I have to mention that you still have to make self-care a priority?

The 5th Chamber of Menopause

Clarity and direction

It's in this chamber that the practicalities start to fall into place. The details of your new calling are emerging; maybe someone mentions that they know a special needs manager at the local borough, or a great dance course.

At this point you have to trust that the right ingredients will come your way and that all will be well. After the darkness of the first two chambers you have developed the spiritual muscle to carry through your transformation.

A woman in clarity and vision will say
"I had the power all along!"
Your task in clarity and direction...

Is to pace yourself, use your energy wisely. By now your self-care routines will be so habitual that you won't even think about them : )

Congratulations! You are now officially a rooting-tooting, bad-ass, mighty powerful wise woman!

The chambers don't necessarily coincide with particular symptoms, so that you may start to enter separation way before your periods start to change or be feeling renewed and clear while also flushing. This is a psycho-spiritual map and the sharp eyed amongst you, you'll have noticed that these chambers hold true for any transformation in life. Pregnancy, birth, death, bereavement all follow similar patterns.

If this map appeals to you, you can delve deeper into the chambers at our next Love Your Menopause workshop or find more articles about menopause well-being. If you are interested in doing more reading, you might enjoy Leora and Kate's menopause booklist.

So where do you think you are in this process? Tell us in the comments below, sharing our experiences is incredibly powerful, remember; there have never been so many educated, aware menopausal women on the planet, let's make this a change for good.

To track your moon cycle, you can use our moon chart, just fill in the form below.

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How to become a rooting-tooting, bad-ass, mighty powerful wise woman The question that I'm most often asked about menopause is "How long?" "How long will these symptoms last? When will I reach 'the other side?" How long is a piece of menopausal string?!

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A cooling dash to the fridge is a common coping tactic for the 80 per cent or so of mid-life women who experience menopausal hot flushes.

Hot flushes can have a big impact on daily life, especially on sleep, work and mood. But my research shows that the fridge is not the only drug-free solution; learning how to be kind to ourselves can also make a big difference.

Wellbeing is often taken for granted. Our own wellbeing is not a fixed trait, however, but a learnable skill. Fostering psychological resilience through strategies like self-compassion can help us better manage life's inevitable changes - including some physical health symptoms, like hot flushes.

Menopausal hot flushes can cause some women difficulty sleeping. Picture: Shutterstock

While hormone replacement therapy (HRT) can help some women manage hot flushes, HRT is not effective or safe for all women. Psychological coping strategies can be powerful tools to help women navigate the menopause transition.

Self-compassion involves treating yourself with the same kindness and understanding you would extend to a friend in need. While many women have a natural gift for empathy, often knowing the right thing to say to make others feel better, research shows that we aren't so kind to ourselves. Self-compassion doesn't always come naturally.

Instead, women often fall into a trap of giving endlessly to others whilst leaving no time or energy to care for themselves. This is a recipe for burnout - especially at midlife when commitments are often hectic.

How self-compassion helps

Midlife women are under enormous pressure. By the time they have reached their late forties, they may have new responsibilities for ageing parents. They might also have teenagers, which can be one of the most challenging (and stressful) age groups to parent. By midlife, women may have gained more seniority in the workplace. This seniority, when coupled with our tendency to over-give to colleagues at work, causes additional stress. Add menopause to the mix, and it's easy to understand why women's well-being reaches an all-time low point at midlife - at least in wealthy, western countries.

(Don't) always look on the bright side of life

The first sign of the menopause transition (MT) is usually persistent changes in the menstrual cycle, caused by underlying changes in estrogen levels. According to research, estrogen changes during menopause can increase the risk of depression for some women. Volatile estrogen levels also contribute to hot flushes, which are also linked to depression.

But not all women get depressed at midlife, and our research shows that self-compassion is an important protective factor that helps them cope.

One intriguing study we completed at the University of Melbourne showed that for a given frequency of hot flushes, women high in self-compassion found the symptoms to be less troubling. Specifically, self-compassionate women reported that hot flushes interfered less with key daily life experiences such as sleep, work, relationships and mood. In turn, this was associated with a reduced risk of depressive symptoms.

This is an important finding, because it shows that self-compassion may help women cope with their menopausal symptoms. The truth is that menopause isn't always smooth sailing, but self-compassion has the potential to help women manage the transition without feeling overwhelmed.

Silencing the inner critic

Many women might notice that they tend to be self-critical, rather than self-compassionate. They don't know how to begin to silence their inner critic. Fortunately, self-compassion is a learnable skill - and a great investment in well-being. Women can learn to be more self-compassionate through cultivating the three facets of mindfulness, self-kindness and common humanity.

Connecting with others through shared experiences is an important part of practising self-compassion. Picture: Shutterstock

Mindfulness involves being aware in the present moment, as opposed to being lost in day dreams. It involves a grounded and peaceful clarity of mind. Mindfulness is the first step to self-compassion, because you need to be aware of your own state of mind before you are able to respond with compassion. A great way to be mindful is to simply feel the weight of the body. During a hot flush, just feel the weight of your feet. You are literally just shifting your focus 'from heat to feet'.

Self-kindness involves using kind language and emotional tone when relating towards yourself. It is the opposite of saying to yourself "you idiot!" when you are running late, or feeling embarrassed or angry at your body during a hot flush. Self-kindness involves meeting your own body's fragilities with understanding, and an open heart. Even just placing your hands gently on your heart with a caring intention evokes self-kindness.

Possibly the strongest component in predicting well being outcomes is common humanity. This involves feeling connected to others during a moment of suffering rather than feeling stranded and alone. Think back to a moment when you suffered: did you feel isolated or connected? All too often, suffering is associated with feelings of 'self' or 'isolation'.

Common humanity involves a less rigid sense of self, where on a deep level you acknowledge that suffering is part of the human condition. You feel connected to others through your suffering (e.g. the suffering of a hot flush), rather than feeling isolated or misunderstood. When done wisely, attending support groups, seeing a psychologist or debriefing with friends can all contribute to a sense of common humanity.

Positive psychology much more than 'Happyology'

Building on our research demonstrating the power of self-compassion, we are now expanding this finding to explore how psychological resilience factors might improve other aspects of health and people's experience of ageing. For example, have you ever wondered why some people grow increasingly grumpy with age whereas others become more happy, peaceful and content? A recent study of ours found that attitudes to ageing might help account for these well-being trajectories.

In this study, we looked at changes in midlife women's psychological wellbeing over a ten-year time frame. We found that those who felt optimistic about ageing experienced improvements in well-being in later years, whereas those who felt bad about ageing experienced well-being declines. While there were important limitations with this study (we measured attitudes to ageing at follow-up, not baseline), it shows that psychological makeup may have an impact on how we age.

We are now partnering with some Healthscope Hospitals to explore how emotional training (such as training in self-compassion and positive emotions) might not just improve well-being, but also potentially heart health (indexed by heart rate variability) among patients with health conditions.

Given that cardiovascular disease is the number one killer of both women and men, this research could have important implications for health and well-being in the second half of life.

Banner image: Shutterstock

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Dr Lydia BrownMelbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne

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Surviving menopause with some (self) kindness

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A cooling dash to the fridge is a common coping tactic for the 80 per cent or so of mid-life women who experience menopausal hot flushes. Hot flushes can have a big impact on daily life, especially on sleep, work and mood.

