This EMAS webinar explores the benefits of oral combined menopausal hormone therapy (MHT) for managing estrogen deficiency symptoms in…
EMAS is a leading international medical society advancing menopause and post-reproductive health through research, education, and advocacy. With members and affiliated societies across the globe, EMAS champions evidence-based, inclusive, and collaborative care for healthier aging.
Prof Petra Stute: Welcome to the EMAS Menopause in the Workplace Podcast, a special series celebrating World Menopause and Work Day, held every year on September 7. This Global Awareness Day was launched by the European Menopause and Andropause Society (EMAS) in 2021, following the publication of our Global Consensus Recommendations on Menopause in the Workplace, to spark conversation and action around an issue that affects millions, yet is still too often overlooked.
I’m Professor Petra Stute, president of EMAS, and here’s what we know: menopause impacts work and work impacts menopause, but too often, no one’s talking about it.
In this episode, Why general practitioners need better menopause training, we hear from two past presidents of EMAS, Professor Angelica Lindén Hirschberg from Sweden and Professor Tommaso Simoncini from Italy. Together, they examine why menopause remains overlooked in medical education, especially for general practitioners, and what needs to change. Because supporting women at midlife starts with making sure the people who care for them are prepared.
Prof Angelica L. Hirschberg: I’m a gynaecologist and professor at Karolinska Institutet and Karolinska University Hospital. And I teach medical students, residents in OBGYN and at all levels and in menopause management. And I think this is very, very important for all health professionals. And in fact, I think menopause management has been silent for almost two decades due to confusion and misinterpretations of benefits and risks with menopausal hormone therapy. And that led to a whole generation of doctors who didn’t learn about menopause. And of course, this also has had consequences for women not given proper treatment. Fortunately, during the late, let us say, seven years or something like that, we can see a really growing interest in menopause. And I think that that is really great. And now it’s important that professionals show women that we have the knowledge and we will give you and offer you high-quality information and treatment.
Professor Tommaso Simoncini: I’m professor of obstetrics and gynecology at the University of Pisa, Italy. I think it’s time, really, for a big menopause review. So there’s a growing interest. The growing interest is because both women are as patients when they go through menopause, are now appreciating again that not everything that happens naturally can be fine for the life, for the health, for the quality of life, for their activities. And there’s a renewed perception that there’s a number of possibilities. That not just us as physicians, but for sure we as physicians have to treat these complaints, but the society at large. So there’s a number of initiatives that can be supported in order to try and easy the life of, women undergoing menopause, trying to make their life, their working life, their societal life, more adapted to the changing experience in their life at this very sensitive time of their life. So I think it’s a very interesting time because there’s a generalized perception that this is important. And this opens the way for scientific societies like EMAS to spread the word, to propose what we know from many, many years and to rediscuss the topic of menopause again with the new perspective.
Prof Angelica L. Hirschberg: I can only refer to how it is in Sweden, but I think the situation is quite similar in other European countries. Menopause education is extremely short for both medical students and residents, and it could involve only a single lecture or a single seminar. So I think this is really a shame, because this is about half of the population and women’s health. So I really believe that menopause management is a neglected area.
