Menopausal symptoms can affect all older women and some aged below 45, and can pose challenges for individuals and employers alike, especially where employees are working in thermally challenged environments. Barbara Grohs and Anne Harriss outline best practice in this area.
Approximately half of the UK workforce are women, with nearly three-and-a-half million aged over fifty-years-old and most will be experiencing the menopause between the ages of 45 and 55 (Unison, 2013).
There will be that some women aged below 45 who will experience an earlier menopause as a result of gynaecological conditions, such as primary ovarian insufficiency or gynaecological surgical interventions including total hysterectomy. This article considers the effect of menopause on those women who work in thermally challenging environments.
About the authors
Barbara Grohs is an occupational health adviser and Anne Harriss is Queens Nurse and a professor in occupational health
Transition into menopause may result in initial hormonal turmoil, with menopausal symptoms including hot flushes and night sweats. Menopausal symptoms place those women who undertake physically demanding work in very hot and humid environments at increased risk of heat stress.
The Health and Safety Executive (HSE) (2013) notes that heat stress occurs when the body’s way of controlling its internal temperature starts to fail. It highlights that heat stress in workplaces such as commercial kitchens could be problematic all year round for workers experiencing the menopause.
The heatwave of the summer of 2018 presented additional challenges for employers to meet their legal obligations and maintain a thermally comfortable working environment for their employees and particularly so for menopausal women.
Strenuous work processes involving exposure to high temperatures, poor ventilation and high levels of humidity have the potential to induce heat stress (Smedley et al, 2013). These effects are exacerbated should tasks be undertaken whilst using personal protective equipment, particularly powered respirators, breathing apparatus and occlusive clothing that may be required when using particularly hazardous, toxic or very toxic chemicals (OSHA, undated).
In health, the body temperature remains at 37degC plus or minus 0.5degC. Once it rises above 40degC there are serious and often fatal consequences (Smedley et al, 2013). If a worker is undertaking physically demanding work in a thermally challenging environment and is completely insulated as a result of the personal protective clothing they must wear, their body temperature is likely to rise at a rate of 1degC per hour (Parsons, 2014).
Smedley et al (2013) refer to the following health effects of exposure to high temperatures:
- susceptibility to other conditions such as cardiovascular disease;
- heat fatigue and heat exhaustion;
- heat syncope (characterised by fainting); and
- heat stroke, the most serious form of heat injury with possible fatal consequences.
Increased risk of some work processes
According to Occupational Safety and Health Administration, (OSHA, undated), there are a variety of work processes with the potential to put menopausal women at increased risk. These include, but are not restricted to, work in foundries, brick-firing, ceramic plants, glass making facilities, and commercial kitchens. The degree of risk is increased in particularly for those whose job tasks require them to wear heavy or occlusive personal protective equipment including the military and fire and rescue personnel. The effects are exacerbated during hot weather.
Employers have a duty of care to ensure the health and safety of their workforce under S2 of the Health and Safety at Work Act (1974). Associated with this is the requirement to undertake risk assessments imposed by Regulation 3 of the Management of Health and Safety at Work Regulations (1999).
Should a thermal hazard be identified employers must make arrangements to reduce the risk. Part of this would be raising awareness of possible adverse health effects of heat exposure from heat exhaustion to the more serious heat collapse. Symptoms of heat exhaustion are those associated with dehydration including polydipsia (significant thirst) and headaches.
Symptoms may progress to include nausea, cramps, vertigo and fainting, the latter being particularly dangerous whilst operating machinery or working at heights. If action is not taken to enhance hydration and reduce the body temperature symptoms may worsen leading to heat stroke (HSE 2013).
Those working in very hot environments, particularly those with high levels of humidity, are at risk of this condition, which occurs when the body’s thermoregulation system fails and their core temperature rises above 40degC. This constitutes a medical emergency.
Symptoms of heat stroke include tachycardia, confusion, convulsions and loss of consciousness. The body temperature must be cooled as a matter of urgency to avoid the prospect of respirator and cardiac arrest.