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Menopause refers to the cessation of monthly periods

Managing diabetes whilst going through menopause can feel like a twin challenge for most women due to the combined effects that each condition can have on the body.

The best way to remain in control is by knowing what to expect so that you can prepare yourself for the unique challenges that may lie ahead.

What is menopause?

Menopause is the general term that describes the end of a woman's menstrual cycle - in other words, the cessation of monthly periods - that usually occurs around the age of 50.

Periods usually come to a gradual halt, becoming less frequent and with longer intervals between each one before stopping altogether. But for some women, the end of menstruation can be sudden.

It is this period that is referred to when a woman is said to be 'going through menopause'.

For many women, the end of menstruation can lead to a number of physical and emotional symptoms, which can be detrimental to health.

Levels of the female sex hormone oestrogen decrease, causing the ovaries to stop producing an egg each month (ovulation). Reduced oestrogen can result in women experiencing hot flushes, night sweats, mood swings and vaginal dryness.

However, changing hormone levels can also trigger spikes and falls in blood sugar levels, which for women with diabetes can lead to a number of problems and may pose a number of health risks.

I have both diabetes and menopause - what should I expect?

Menopause will not affect every woman in the same way, however, there are a number of common effects.

Fluctuating blood sugar levels

As mentioned above, changes in the levels of oestrogen and progesterone - hormones that affect how your cells respond to insulin - can lead to unexpected fluctuations in your blood sugars, making it harder to keep diabetes well controlled.

Weight gain

Putting on weight is a common issue for some women who go through menopause and after menopause, and can increase the need for insulin or oral diabetes medication.

Infections

Diabetes raises the risk of urinary and vaginal infections, and this risk increases further during and after menopause as less oestrogen in the body makes for even more ideal conditions in the urinary tract/vagina for bacteria and yeast to thrive in.

Sleep problems

Hot flushes and night sweats after menopause can cause sleepless nights. This, in turn, can have a negative impact on blood glucose control.

Sexual dysfunction

Over time, high blood sugar levels can damage the nerves of in the vagina and cause thinning and inflammation of the vaginal walls, making it more difficult for women to become aroused or achieve orgasm. This problem is often exacerbated by vaginal dryness, a common symptom of menopause, which can cause pain during sex.

How can I better manage menopause and diabetes?

While menopause can make it harder for you to keep your blood sugars levels in check, the good news is that there are a number of simple steps you can take to improve menopause management and reduce the impact it has on your diabetes control.

These include:

Healthy lifestyle changes

Eating a healthy, balanced diet, avoiding smoking, reducing alcohol intake and keeping physically active are all healthy lifestyle factors that can help you feel your best after menopause, as well as helping to keep your diabetes well controlled.

Test your blood glucose regularly

Testing blood sugar levels more often than usual during the day, and occasionally during the night, will help you to see how your blood sugars respond to menopausal symptoms such as hot flushes and changes in mood ( anxiety, tiredness, etc).

Note down your blood sugar readings and symptoms and provide this information to your doctor as they may use it to adjust your diabetes treatment plan as needed. For example, if your blood glucose continues to rise, a higher dosage of your diabetes medication, or new medication may be needed.

Regular HbA1c testing may also be advised by your doctor to get an idea of what your average blood sugar level has been over the previous 8-12 weeks.

Seek help for menopausal symptoms

If you're struggling to cope with vaginal dryness and pain, sleeping problems, hot flushes or other menopausal symptoms, remember that support is available. For example, to restore vaginal moisture your doctor may recommend a vaginal lubricant, or if weight gain is a problem, expert advice from a dietician may help.

Hormone replacement therapy (HRT) is also an option for some women. This form of treatment is used to relieve symptoms of menopause by replacing the female hormones (oestrogen and progesterone) no longer produced after menopause.

Get assessed for heart disease risk

Menopause triggers metabolic changes that can cause your weight to increase. For women with diabetes, weight gain can elevate their risk of heart disease even more, as well as complicating management of blood sugar levels.

As your doctor about regular blood pressure and cholesterol screening as both health factors are important for controlling diabetes and heart disease risk, but can be affected by menopause.

Protect your bones

Over time, diabetes can cause a number of bone and joint problems, particularly in women. Problems such as bone thinning can escalate during and after menopause, so it's important to build up strength in the bones. This can be done by adding calcium and vitamin D supplements to your diet and getting your bone density assessed.

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Menopause refers to the cessation of monthly periods Managing diabetes whilst going through menopause can feel like a twin challenge for most women due to the combined effects that each condition can have on the body. The best way to remain in control is by knowing what to expect so that you can prepare yourself for the unique challenges that may lie ahead.

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wise woman herbal for the childbearing year

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down there: sexual and reproductive health the wise woman way

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Menopause - Wise Woman Way - Menopausal changes: premenopause, menopause, postmenopause - Susun Weed

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Susun Weed - Herbal Medicine: Advice, Articles, Books, Workshops, Intensives, Apprenticeship, Correspondence Courses

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The Secret Pleasures of Menopause is a groundbreaking book that is long overdue! Christiane Northrup, M.D., delivers a breakthrough message that will help millions and millions of perimenopausal and menopausal women just like you understand that at menopause . . . life has just begun!

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For most women, menopause occurs between the ages of 50 and 52. In the lead-up come the hormonal changes of perimenopause, which often last between four to ten years.

Though some women sail through these hormonal shifts, many experience symptoms that come and go or occur daily.

In the perimenopausal phase when progesterone is starting to lower, many women experience a shorter cycle that has menstruation coming every 21 days. Not only are cycles shorter but they can have much heavier bleeding.

These lower progesterone levels can also cause issues with falling asleep and create more anxious feelings for no reason. Progesterone is the hormone that makes us feel grounded and keeps a hold on anxiety, without it we can feel edgy, anxious, and airheaded. When you start to skip cycles and the sleep disturbance changes to waking up at 2 a.m., then you know estrogen is starting to lower.

Additional symptoms at these phase range from hot flashes, weight changes, sleep issues, vaginal dryness and itchy skin to breast tenderness, loss of libido and mood swings.

Migraines can be triggered more in either phase, peri or menopause because both high and low levels of estrogen can be a trigger.

During this time most women feel they are chasing their tail as symptoms come and go, but herbal medicine is a great support during this transition.
If you would like to learn more else herbs can help to rebalance your hormones, join the FREE online workshop "How to Use Herbs to Rebalance Hormones."
The right choice of herbs, plant roots and seeds can be used as natural treatments for some of these symptoms and help to reduce their severity. Here's a rundown of potent therapeutic plants to use to address top health issues for women related to menopause and perimenopause:

1. Hot Flashes and Night Sweats

Research shows around 85% of women experience hormone symptoms such as hot flashes and night sweats in the first year or two of perimenopause. These occur due to estrogen levels dropping. Up to half continue to have them regularly, even after menopause.

Why? Falling estrogen levels cause a woman's 'thermoneutral' zone to narrow - this can cause sweating to be triggered at lower temperatures and dilation of the peripheral blood vessels, which also increases heat. When anxious or stressed, peri and menopausal women also release slightly higher amounts of the stress hormone noradrenaline, which increases body temperature and hormonal hot flashes.