Professor Tommaso Simoncini: I think it’s really, it’s really peculiar that physicians are not exposed extensively to menopause education. This is funny because, when you know, we teach gynecology and obstetrics, and menopause is one lecture, similar to ovarian cancer or to myomas, or to bleeding disorders. But those conditions just interest some women. Only a small number of women. While menopause is something that is ubiquitous. So all women that reach the age of menopause will undergo menopause sooner or later. So it’s more than a condition. It’s something that should be taught more in general because all physicians need to understand what changes in a woman’s life, at midlife, in order to understand better all the conditions that will ensue because menopause, we know, alters significantly the aging process. It alters the development, the risk of developing chronic diseases like cardiovascular disease, brain disorders, and musculoskeletal disorders. It’s very important. It’s very gender specific. So it should certainly deserve more space in medical education. I think the first blind spot is providing simple and understandable information for women, delivering them the information, an appropriate and informed information on what is menopause, what it involves, what are the consequences, so that we can empower them to seek, assistance if they need it. So this is something that is, in theory, quite easy. It’s actually made much easier nowadays by the widespread use of web-based applications, website and chats. Menopause is a trending topic more than it was a few years ago. So I think this is a blind spot that is becoming, covered by spontaneous interest by women. The only thing is that we need to be sure that women receive appropriate information. So scientifically sound information. And so scientific societies like EMAS are to be commended if they undergo this information like what we are doing now with podcasts or other things that can reach out. So the other blind spot is, GPs. So the GPS are, in most countries, the first interface, sometimes the only interface between women and their health. So, GPs are extremely busy. Nowadays, they have to know a vast amount of information on all types of disorders. They have lots of bureaucracy, so it’s perfectly understandable that they might have trouble in undergoing new training or new updating into fields like menopause, which is not diabetes, it’s not brain disorders, it’s not cardiovascular disease, it’s not oncology. So it’s kind of less, pressing for them. But nonetheless, it’s very important. So we need to try to find a way to deliver them the right information in a very simple format so that it’s acceptable for them, so that it’s feasible for them to take those, you know, right informations and to make the right use for the clinical practice. That is I think the most difficult task for us. So to make small pills that are very targeted to GPs, so that they can have the time to take these pills.
Prof Angelica L. Hirschberg: In Sweden, we know that menopause management is very unequal. For instance, there is good access to private colleges in the big cities, but in smaller cities and in rural areas, there is hardly any private gynaecologists. And then we have to rely on GPs, and some GPs, they are really well educated in this field, but it could be less good in other areas. So I think it’s very important now to focus on the education for GPs. And when it comes to inequality, we also know that there is a clear association between the use of menopausal hormone therapy and education and income of the women, and also the country of birth. So I think we have to be aware that the access to care in this field is, is very unequal. And for fragile groups or women, they may not come to doctors to ask for information and treatment. So it’s really important to educate, about this in general terms, and not at least to focus on the education for GPS. For instance, in Sweden now, it has been paid attention to the need of better education for GPs, but the problem is that, like you Tommaso said, that the poor GPs, they have a big responsibility for many patient groups. But, actually, I believe that these patients are already in primary care, but maybe the GPs are not aware of it. Maybe they misinterpreted the symptoms that women have and believe that this is primarily anxiety or sleeping disorders. And instead of treating with menopausal hormone therapy, they give them sleeping pills and so on. So I think it’s very important that they have menopausal symptoms in their mind to really understand women. And, so they get proper treatment.
Professor Tommaso Simoncini: And if I may add another, another level of awareness, should be the one that we are trying to convince that it’s important to develop, the workplace. So most women work in environments where it is becoming important to promote health and the welfare of the people who work in that certain setting. Now, there is, there’s more attention to women’s specific needs, so there’s more attention to menstrual cycle disturbances, to pregnancy and fertility care. Menopause should be one of the parts that should be implemented most. So we know that it’s very important not just for women, but also for the sake of the good performance of the workers. So it’s a win-win situation where helping working environment can spread knowledge, can kind of make everybody in the workplace more sensitive to the issues that women undergoing menopause might encounter. And this, of course, is a chain of knowledge that grows and makes menopause more of a normal thing, but it also follows menopause, with things that can help, coping with that situation, and that help women accept this new phase of their life. So I think that there is also a site of our society, where new knowledge of menopause should be really implemented. And there’s a lot of space to do more than what is done right now.
Prof Angelica L. Hirschberg: So my final message would be that there is a great need for education in menopausal care, and particularly for GPS in primary care. And I think it’s important that healthcare professionals regain the competence and trust in the field in order to offer professional and personalised care for women with menopausal symptoms.