Although the menopause represents a major challenge for some women, it has not yet been widely regarded as a significant occupational health concern by many employers (Griffiths et al’ 2008) . Employers may not have considered the needs of menopausal women when managing workplace thermal challenges.
Although one in every 100 women experience the menopause before the age of 40, it generally occurs between the ages of 45 to 55 and is when a woman stops menstruating and is no longer able to get pregnant naturally.
Some eight in every 10 women will have additional symptoms some time before menstruation ceases. Common symptoms which may impact on them in the workplace include: hot flushes, night sweats and difficulty sleeping, headaches, low mood or anxiety, palpitations, joint pains and stiffness, reduced muscle mass and recurrent urinary tract infections (NHS Choices 2015).
Raising awareness and understanding
These symptoms will pose difficulties for all women but particularly so for those undertaking physically demanding tasks in a thermally challenging environment. Most symptoms of the menopause last around four years from a woman’s last period, but around one in 10 women experience them for up to 12 years (NHS Choices, 2015). For a woman who enters the peak of the menopause at the age of 55, she may have had symptoms before that age and they may continue up to the time she retires from work.
Project Aware (2010) presents real-life experiences of hundreds of women and lists 35 symptoms associated with the menopause. Hot flushes are the most challenging symptom for them, particularly in relation to maintaining thermal comfort and this may exacerbate the effects of heat stress.
To assist employers in supporting women who are experiencing the menopause, the Faculty of Occupational Medicine (FOM) (2016) published guidance regarding the effects of menopause in the workplace.
This served to make the topic current and bringing it to the attention of the public, employers and occupational health professionals. This initiative was particularly high-profile at that time and in November 2016 Richard Heron, then FOM president, featured in an ITV broadcast The truth about menopause.
Its guidance confirms that 20% to 25% of women will have hot flushes during menopause, adversely affecting their quality of personal and working lives (FOM, 2016).
FOM (2016) highlights that employers should review control of workplace temperature and ventilation and endeavour to adapt these to meet individual needs. The same guidance adds that, where uniforms are compulsory, flexibility in use of thermally comfortable fabrics, optional layers and being allowed to remove jackets whilst at work may be helpful.
Griffiths et al (2010) explored the menopausal symptom experiences of 912 women aged between 45 and 55. A total of 40% of them experienced hot flushes, a sudden feeling of heat seeming to come from nowhere and spreading throughout the body; sweating, palpitations, and flushing of the face, may also be experienced (NHS Choices 2015).
During the peri-menopausal and menopausal phases these women adjusted their immediate work environment by a variety of means including adjusting the clothing they wore (93%) and finding ways to cool themselves down by increase their immediate ventilation by opening windows, using a fan or going outdoors (95%).
Some women were less fortunate, 47% reporting being unable to control the temperature in their usual work environment. A total of 5% reported having no access to drinking water, a significant concern as all workplaces should provide access for drinking water for all workers as this is a requirement under the Workplace (Health Safety and Welfare) Regulations (1992).
Warning from tribunal case
As already highlighted, women comprise approximately half (47%) of the UK’s workforce, and 45% of those over the age of 50 are women, representing 3.5 million workers. These women are therefore working through a difficult stage of their life and this is rarely discussed. There is a strong case to include menopause on the health and safety risk assessment agenda in the workplace, and to increase compliance with the laws and regulations as stated below for this generally forgotten group of workers.
The Equality Act 2010 provides a legal framework that protects the rights of individuals. For women who are having health problems associated with the menopause which impact on them in the workplace the protected characteristics of age, gender and disability can be applied. This view is supported by FOM (2016), which states that: “Severe menopausal symptoms and their consequences may combine to have a substantial adverse effect on normal day to day activities- potential meeting the legal definition of a disability under the Equality Act.”
In February 2018 an employment tribunal in Scotland heard the case of Ms Mandy Davies, a court officer with the Scottish Courts and Tribunals Service, (Davies vs Scottish Courts and Tribunal Service (2018)).