Chaste tree: Chaste tree (Vitex agnus-castus) also known as Monk's Pepper got these names from the anti-aphrodisiac qualities of the plant. Monks used to chew the berries and leaves of this plant to reduce urges. When used in large quantities some may experience a reduced libido.

Chaste tree works by increasing luteinizing hormone which helps to raise progesterone levels so that estrogen levels are not so dominant. It can improve issues such as short and heavy cycles, falling asleep, painful, lumpy breasts, bloating, depression, headache, and constipation.

Has long been used in Europe for treating hot flashes. Black cohosh: Researchers from the University of Illinois have found that black cohosh appears to act on human opiate receptors, which play a role in regulating the body's temperature.

Dong Quai: Known as 'Female Ginseng", this fragrant herb is used to treat period pain, amenorrhea (absent periods), Pre-Menstrual Syndrome (PMS) and symptoms of peri and menopause, such as hot flashes and lack of libido.

Red Clover: This is rich in phytoestrogens called isoflavones, which helps to combat the intensity and frequency of hot flashes. Research from Aarhus University Hospital has shown that daily intake of red clover can reduce menopausal hot flashes, particularly when combined with probiotics.

In the FREE online workshop, "How to Use Herbs to Rebalance Hormones," I will be covering a number of these herbs and how to use them in your kitchen! 🙂

Many women find they feel substantially more anxious, wired, or teary during perimenopause and menopause. The hormonal changes during this time can affect brain structure and function, impacting memory and concentration. Hot flashes may also cause temporary memory dips.

Helpful Plants:

Ashwaganda: A powerful adaptogenic herb used in Ayurvedic practice, it helps to promote mental calm, reduce anxiety, depression, and insomnia. In one study, Ashwaganda was shown to increase serum DHEA levels by 13.2%. DHEA is the "mother" hormone because it is the precursor of other hormones like estrogen and testosterone, which can be helpful at this time. (Auddy B, Hazra J, Mitra A, Abedon B, Ghosal S. A standardized Withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: A double-blind, randomized, placebo-controlled study. . 2008;11(1): 50-56). NOTE: if you are sensitive to the nightshade family, which includes foods like potatoes, eggplant, and peppers, ashwagandha may not be a suitable choice.

Is a calmative that promotes relaxation and reduces anxiety. Passionflower: Research shows that it can be effective in easing anxiety symptoms.

This ancient Peruvian women's tonic can help increase energy and mental clarity. Choose the gelatinized (but not raw) Lepidium Peruvianum Chacon variety. The powder can be added to smoothies, lattes and tea or coffee. It contains a flavonoid called Apigenin - which may benefit brain cells and ward of depression, suggests research from Brazil. To learn more about the other benefits of Maca: maca take a look at my post.

Many women mistakenly think that heart disease is a man's condition, but heart disease is one of the top killers of women. A woman's risk dramatically increases at menopause due to a drop in estrogen - leading to your heart and blood vessels stiffening and ultimately less elastic. As a result, your blood pressure rises, which can put a strain on your heart. Issues like Atrial Fibrillation (abnormal heart rhythms) may also occur.
These herbs can be used in easy to make salves, tinctures, and infusions. Learn how to use herbs in your everyday routine in my FREE online workshop "How To Use Herbs To Rebalance Your Hormones"

1. Healthy omega 3 fatty acids

2. Soluble fiber: this binds to cholesterol and removes it

3. Lignans: plant compounds with antioxidant and estrogen-like (as well as estrogen-detoxing!) properties.

Helpful Plants:

Flaxseed can be as effective as estrogen for combatting some of the adverse blood lipid changes that occur in menopause, shows research from the Canadian Institute of Cardiovascular Sciences. The study found that flaxseed can retard the growth of plaques that block arteries, increasing the risk of stroke and heart attack.

Motherwort: Has been used since ancient times to treat high blood pressure, racing heart, and angina (mild chest pain). Enjoy it as a tea and combine it with hawthorn to help stabilize erratic heart rhythms.

Works like a natural form of HRT because it can boost sexual arousal and desire in women and raise estrogen levels, Fenugreek: shows research from the University of Queensland. Fenugreek also helps lower cholesterol and contains steroidal saponins that prevent your body from absorbing harmful LDL cholesterol and triglycerides. Plus it contains potassium levels, which can balance levels of sodium and stabilize heart rate and blood pressure.

It is important to note that as women approach menopause, they will see a drop in estrogen, which happens because bone cells break down faster than new ones can form.

Helpful Plants:

Dandelion: Long used as a tonic and diuretic, dandelion is rich in Vitamins A, E, C, K and B2 (riboflavin) and contains potassium, iron, calcium, magnesium, manganese, zinc, and phosphorus - minerals that are great for building strong, healthy bones. Be mindful that dandelion root is high in polysaccharides, so it should be avoided if you are sensitive to FODMAPs (carbohydrates that can cause digestive problems).

Camellia Sinensis: This is the plant you enjoy when you savor a cup of green or black tea. Research from the University of Western Australia, not only shows that women who drink tea have higher bone density, but it also promotes a more alkaline balance in the body. Be careful as a more acid state can lead to minerals like calcium being leached from the bones.

Alfalfa, Nettles, and Horsetail: These are rich sources of nutrients including calcium, magnesium, silica, and boron which are also pivotal to building bone new bone and maintaining bone density and strength.

Learn about 20 healing herbs and spices to help support and heal your thyroid, adrenals, menopause, weight, hair loss, cellulite, PCOS, hot flashes (and more).

5 simple and delicious herbal recipes to restore and rebalance your hormones:

Ashwaganda Latte

Matcha Morning Kickstarter

Protein Balls

Women's Health Infusion (Drink)

Anti-wrinkle Oil (a chemical free and affordable recipe)

How to avoid common chemicals found in everyday skincare, personal care and house cleaning products that disrupt your hormones

Discover which herbs are best for your individual needs
Discover what herbs are best for you

In this FREE online workshop you will:

Get more delicious healing recipes and learn how to rebalance your hormones with food in my book, Cooking for Hormone Balance.

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7 Herbs That Support Menopause (Hot Flashes, Sleep Issues, Mood Swings) - HormonesBalance.com

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For most women, menopause occurs between the ages of 50 and 52. In the lead-up come the hormonal changes of perimenopause, which often last between four to ten years. Though some women sail through these hormonal shifts, many experience symptoms that come and go or occur daily.

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Helena Frith Powell claims the French attitude to menopause is different to Brits

French women are open to HRT, where as the number of Brits using it has halved

She claims French women use menopause as opportunity to shake things up

The main menopause symptoms include weight gain and hot flushes

Dr Anna Marie Olsen says age is no barrier to sexiness in France

They can replace hands and even lungs. They can fit pacemakers. But they can't do a damn thing about hot flushes,' laments the female lead in the new French film Aurore, or I Got Life! to give it its English title. My first reaction on hearing this was: 'Do French women even have hot flushes?'

I moved to France almost 18 years ago and unlike Aurore, the 50-year-old menopausal star of the film, my French friends have never suddenly ripped off their T-shirts to cool down in mid-flush, or, now I come to think of it, ever mentioned 'la ménopause'.

