Better awareness and understanding of the factors that can influence whether a woman is prepared to open up about otherwise stigmatised, taboo or ‘hidden’ health issues will improve the support she receives in the workplace. Dr Belinda Steffan and Professor Wendy Loretto report.
Women’s health and work have a reciprocal relationship that, up to now, has been relatively under-reported. However, government, policy-makers and employers are now realising that barriers to better supporting women’s health throughout the life-course must be addressed in order to improve workplace outcomes for all stakeholders.
‘Women’s health’, too often, only covers a range of hormonal and reproductive health and transitional phases and, further, women are more likely to experience non-gendered health issues such as chronic pain (Vincent and Tracey, 2010) and anxiety (Jalnapurka et al, 2018).
Many of these can be categorised as hidden health issues, in that they cannot be seen and/or might be considered taboo, hence proactively ‘hidden’.
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This article focuses on menopause as one aspect of ‘hidden health’ that typically affects women in mid-to-later life phases of their working lives.
For the purposes of this article, peri- and post-menopause are collectively referred to as menopause, bearing in mind that menopause (the cessation of menstruation of at least 12 months) is a highly individualised experience of wide-ranging physical and psychological symptoms (see NHS (2024) for more detailed information).
Because of the stigmatised nature of hidden health issues, many workers choose not to disclosure how health affects them, largely due to fear-related outcomes of disclosure, specifically relevant to the mid-to-later life stage (Gignac et al, 2024).
This article highlights reasons behind non-disclosure of hidden health at work, and due to the gendered nature of health and age-specific mechanisms behind non-disclosure, we focus on barriers to disclosing menopause at work.
Drawing on in-depth, life-course interviews of 80 women aged over-50 in the UK from four different organisational settings in the ‘Supporting Healthy Ageing at Work’ (SHAW) project, this article provides a summary of key findings around non-disclosure of women’s health.
The SHAW project was a three-year multi-disciplinary study of how organisations can better support aspects of ‘hidden health’ including menopause, sleep, cognitive decline, anxiety and other aspects of bodily ageing.
Increasing awareness of the complex decision-making processes behind why employees disclose, or not, hidden health at work among occupational health (OH) practitioners, as well as other formal routes to workplace health supports, including human resources (HR) and line managers (LM) is needed in order to better support the health of the whole workforce.
1) Individual factors affecting non-disclosure of health
The complexity of disclosing health at work is a deeply individualised and contextualised choice, influenced by a range of social and organisational factors.
In theory, disclosure at work begins with decision-making processes, which weigh up a range of goals (positive outcomes), sources of support, and outcomes affecting oneself as an individual (for example, health) as well as inter-personal relationships (for example, trust) (Chaudoir and Fisher, 2010).
However, in reality, health disclosure can lead to both positive and negative outcomes, highlighting the challenging environment that people experiencing less-discussed, stigmatised or taboo aspects of health must navigate.
Disclosure can lead to appropriate supports that reduce stress (Munir et al, 2007), which is clearly a positive outcome. However, disclosure can also lead to increased stigma and discrimination (McGrath et al, 2023).
Setting disclosure boundaries
Disclosure of sensitive aspects of health at work is predicated on employee preferences around disclosure of personal and private information at work. This is especially when relevant and sensitive disclosure topics are not openly discussed in the workplace setting, which results in individuals creating their own ‘privacy boundaries’ around workplace health disclosures (Petronio and Child, 2020; page 76).
In relation to menopause, results from the SHAW project suggest that the reality of disclosure decision-making was far more complicated than theoretical frameworks suggest.
Female participants reported that they had set up their own highly personalised disclosure boundaries representing a range of processual conditions of disclosure, such as gender and age of disclosee and whether the disclosure would exacerbate perceived performance judgements.
Privacy boundaries were constructed to protect against adverse impact of menopause symptoms on their work performance and attitudes to work. For example, the fear that an official documentation of menopause symptoms and their effects might factor into future appraisals was central to an overwhelming avoidance of disclosure to traditional supports, including OH, HR and LMs.
SHAW participants preferred informal pathways of disclosure, such as social support networks and informal talking sessions, where they felt that disclosing their health would lead to positive outcomes of support.