Davies suffered from at least 11 menopausal symptoms; her menopause was ruled as a disability in Scotland in a £19,000 tribunal claim (Harrison 2018). Legal obligations relating to the menopause should be addressed by employers. This should be considered as a matter of urgency as it is likely that other cases will now follow.
Griffiths et al (2010) refers to four overarching elements in relation to their duty of care and managing the health risks of the thermal environment for women experiencing symptoms associated with the menopause:
- raising awareness amongst managers about the effect of menopause on health and safety at work;
- considering flexibility of working arrangements including working hours;
- improved access to formal and informal sources of support for women going through menopause. This should include occupational health and primary care services; and
- improving workplace ventilation and temperature control.
Studies between 2000 and 2015 are consistent in their recommendations to employers and how best they can support women going through menopause (Jack et al, 2016) and complement the stance of Griffiths et al (2010) highlighted above. These studies confirm that employers can ensure their organisation is supportive of women who are experiencing difficult symptoms of menopause by:
- reviewing their occupational health and safety frameworks, policies and procedures to ensure that they are compliant with legislation;
- undertaking risk assessments to identify any shortfalls in the management of health and safety which may impact on them;
- considering any reasonable adjustments that may be necessary to support these women;
- developing health promotion programs that include information about menopause and managing menopausal symptoms; and
- developing organisational training and development policies, programs and activities that generate supportive working environments.
Managing work and environment
The Chartered Institution of Building Services Engineers (CIBSE) (2015) refers to HSE guidance for minimum workplace temperatures and notes that there is no guidance for maximum temperature limits. Work processes should be managed to ensure that the health and safety of employees is not compromised. Rescheduling work times for cooler times of the day or allowing employees to have flexible hours may be the easiest strategy to implement.
If temperatures cannot be reduced, then ventilation should be adequate, regular breaks and job task rotation can be put in place. Employers should be cognizant that working in indoor temperatures above 28degC for prolonged periods results in a reduction in productivity (CIBSE 2015) with a negative effect on profitability as a result.
CIBSE (2015) highlights the importance of individuals having control over their immediate thermal environment, and it should be recognised that ambient temperature alone is insufficient in determining thermal comfort, other influences include relative humidity and air movement.
Without air conditioning it may be difficult to resolve high levels of relative humidity but increasing ventilation will assist in making this more tolerable. In areas with low levels of air movement, the local use of appropriately sized fans will increase air movement, which can have the same effect of reducing temperature by 2degC.
It may be necessary to remove the employee from sources of heat. Where this is not possible, an alternate strategy is the provision of opportunities for “heat breaks” allowing access to cooler rooms and drinking water throughout the working day.
Taking the impact and effect of menopause seriously
Employers should take the impact of menopause seriously. In order to meet their legal obligations, employers must include risk assessments for the work processes undertaken by this group of workers. They should consider the effects of the menopause on middle-aged workers in the same way as they would consider the effects of pregnancy on their younger colleagues.
This article has focused on the challenges of menopause for women working in areas where there are thermal challenges. However, menopausal women not working on processes exposing them to such challenges should not be forgotten. There are many ways employers can work with occupational health practitioners to support all women experiencing difficulties as they live through the menopause.
The successful claim of Davies vs Scottish Courts and Tribunal Service (2018) highlighted earlier and the earlier FOM guidance should result in employers being cognizant of the effects of menopause will increasingly be seen as a significant employment issue. These can include occupational health initiatives including menopause awareness campaigns and the development of a menopause policy.
Exhaustion, anxiety and depression are common experiences for menopausal women and result from sudden changes in their hormone levels. Flexible sickness absence procedures may better cater for menopause related sickness absence.
Where possible the accommodation of flexible working requests may assist women to better manage their symptoms and be more productive in the workplace. The use of well-written policies and flexible attitudes employers can demonstrate positive attitudes to the effects of what are normal, if for some very uncomfortable and inconvenient physiological changes.
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