For them it is just a physical function that was best kept private or even ignored. Until now. Because this spring a spate of French films, on release in both France and Britain, including I Got Life! and Let The Sunshine In (which sees Juliette Binoche searching for another shot at love at a time most women go through the menopause) have made the change a rather - pardon the pun - hot topic.

In cafes and restaurants, on radio and TV, French women (and men) are talking openly for the first time about the menopause and what it means in France.

And it's clear that the attitude across the Channel is very different from our own.

For while in England women sometimes seem to see the end of their fertility as the end of life as a sexual being, in France this stage in a woman's life is often about shaking things up - having more sex, not less.

The catapulting into public view of Brigitte Macron must surely have contributed to reframing the conversation about older women and sex. While she may not be the most popular first lady, with her leather leggings and ultra-short skirts she is, at 64, unapologetically aiming for a sexy aesthetic rather than a demure one.

A Parisian friend of mine, whose children were at the school where Brigitte Macron taught, says she will never forget the first time she met her. 'We were all in a classroom and this stunning woman walked in wearing tight leather trousers and stilettos and introduced herself as the Latin teacher. I have no idea at all what she said, I was mesmerised. It is not the kind of school where teachers wear leather trousers! But she looked incredible.'

Mme Macron is not alone in refusing to equate her more mature years with a more sedate approach to life.

A 55-year-old French friend of mine called Marie-France says the menopause has made her 'feel better than I have done in years, more at ease with myself and looking forward to my future'.

She recently got divorced from her husband of 22 years. Their marriage had been a sham for a long time, but they stayed together for the sake of the children. Once the kids left home they decided to split up and sell their apartment in central Paris.

With the proceeds, Marie-France bought a home in her native Toulouse as well as a pied-a-terre in Barcelona.

'There are two of me now,' she tells me. 'The divorced mother who lives in Toulouse, where she welcomes her family home, and the woman who spends her weekends alone in Barcelona. I know which one has more fun.'

Marie-France says she feels lucky her menopause coincided with her divorce. 'I think within the confines of a barren, dull marriage it might have really affected me badly. As it was, it was part of a new direction in my life and spurred me on to greater things.'

Her symptoms are, in the main, hot flushes, so she always carries an Evian spray in her bag. She also gets her doctor to prescribe an oestrogen gel called Oestrodose - HRT in gel form - which she applies daily.

French women are extremely open to HRT. Every single friend in France I spoke to about the menopause said she was either taking it or would do when the time came.

Unlike us Brits. The number of British women taking HRT has more than halved since a major 2002 study linked it to an increased risk of breast cancer.

Dr Anna Marie Olsen works for French dermatology guru Dr Jean-Louis Sebagh, who has offices in Paris and London. She sums it up: 'The difference is that European women are more open to bio-identical hormone therapy and that does make a difference.'

The fact that age is no barrier to sexiness in France means that, for most women, the menopause has little or no bearing on a woman's desire to be attractive (and attracted to) others. I remember once chatting to a lady who was buying underwear in Galeries Lafayette in Paris. I guess she was in her mid-60s. I asked her why she bought lingerie. 'To be sexy,' she replied.

The simple fact is that sex is not linked to fertility in French culture. In fact, according to Chantal, a married friend who is going through the menopause, lack of fertility can actually make you feel better about sex. 'Having sex for the sake of having sex has made me feel young again,' she says.

That sentiment is echoed by the psychologist and therapist Marie de Hennezel, who has written a book called A Frenchwoman's Guide to Sex After Sixty. 'The heart does not age,' she says. 'Try to think about the body you are, not the body you have. Develop your ability to be erotic and seductive. An inner youthfulness can be sexier than youth itself.'

Chantal agrees. 'At 51 I am now having the best sex of my life. I look back on my younger self and almost feel sorry for her with all her angst and insecurity.'

It's not all plain sailing though. 'There was one rather embarrassing moment when I had a hot flush in bed,' she says, 'but I put it down to our exertions.'

'We French have a relationship to sexuality that is very different from other countries,' Agnes Jaoui, the 53-year-old star of Aurore, tells me.

'French women are lucky - it's very important to us that we don't stop being sexy at 30, 40, 50. Just because we see a woman having a discreet hot flush or forgetting her words, it doesn't make her less interesting. You can still be a sexual being.'

Agnes, who is divorced and lives in Paris with her two teenage children, says she had no idea about the menopause until she experienced it herself.

Can the menopause cause you to age?

2 the number of years a difficult menopause can age you by

'I didn't realise the menopause is like a second adolescence. It's exactly like when we are teenagers! I had no idea that my hormones would be everywhere. My doctor advised me to take HRT because it helps you be in better shape when you're older.

But while French women generally don't like to discuss the menopause, they will talk to their pharmacist.

My local pharmacienne says the two most common symptoms she hears menopausal women complain about are hot flushes and weight gain - and in the treasure trove that is a French pharmacy there are pills aplenty that can tackle those.

One brand is Acthéane, which contains a cocktail of ingredients including arnica and glonoinum, a nitroglycerine, and claims to 'ease menopausal discomfort'. Another popular brand is Ménophytea, which targets hot flushes with herbal ingredients including hop extract, flaxseed and chicory.

Similarly, a discreet enquiry will lead to PH-balancing, soap-free intimate washes and gels to deal with one of the most unpleasant effects of menopause, the fact that sex can become a little uncomfortable - though this, according to another friend, is 'always the husband's fault!'

And there's no French skincare brand that doesn't have an anti-rougeur (anti-redness) cream within its range - and an SPF 50, which, according to Dr Anna Marie Olsen, is essential for dealing with the three major areas of concern in menopausal skin: enlarged, visible pores, pigmentation and crepey skin. 'You need to use it every day, not just in summer,' she warns.

My pharmacist says that actually a lot of French women are blissfully unaware that the menopause is happening, due to their choice of contraception.

The coil, which is more common in France than in the UK, according to a UN report, can hide the symptoms of menopause by lessening the frequency of periods or even stopping them altogether, as well as releasing hormones.

The hormonal coil releases progesterone, which naturally falls during the menopause. Some contraceptive pills and implants can have a similar effect.

My pharmacist says: 'Once you find a method of contraception that works, while you are peri-menopausal (pre-menopausal) there is no need to change it, even if its main function changes from contraception to hormone replacement. It can really make the transition much smoother.'

Another reason why so many French women look and feel as if they glide through the menopause could be the fact that many of them have spent the past 40 years watching their weight.

Research suggests that the higher your BMI is (body mass index, relating weight to height), the worse your menopausal symptoms will be, especially hot flushes and joint pain.

The French obsession with weight is well documented, which may explain why, in addition to what they can find in the pharmacy, women who do experience the effects of the menopause look to their diet for a remedy.

My friend Marie-France swears by the gâteau pour la menopause, a cake made with seeds, ginger and nuts that is stuffed full of dietary oestrogens. She also avoids salt to reduce water retention and eats lots of green, leafy vegetables.

Others turn to Dr Jean-Claude Houdret, a Parisian weight-loss and anti-ageing specialist, and his book Bien Vivre sa Ménopause (Live Well During Menopause). His advice to the mainly high-end clients who visit him complaining of bouffées de chaleur - yes, even their hot flushes sound glamorous - is to use mainly natural methods. 'Hydrotherapy, aromatherapy and, above all, herbal remedies will all restore equilibrium,' he says.