Gendered ageism
The intersectional effect of gender and age means that gendered ageism plays a key role in decisions made around disclosing health at work. As societal attitudes at the intersection of gender and age (gendered ageism) are embedded in how older women are treated (Rochon et al, 2021), menopause, as a manifestation of gendered-age, can lead to discrimination and bias in the workplace (Atkinson et al, 2021).
The desire to avoid gendered/ageist assumptions can motivate mid-to-later life employees to hide the impact of health-related issues in order to be seen as productive and a good ‘fit’ within their team or organisation.”
The desire to avoid gendered/ageist assumptions can motivate mid-to-later life employees to hide the impact of health-related issues in order to be seen as productive and a good ‘fit’ within their team or organisation.
This has been found to be the case for women who chose to hide menopause symptoms at work, and who then experienced a form of cognitive dissonance between presenting as a productive worker while experiencing a precarious and stigmatised body (Steffan, 2021; Steffan and Loretto, 2024).
SHAW project data extends findings around the menopausal body by highlighting the salience of mental health concerns associated with menopause.
Memory deficits, lack of concentration and slower processing speeds were experienced by many participants of menopause-age. Yet it was a fear of being seen as ‘an older woman’ and all of the connotations of that social construction (Rochon et al, 2021) that was a key factor behind decisions not to disclose health concerns to OH, HR and LMs.
This highlights that provision for medical disclosure must also consider psychological and social factors (in other words, a biopsychosocial model of workplace disclosures).
Specifically relevant to the mid-to-later life phase, decisions around disclosing age-related aspects of health requires high levels of trust in others, largely driven by a fear of adverse performance-based appraisal by meaningful others (manager, colleagues, clients) at work (Gignac et al, 2024).
Fear is activated when the employee perceives that these appraisals will draw on ageist stereotypes, which feed off an unhelpful age-as-decline narrative.
SHAW project findings demonstrate that women experiencing disruptive menopause symptoms frequently wrestled with this narrative. For some this prevented disclosure, but for others, more positively, trust between the employee and the formal processes of OH, HR and LMs had the power to reduce fear within the decision-making process.
Professional and personal identity
Professional and personal identity is highlighted as a key reason behind non-disclosure of mental health issues at work (McGrath et al, 2023).
Further, women might choose not to disclose gendered health at work in order to protect their professional identity, due to stigma associated with certain health conditions, such as the range of psychological and physical menopause symptoms (Grandey et al, 2020).
This is also referred to as reputation management whereby ‘maintaining one’s reputation’ is a key influence in health-disclosure decisions in mid-to-later life (Gignac et al, 2024; page 178).
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While much of the research in this area would suggest that reputation management and protection of professional identities is the purview of individuals in higher status roles and job types, or that non-disclosure is actioned through fear of loss of status (McGrath et al, 2023), SHAW data found that women from a range of job types and backgrounds draw on these principles to make decisions about disclosure.
Job type or seniority did not appear to be a significant contributor in reputation management or protection of their perceived performance at work.
In their avoidance to disclose, women draw on personal coping and adaptations to cope with the effects of menopause symptoms at work. For example, Gottardello and Steffan (2024) found that neurodivergent women experiencing menopause symptoms masked their symptoms, feeling unable to ask for support from formal employer support systems such as OH, HR and LMs.
Anticipated and expected reactions factor heavily in associated decision-making around disclosure of health at work. While previous research has been unclear as to the reasons behind a preference of personal coping over seeking workplace supports, female participants in the SHAW project reported that they generally had little expectation of support with menopause symptoms at work, as well as a range of other aspects of health that they felt were connected with menopause, such as poor sleep, fatigue, anxiety, and stress.
It was this low expectation of organisational support that led to non-disclosure, itself a form of masking effects of symptoms, while choosing to channel their resources into self-care demonstrating and performing a personal responsibility of health.
Implications for organisations and researchers
Women make complex decision-making judgements based on whether or not to disclose menopause at work based on a number of highly individualised factors. These include:
- Setting disclosure boundaries through a range of individual needs and inter-personal relationships.
- Gendered ageism plays a key role in disclosure decisions, actioned through fear as an emotional response to a lack of trust.
- Professional identity and reputation management were relevant to women from a broad range of job types.
- Engaging in self-care and personal responsibility of menopause can be a result of low expectations of organisational support.
2) Organisational factors affecting individual health disclosure choices
A workplace culture that promotes openness to discuss hidden health, such as menopause, is generally considered influential to disclosure decision-making processes.