Whichever methods they choose to deal with menopause, discretion has always been key for French women. When, in the new film, Aurore says the word 'menopause' in her ex-husband's presence, he covers his ears and makes a silly noise. French men do still like their women to be mysterious, sexy and on a pedestal. Which is one more reason this film is so groundbreaking.

Another French friend, Sophie, said that when she went to see her doctor about dealing with the symptoms of menopause, his main piece of advice was not to discuss it with her husband.

Perhaps this refusal to acknowledge the menopause explains in part why French women seem to have an easier time navigating it. Rather than giving in to hot flushes and accepting that, in the words of an English friend of mine 'the war is over', they are treating this 'certain age' as a golden age, full of possibilities.

'Women joke that we have a superpower after 50,' says Agnes Jaoui - 'that we become invisible. But it's not true in France.'

What do France's top experts advise?

By French menopause expert Dr Jean-Claude Houdret, author of Live Well During Menopause.

In general the menopause happens between the ages of 45 and 55. Sometimes it comes on immediately - one day periods just stop, then it's over. Other times it happens over a period of months or even a year where your periods are irregular and you miss a month.

Some women don't have any trouble at all. Others may have several symptoms such as hot flushes (often at night), nervousness, irritability and sometimes depression.

HRT gives women a great deal of comfort because not only are they managing the menopausal symptoms but they have better skin and fewer wrinkles - it actually slows the ageing process.

I would suggest that those women who react well to HRT should stay with it, but those who are newly menopausal should try phytotherapy, which is the science-based use of medicinal herbs.

There are two plant-based pills that I recommend to my patients, Menosun and Menestro. The latter has some soya in it, which we know to be effective [as it contains plant compounds that mimic oestrogen] but should be avoided in large quantities. [Too much soya has been linked to thyroid dysfunction and cognitive decline.] Menestro also contains sage [which has been shown to relieve night sweats], thyme and yam [which is particularly good for hot flushes, mood swings and insomnia].

Menosun has no soya but contains seeds from the African plant griffonia, hawthorn and a medicinally potent brown berry called chasteberry, which can help balance the ratio of oestrogen to progesterone.

Other treatments include hydrotherapy and aromatherapy using products to target the individual symptoms.

Smart Women Don't Get Wrinkles (£8.99, Gibson Square) by Helena Frith Powell is out now. Let the Sunshine In is in cinemas nationwide. I Got Life! (Aurore), is released on DVD on June 1.

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Helena Frith Powell claims the French attitude to menopause is different to Brits French women are open to HRT, where as the number of Brits using it has halved She claims French women use menopause as opportunity to shake things up The main menopause symptoms include weight gain and hot flushes Dr Anna Marie Olsen says age is no barrier to sexiness in France They can replace hands and even lungs.

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Employers need to do more to "normalise conversations" about the menopause in the workplace, say experts.

The comments came after a BBC survey found 70% of respondents did not tell their bosses they were experiencing symptoms.

Some firms have brought in menopause-specific policies but experts said for many it was still a taboo subject.

GP and menopause expert Louise Newson said it was a "silent issue for too many organisations".

The menopause is when a woman stops having periods and is no longer able to get pregnant naturally as oestrogen levels decline.

It usually affects women between the ages of 45 and 55 and includes symptoms such as poor sleep, hot flushes, anxiety, and poor memory.

Experts said employers did not necessarily have to make costly adjustments, but changes such as flexible working or having a desk fan could be helpful.

Professor Amanda Griffiths, a psychologist specialising in mid-life and older people's health and wellbeing at work, said: "Employers can help by communicating to their workforce that health-related problems such as the menopause are normal.

"I have heard of cases where women have not admitted the cause of their problems until matters have reached disciplinary stages at work."

She said organisations could access online guidance and advice on the issue from the Faculty of Occupational Medicine and also from trade unions.

'Stay at home'

The BBC survey asked 1,009 women aged 50 to 60 how their experience of the menopause had affected their work and relationships and what their symptoms and treatment were.

The poll, by Comres for BBC Radio Sheffield and Radio 4's Woman's Hour, found 70% of women did not make their employer aware they were experiencing symptoms, while nearly a third said they had not visited their GP.

Nearly half of respondents said the menopause had affected their mental health, while a quarter said it made them want to stay at home.
Sue's story
Former Nottingham Police chief constable Sue Fish was responsible for introducing the force's menopause policy.

"I was horrified to find out women were leaving early because of the severity of their symptoms.

"Some had been rebuffed by line managers or they'd chosen not to talk about what they were going through.

"It was such a waste of all that talent and experience that these women had in serving the public.

"Bringing in a policy was absolutely the right thing to do. Talking about it helped build a culture of openness.

"I also had my own experiences of the menopause to draw on and I talked about it very candidly.

"There was me, at the top of an organisation making difficult decisions, and I didn't want anyone blaming those decisions on irrationality. It was quite a challenge to overcome."

Ms Newson works with West Midlands Police and the fire service to give advice and support on the menopause and its impact on work.

She said: "Is enough being done to address it in the workplace? No. It's still a silent issue for too many organisations.

"We don't talk about the menopause. We don't get taught it at school and it's not standard to learn about it in medical training either."

She added: "Things are improving but there needs to be much more openness and understanding not just from employers but doctors as well."

An ageing population and an increasing number of women in the workforce means in the future there will be a higher proportion of working women at menopausal age.

A similar study is being carried out at Kings College London in collaboration with the University of Nottingham, looking to improve the menopausal experience for working women.

Dr Claire Hardy is the lead author. She said: "It might be possible to make some adjustments at work, things like having a desk fan, or moving to a desk that is near a window that can be opened to cool down.

"Or even having some flexible working. The woman might have been having difficulty sleeping so having a later start to work might be feasible for some women, or just to miss the rush hour as well."

'Thirty years behind'

Employment lawyer Jenny Arrowsmith from Irwin Mitchell said greater openness in the workplace would help women feel supported.

She said: "Just as many employers now have a stress policy, some employers have brought in a menopause specific policy which provides guidance for managers and reassurance for employees on how menopause related issues will be managed and what support is available."

Professor Jo Brewis, who authored a government report on the issue, said: "I feel like we're 30 years behind where we should be.

"The menopause needs to be normalised in the same way that it is standard to talk about pregnancy.

"Every woman will experience it differently so there is no one-size-fits-all solution.

"Not all women will want to talk about it at work and that is fine. The main thing they need is understanding and flexibility and an awareness that the support is there if needed."

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Employers urged to 'normalise' menopause

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Employers need to do more to "normalise conversations" about the menopause in the workplace, say experts. The comments came after a BBC survey found 70% of respondents did not tell their bosses they were experiencing symptoms. Some firms have brought in menopause-specific policies but experts said for many it was still a taboo subject.

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Cognitive behaviour therapy is a brief, non-medical approach that can be helpful for a range of health problems, including anxiety and stress, depressed mood, hot flushes and night sweats, sleep problems and fatigue.

CBT helps people to develop practical ways of managing problems and provides new coping skills and useful strategies. For this reason, it can be a helpful approach to try because the skills can be applied to different problems, and can improve wellbeing in general.

Anxiety and stress

Anxiety and stress are common reactions to everyday life. The menopause is not necessarily a stressful time but it occurs during midlife when you may be dealing with other life challenges, such as parents' ill-health or bereavement, adolescent children, children leaving home (or not leaving home), or work demands. Having hot flushes and night sweats can also be stressful, and being anxious and stressed can make hot flushes more difficult to deal with.

Stress usually happens when we are in a situation that seems too demanding or overwhelming and we think that we don't have the personal resources to deal it - we start to think that we can't cope, which then adds to the stress. When we feel stressed or under threat, the body releases adrenaline to quickly send blood and oxygen to the muscles so that they are prepared for action. Our breathing becomes faster in order to take in more oxygen, and muscles tense to help the body fight or run. This response is not very adaptive in modern life, when most of our stresses are not life-threatening, such as being late or pressure at work. If you have many demands in your daily life, this stress response can be constantly activated. While this is not dangerous over time it can build up and affect health and wellbeing.

Similarly, anxiety is a normal reaction to threatening situations, but it becomes problematic when benign and non-dangerous situations and events are regularly perceived as threats, which is more likely to happen if you feel stressed. So reducing anxiety and stress is a helpful strategy to improve wellbeing and to reduce their impact of menopausal symptoms on your daily life.

CBT for anxiety and stress focuses on the links between physical symptoms, thoughts, feelings and behaviour. The way we think about symptoms in certain situations tends to affect how we feel and what we do, and these reactions can in turn increase intensity of bodily reactions.

Anxious thinking, such as expecting the worst possible outcomes, has been identified as an important factor that triggers and maintains anxiety. Anxious thinking tends to 'catastrophize', or overestimate the likelihood of the worst-case scenario happening, and underestimate our ability to cope, leading to an increase in feelings of anxiety. For example, people who are anxious in social situations might assume that others will have negative thoughts about them (e.g. judge them negatively) leading to social anxiety and avoidance of social situations. With panic attacks, people tend to interpret anxiety symptoms, such as rapid breathing and increased heart rate, as being signs that they might have a heart attack or faint. In turn, this pattern of thinking actually leads to an increased anxiety response leading to feelings of panic. Other people might misinterpret normal physical sensations as signs of serious disease and become overly worried about their health. During the menopause palpitations can also occur quite normally with hot flushes. Keeping a diary can help to clarify if they are associated with hot flushes or stressful situations.

Cognitive and behavioural strategies for anxiety and stress

Cognitive and behavioural strategies can be used to develop a calmer or accepting view of a situation and therefore to respond (behave) in a helpful way. If you feel anxious or stressed write down your thoughts, feelings and behavioural reactions on the diagram. Once you have identified a typical anxious thought, consider whether it is overly negative, overestimating the threat or underestimating you ability to cope. Remember - anxious/stressful thoughts are not facts but are just one view of a situation. Ask yourself: Is there really a threat? What would a calm person think in this situation? What would you say to a close friend if they were in this situation? Have I managed similar situations before?

Check your behavioural responses to anxiety and stress and if you are over-working, eating/drinking too much, or avoiding certain people or activities, then consider more helpful alternatives. Think about what you do that makes you feel calm or content, however small those things might be (e.g. relaxing, yoga, going for a walk, exercise, calling a friend, reading a book). Try to do more of these activities even for just a short time every day. Aim for a balance between rest and activity, and by pacing activities throughout the day.

"I realise now that I can make mistakes and its not the end of the world - I don't have to be perfect."

Low Mood

Low Mood should not be expected during the menopause, and many women are relieved not to have periods. But it can occur at this time for a variety of reasons. For example, hot flushes and night sweats can be tiring and affect sleep; self-esteem can be affected by overly negative beliefs about menopause, and overly negative expectations about aging; and busy lifestyles and demands often accumulate during mid-life. Some women report premenstrual type symptoms, which may be associated with fluctuating hormones. Most of these factors are time limited and after the menopause in general women tend to report increased wellbeing compared to when they were in their 40s.

"When my periods stopped I thought this is it - I started to notice wrinkles and kept thinking about growing old - maybe because my mother was very ill. I felt that it was all unstoppable. Now I realise that I was focusing on age too much - if fact I am still the same me. It helped to pay more attention to the good things in my life. "

CBT for low mood is helpful for people across the age range and when physical and emotional symptoms occur together. As for anxiety, low mood and hot flushes often occur together and the cognitive and behavioural strategies are helpful for both emotional and physical symptoms.

When people are depressed, they tend to think more negatively about themselves, the world in general and have negative expectations about the future. Depressive thinking and behaviour can lead to a cycle of self-criticism and hopelessness, and many people often withdraw and avoid situations and feeling worse as a result. This can happen to people who would normally think quite differently, when they are not depressed. CBT can help people to identify overly negative thoughts, so that they can gain a perspective on their concerns and gradually learn how to manage these thoughts.

Cognitive and behavioural strategies for low mood

Cognitive and behavioural strategies can help people to make changes so that they begin to increase activity and be less self-critical. The first step is to look at life from a broad perspective - the things that you value (about yourself and life in general), what you used to enjoy doing, and/or how you would like things to be in 5 years time. Then you could gradually reengage in activities that you previously valued and enjoyed but which you might have dropped or withdrawn from since feeling low. Making these changes in behaviour by engaging in pleasant activities and developing a structure to the day can help to initially lift mood.

As with anxiety and stress - remember that depressive thoughts are not facts but are just one view of a situation. Ask yourself: Is this view of myself really accurate? What would a close friend/family member say to me? What would a self-supportive alternative be? For example, instead of 'I'm not good enough', ask yourself who is saying this and what is the evidence - we are usually harder on ourselves that we need be. Talking to other people can help to gain a helpful perspective. Small changes such as gradually doing things that you have enjoyed, or new things, and writing down three things that went well at the end of each day (however small) can lift mood and improve wellbeing. An important part of CBT is to encourage people to value their own qualities, strengths and competencies. If problems are persistent, e.g. financial, health, housing etc, then 'problem-solve' considering all options with someone else, and seek practical help and advice.

Hot flushes and night sweats

Hot flushes and night sweats are the main changes experienced by women during the menopause transition - the time when menstrual periods stop. Flushes can be accompanied by sweating, and palpitations or sometimes shivering, and can cause embarrassment, anxiety, discomfort and sleep disruption.

What causes them? Hot flushes occur when oestrogen levels are changing and adjusting to a lower level during the menopause transition. They tend to be more frequent when oestrogen reduces rapidly, e.g. following surgical menopause or some treatments for breast cancer. Hormone levels affect our body temperature control mechanisms - it is as if a thermostat has a narrower range of temperature changes it can tolerate, so that our bodies try to 'cool down' by having a hot flush in response to small changes in our bodies and in our surroundings that previously would have gone unnoticed. The threshold for flushing also narrows if we are under stress so reducing stress and relaxation is an important part of managing hot flushes.