An open culture can be achieved through training, health promotion programmes and formal/informal support networks (Mackenzie et al, 2019), requiring explicit organisational buy-in to workplace well-being supports (Manner et al, 2024).
SHAW project findings found that disclosure choices take into consideration how an inclusive culture is communicated (or not) throughout organisational culture and more locally through team culture.
There was variance in which level of culture was more salient to the decision-making process, an area requiring further investigation.
Formal and informal influences of disclosure
Organisations with clear policies and supportive health-related practices tend to encourage health disclosure at work (Munir et al, 2016), which also contributes to an open and inclusive culture that can reduce fear of discrimination in response to health disclosure.
Management training on aspects of hidden or taboo health can help mangers cope with having potentially uncomfortable conversations, although the dynamics of these conversations can be gendered.”
Management training on aspects of hidden or taboo health can help mangers cope with having potentially uncomfortable conversations, although the dynamics of these conversations can be gendered (Figueroa et al, 2024).
While research has identified the need for management support on menopause specifically (Beck et al, 2020), SHAW project findings suggest that managers themselves are over-worked and expecting them to be experts in all aspects of health is unfair and can adversely impact their mental health.
Participants overwhelmingly preferred to disclose menopause-related health to same-age, same-sex support channels at work, suggesting that blanket management training on menopause for all might not be as efficacious as mechanisms that ensure there are sufficient same-age, same-sex supports in place, even if informal in nature.
When to disclose?
The timing of disclosure is an area of disconnect between the individual and the employer in that OH and HR processes prefer an earlier disclosure than do individuals with lived experience.
One reason for this is that individuals need time to determine who to trust with their private health information (McGrath et al, 2023).
SHAW project data reinforces this finding. Typically, participants reported a high level of reluctance to disclose and only did so when their health issues were, or were likely to, adversely influence performance.
The outcomes of individual decisions around disclosure can influence how and when employees choose to disclose in future. When employees experience a positive outcome of disclosing something sensitive about themselves, they are more likely to disclose in future (Chaudoir and Fisher, 2010).
This finding reinforces the importance of organisational and/or team culture in providing an inclusive and supportive environment where employees feel safe to disclosure sensitive health issues at work.
Implications for organisations and researchers
- Disclosure is more likely to occur when inclusivity is communicated through organisational culture, although this could relate to a local team rather than a global organisation.
- Management training must consider the viability of managers being the route for menopause disclosure, suggesting that the role of manager is to signpost to resources, a communicator of an inclusive culture, rather than as a menopause expert.
- Employees are likely to prefer a reactive disclosure, whereas OH and HR prefer a pre-emptive disclosure, suggesting a disconnect between the desired time of disclosure.
- A positive organisational response to disclosure encourages how and when disclosure might occur in future.
Conclusion
An awareness of the factors that influence decisions on whether or not employees disclose how less-discussed, stigmatised, taboo or ‘hidden health’ issues influence work is crucial to the efficacy of workplace health supports.
This article focuses on menopause as a common yet hidden aspect of health at work. Findings from the Supporting Healthy Ageing at Work (SHAW) project suggest that occupational health, human resources and line managers should all be aware that providing formal health supports alone is not enough to encourage disclosure.
Similarly, a bio-medicalised approach can exclude psycho-social factors influencing health disclosure. The interconnectedness of individual factors (trust, fear, reputation management), societal factors (gendered ageism) and organisational factors (open culture of inclusivity) can all influence hidden health (for example menopause) disclosure at work through creation and maintenance of disclosure boundaries.
Formal organisational health support pathways should navigate individual disclosure boundaries and proactively work to provide access to appropriate workplace health supports.
- The Shaw Project
The Supporting Healthy Ageing at Work (SHAW) project can be found at https://www.shaw.business-school.ed.ac.uk/. The authors, Dr Belinda Steffan and Professor Wendy Loretto, were project members of the SHAW project, which was funded through UKRI Healthy Ageing Challenge Social, Behavioural and Design Research Program, grant number ES/V016148/1. The authors acknowledge other project members, who are listed on the SHAW project website.
For more information on the methodology of the SHAW study, please refer to Steffan B and Loretto W (2024). ‘Menopause, work and mid-life: Challenging the ideal worker stereotype’. Gender, Work & Organization. Available online at: https://onlinelibrary.wiley.com/doi/full/10.1111/gwao.13136
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