Relaxation and paced breathing can be used to calm down your body's physical and emotional reactions. Paced breathing is slow, even breathing from your stomach. The diaphragm is located just below the lungs and forms a barrier between the lungs and the stomach. Breathing from the stomach or below the diaphragm increases lung capacity, so that we get more oxygen, and it also has a significant calming effect. If practiced regularly, paced or diaphragmatic breathing can help you to relax. You can practice by keeping the chest and shoulders still and pushing the stomach out as you breathe in, and taking slow, deeper breaths. Putting one hand on your chest and one hand on your stomach helps as you get used to this way of breathing. The hand on your chest should stay fairly still and the hand on your stomach should rise and fall as you breathe. It might be easier to practise this lying down at first. Once you get used to it you will be able to use this breathing for a few minutes during the day to reduce stress and to feel calm. Let your shoulders relax and focus on your breathing for a few minutes can give you time to pause and to think how you want to react in a stressful situation.

What can help to cool down? Wear light layers so it is easy to remove layers if you have a hot flush. Try wearing loose fitting clothes made of natural, light fabrics such as cotton. Cotton sheets, with a lower thread count, will also help you to remain cool at night. Remove any heavy, thick down duvets from your bed; placing a towel in your bed can absorb some of the sweat, preventing your sheets from becoming drenched. Some women also use a Chillow Pillow, which remains cool throughout the night.

Hot flushes can be triggered by stimulants, such as coffee, hot drinks and some spicy foods, alcohol, stress, by changes in temperature, or activities, e.g. rushing to work. If you keep a diary of hot flushes and note down was happening just before the flush you might be able to identify your hot flush triggers, and then by making small practical changes you can gain some control over them.

CBT for hot flushes focuses on the links between physical symptoms, thoughts, feelings and behaviour. The way we think about symptoms in certain situations tends to affect the emotions we feel and what we do, and these reactions can in turn increase intensity of the hot flushes.

For example, in the diagram, when this woman feels the onset of a hot flush, she thinks that everyone is looking at her and that she can't cope; this leads to feelings of embarrassment, loss of control and anxiety. These feelings might then lead to increased tension, palpitations and sweating, which intensify the hot flush experience. CBT can help you to find ways to reduce these negative reactions to hot flushes. Learning calmer more neutral responses will help you to feel more in control and more able to cope.

Cognitive and behavioural strategies for hot flushes and night sweats

Paced breathing is an important part of the CBT approach for hot flushes. As with any skill it requires regular practice - breathing from your stomach. At the onset of a flush - relax your shoulders - breathe slowly from your stomach - concentrate on your breathing. Paced breathing involves focusing on your breathing, accepting that the hot flush will pass and just letting the hot flush flow over you.

Cognitive (thinking) strategies - women's main types of worries about hot flushes and night sweats tend to be:

1. Social embarrassment (especially around men, younger people and at work) -
"Everyone's looking at me" - "I look terrible".

2. Lack of control -
"This is out of control", "I can't cope with these", "not again!"

3. Worries about disrupted sleep -
"I'll never get back to sleep", "I'll feel terrible tomorrow".

"My work colleagues will think badly of me, I need to hide my symptoms"

Women with the highest levels of distress in reaction to hot flushes tend to 'catastrophise' about the hot flush, i.e. think the worst. They are more self-critical within the situation, especially about their appearance. Notice what goes through your mind when you have a hot flush, so that you can identify your typical thoughts and any overly negative thinking, and write them down.

Next work on developing a calmer self-supporting responses to hot flushes, e.g. "This will pass soon". Some examples are shown here but try to develop your own:

'Oh no I can't cope' 'Let's see how well I can deal with this one, one flush at a time'

'Everyone is looking at me' 'I will notice my flushes more than other people, they may not notice'

'I am out of control' 'There are things I can do to take control'

'They will go on for ever' 'They will gradually reduce over time'

"People are unlikely to notice and even if they do, they won't judge you for having a hot flush - just try and keep calm"

It might help to ask yourself:
Is this though really accurate?
What would a close friend/family member say to me?
What would I say to them if they were having a hot flush in this situation?
What would a self-supportive alternative be?

Using paced breathing at the onset of a flush can give you a moment to pause, and help to switch your attention to breathing rather than the flush and to think of neutral and calming thoughts.

Generally it is better to stay in a situation and not leave, or avoid activities, if you can, as avoiding social and other situations means that you won't learn that you can manage, and that you might stop doing things that you might enjoy.

It is also helpful to challenge negative social images and negative attitudes about menopausal women, that are still often held and that can reduce our self-esteem. Women do not age dramatically at the menopause - but it helps to take time to help yourself through the process. Look around you - the average 50 year old can be healthy, and active, with many social roles. Many women are ashamed to mention the menopause - so try talking to your friends and family and help reduce the stigma around the menopause.

Night sweats and sleep problems can be particularly challenging to deal with given the negative impact that night sweats can have on sleep. Research studies with women going through the menopause have found that worrying at night about sleeplesness and its effects on the following day (tiredness, wellbeing and performance) can lead to anxiety which then makes sleep less likely. Therefore, managing sleep and night sweats requires a two pronged approach:

1. creating good habits to optimise sleep behaviour and environment, and

2. applying the cognitive behavioural work for hot flushes to develop calmer thinking and behavioural responses when sleep is disrupted due to night sweats.

The following changes can help to improve sleep quality when practised consistently over time, as they train your body's natural rhythms to facilitate sleep:

Limiting light in the early evening and in the bedroom helps the brain to release chemicals (melatonin) linked to sleep onset. This includes light emitted from mobile phones and laptops so switch these off.

Limiting caffeine and alcohol, both of which have a negative impact on sleep onset and quality.

A cool sleeping environment helps facilitate sleep as the body naturally cools as we sleep. This is particularly important when you are having night sweats.

Develop a good bedtime wind-down routine that you practise each night to help you relax prior to going to bed which makes sleep more likely.

Maintain a regular sleep pattern - 'lie-ins' and naps after 3 p.m. eat into sleep the following night which means you could have difficulty dropping off. It is best to avoid naps all together is possible, but if you really need one, make sure its before 3pm.

Even after a poor night sleep, research consistently shows that it is better to continue as planned the next day and not cancel activities and plans, as this can set up unhelpful thinking and behaviour that makes sleep problems worse.

CBT for night sweats and sleep As with hot flushes, take time to notice and manage worrying thoughts - about stress and loss of sleep. Ideally, set aside time during the day to address unhelpful thinking patterns or to manage problems or stress that may keep you awake at night. As part of a wind down routine, practising relaxation and paced breathing can reduce overall stress and provide a balance to busy lives. Paced breathing, when used regularly throughout the day, is then easier to apply at night to induce relaxation when required.

Even if you make some of the changes described above and improve sleep quality, it is likely that you will still be woken by night sweats. As with hot flushes during the day, the key to managing night sweats is to use cognitive behavioural strategies to remain calm. Feeling anxious about missed sleep makes it more difficult to get back to sleep. With consistent practice, this should become easier and more effective.

1. Calmly and automatically get up and do what you need to cool down.

2. Watch your thoughts while doing this - try not to engage with them, and return the focus of your attention to your breathing.

3. Once you have cooled off, get back into bed and practise paced breathing and relaxation.

Overall, it is easier to deal with the content of worrying thoughts in the day time so say to yourself, 'I'll deal with this tomorrow when I can think clearly', and return to your automatic routine, without engaging with them. If you are able to manage anxious thinking, it will be easier to get back to sleep after a night sweat. Here are some examples of changing 'catastrophic' thinking into calmer more helpful thoughts:

'I won't be able to function tomorrow' 'I have managed before so I know I can cope'

'I'll never get a decent night's sleep again' 'This is tough at the moment but will pass'

'I've got so much to do tomorrow!' 'I can prioritise what I need to do and a bit of distraction will help me get on with things'

Practising paced breathing and making some adjustments to your reactions to hot flushes might be all you need to feel a bit more in control. But if you are interested in finding out more about CBT for hot flushes and night sweats, or following a more detailed programme, then this is available in a self-help guide over four weeks that has been shown to be effective in clinical trials.

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Cognitive Behaviour Therapy (CBT) for Menopausal Symptoms

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Download PDF factsheet Cognitive behaviour therapy is a brief, non-medical approach that can be helpful for a range of health problems, including anxiety and stress, depressed mood, hot flushes and night sweats, sleep problems and fatigue. CBT helps people to develop practical ways

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British MPs are pushing for clear workplace policies to protect women going through the menopause, which exacts a hefty personal and professional toll on as many as one in four females.

A menopause policy should be as commonplace as maternity schemes in businesses and organisations, said the MPs, some of whom want legislation to force through the reforms.

Women have told the Guardian how their careers have been ruined by symptoms such as anxiety, confusion and loss of confidence. Some have faced disciplinary action and many have been forced to take time off, while others have sold their homes so they can afford to work part-time or stop working altogether.

The Labour MP Carolyn Harris said: "You wouldn't dream of having a workplace where people weren't entitled to certain things because they were pregnant, and it's exactly the same for women with the menopause. I firmly believe there should be legislation to make sure every workplace has a menopause policy, just like they have a maternity policy."

The often unspoken impact of menopause on women at work has become a cross-party issue. The Conservative MP Rachel Maclean was the first to speak out about it in the House of Commons and has been campaigning to normalise menopause as a workplace issue.

She said she wants women to be able to have time off or change shift patterns or conditions of work when they need relief from symptoms that often go well beyond the stereotypical hot flushes and night sweats.

Q&A
What is the menopause and how does it affect women?

The menopause is a natural part of ageing and usually occurs between 45 and 55 years of age after levels of the hormone oestrogen have declined to the point where ovulation and menstruation stop. It is defined as a woman going 12 months without a period. In the UK, the average age for a woman to reach the menopause is 52. However, about one in 100 women have their menopause before the age of 40.

Common symptoms can include hot flushes, night sweats, vaginal dryness and discomfort during sex, a reduced sex drive, low moods or anxiety and difficulty sleeping. Memory and concentration can also be affected.

Symptoms can begin months or years before periods stop - this time is called the perimenopause - and can last around four years after the last period. However, some women have them for much longer, with 10% experiencing symptoms for up to 12 years.

About 25% of women experience such severe symptoms that they can be diagnosed with mental health problems. The principal treatment is hormone replacement therapy, which can control symptoms well, but does increase the chances of breast and ovarian cancer.

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"I absolutely agree that employers need to do more. It's not well understood," Maclean said. "Employees don't get the support they need. It is very difficult for women at work often." She said she had heard many "horrific and heart-rending" accounts.

"My central message is: menopause is the last taboo because it is still hidden and it only affects women and it only affects older women. It's ageism, it's sexism, all rolled into one."

Harris said she believed that if legislation was required, it would be passed by MPs. There was "tremendous support" across the benches when the house debated the issue recently, "especially from men whose wives have been through it. They understand."

About 80% of women experience some symptoms of the menopause, brought about when ovulation stops as a result of hormone levels dropping. One in four have severe symptoms, including anxiety and depression, which can lead to them being diagnosed with mental health problems and put on drugs.

Harris told of going to see a GP in 2010 after she had treatment for a gynaecological condition. "I was having a nervous breakdown," she said. "I was really depressed and had mental health issues. I think that's down to the fact I was going through the menopause. So many women end up on antidepressants or being told to pull themselves together."

Amanda Griffiths, a professor of occupational health psychology at the University of Nottingham who has done substantial research on the impact of the menopause on working women, said it had "quite a significant impact" on the personal and professional lives of up to a quarter of women.

She said women made up an increasing proportion of the ageing workforce. "For me there is a big issue here, which is not just about women having problems with menopause. It is about managers understanding it is perfectly normal for us to have health problems," she said.

There needed to be an atmosphere at work where people could talk about health, she said, "instead of which we tend to have this fear in some organisations that if we have a health condition there will be some sort of stigma attached to i".

Two separate surveys of women going through the menopause and perimenopause - the time leading up to when ovulation stops - found they were struggling in work and felt unsupported by managers.

In one survey of more than 1,100 women, undertaken by the menopause clinic Newson Health and published last month, 94% said they felt their work had suffered as a result of their symptoms, and 53% said their colleagues had noticed a deterioration in their performance.

Just over half had taken time off sick, and one in 10 had missed more than eight weeks of work.

A separate survey by the shop workers' union Usdaw found that one in five women had taken time off work and that more than half did not feel able to approach their managers if they were suffering.

In the Newson Health survey, more than a third said their employer did not offer any kind of discussion group, awareness session or training on the subject of menopause, despite there being more than 5 million working women aged between 45 and 60.

Dr Rebecca Lewis, a GP who works at Newson Health, said: "Women are suffering quietly for fear of saying 'it's the menopause' and being laughed at and told to get on with it.

"A GP might not think to put it down, or the woman might not want it put down because of a feeling that it's not a 'proper' illness."
The taboo around menstruation and menopause doesn't only hurt women | Karen Pickering
Sue Hackett, the London regional equality officer at the GMB union, said: "It is high time we stop treating menstruation and menopause as taboo subjects. Women have put up with insulting comments and a woeful lack of provision for far too long for what is a completely natural condition."

She said workplace policies around sickness absence or performance management could unfairly penalise women "because of key symptoms like memory loss or lack of concentration".

Unions said there were examples of good practice in workplaces. In 2017, Nottinghamshire policeintroduced a menopause policy and issued guidance to managers saying they could consider requests from women who needed to adjust their uniform or their working hours.

Among other practical support, it recommended access to private areas where women could "rest temporarily, cry or talk with a colleague before they can return to their workspace".

The Welsh government has put in place guidance for its workers. It said: "All reasonable adjustments will be considered when a health issue may be impacting on a person's ability to carry out their role - this can include changing working location or conditions for a more comfortable working life."

Unfair dismissal case

Last year an employment tribunal judge found in favour of Mandy Davies, a court officer working for the Scottish Courts and Tribunals Service who was dismissed after an incident involving medication she was taking.

Davies alleged that under the 2010 Equality Act she had been unfairly dismissed and discriminated against as a result of a disability.

The tribunal heard how she had been suffering from symptoms including heavy bleeding, memory loss and confusion, and that she had previously had a 20-year unblemished employment record.

Her employer accepted that the menopause was a disability, but argued it had not unfairly dismissed her as a consequence, a position the judge did not accept, ruling that she should be reinstated and paid £14,000.

The court service is appealing against the decision.
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Workplaces must protect women going through menopause, say MPs

# data[].attributes.attachment_link.description
British MPs are pushing for clear workplace policies to protect women going through the menopause, which exacts a hefty personal and professional toll on as many as one in four females.