Professor Tommaso Simoncini: My final message would be that, either if one is a healthcare professional, like a GP or any other allied professional, or if anyone is a woman, in both cases, it’s very important not to minimise Menopause. Menopause is an important step in a woman’s life. It’s not necessarily a dreadful step, but it can be in some cases. So anyhow, it’s very important to be able to discuss menopause with women. Women are really willing to discuss about their lives and what menopause means to them. This is a very powerful step in their lives. So nobody should minimise the relevance of this relevant step in a woman’s life. So, correct knowledge is the basis for correct discussion. And, from then, from there, you know, it’s where the correct care starts. So if the people receive the right information, then they would be able to inquire for solutions for problems they might have, and not just be left with a generalised understatement that menopause is something natural, so you shouldn’t care if you’re not feeling well. That’s not correct. So it’s not a modern concept. And women are understanding that, and GPs should follow.
Prof Petra Stute: Thanks for listening. If you enjoyed this episode, don’t keep it to yourself. Share it with a colleague, a friend, or someone in your workplace who might need to hear it. To discover more about menopause at work and how to take action, visit emas-online.org and explore our resources, events, and educational tools. Let’s keep the conversation going.
Prof Petra Stute: Welcome to the EMAS Menopause in the Workplace Podcast, a special series celebrating World Menopause and Work Day, held every year on September 7. This Global Awareness Day was launched by the European Menopause and Andropause Society (EMAS) in 2021, following the publication of our Global Consensus Recommendations on Menopause in the Workplace, to spark conversation and action around an issue that affects millions, yet is still too often overlooked.
I’m Professor Petra Stute, president of EMAS, and here’s what we know: menopause impacts work and work impacts menopause, but too often, no one’s talking about it.
In this episode, Symptoms of perimenopause and menopause and how they may be affecting your productivity and work, we hear from Dr Angela Derosa, a board-certified internist, hormone health specialist, and member of the EMAS Advisory Board. Drawing from both clinical expertise and personal experience, Dr deRosa dives into the often overlooked symptoms of hormonal change and the powerful ways that can affect women’s energy, confidence, and career path. Her message is clear: what many women are feeling is real, treatable, and deserving of attention, especially in the workplace.
Dr Angela deRosa: Hello, my name is Dr Angela deRosa, and I’m a board-certified internist with a specialty background in Women’s Health. And I have really largely spent my career dedicated to the understanding of hormones and the role they play not only in the quality of life, but also how they prevent chronic illness. Of special note, my patients and colleagues call me Dr Hot Flush. Today, I want to talk to you about the symptoms of perimenopause and menopause and how they may be affecting your productivity and work.
Women are often leaving the profession early at the height of their careers due to the hormonal changes that are occurring within their bodies and the subsequent symptoms that are becoming debilitating. Where I really think it would be helpful to start is really to understand the difference between perimenopause and menopause. I know this creates a lot of confusion for my patients and fellow colleagues, for that matter. But it’s important to understand that there are distinctly different. So let’s start with menopause. Menopause is the absolute time that the ovaries fail. It’s a moment in time. The ovaries shut down. Elvis has left the building. They are no longer working. You are going through menopause right at that moment. Perimenopause is the time leading up to that failure of the ovaries, so the perimenopause is a really important transition because it often takes 10 to 15 years for those ovaries to slow down until the point they just said, “I’m tired, I give up. I’m done”. Menopause. They shut down. And then everything from that point forward, we call post-menopausal.
So, reminder that menopause is the absolute time that the ovaries shut down. Perimenopause is the time leading up to that. And as I said, it can take 10 to 15 years on average for women to start experiencing that ovarian hormone secretion decline. And I often see it occur in different stages. So let’s imagine for a second, a woman’s average age of menopause is around 50, which means a woman may start experiencing hormonal decline in the mid-30s on average. But interestingly, a lot of women, when they start to experience those changes in their 30s, get labeled as being depressed or having mood disorders or various other things. And it’s not uncommon for women to be thrown on antidepressants when they actually really need their hormones balanced, and in particular one at that time, which we’re going to talk about. So, again, women can start to experience hormonal decline mid-30s on average, leading up to the menopause at the age of around 50. And the other thing to note is you could be having significant hormonal changes going on, and you could still be having regular cycles. So if someone tells you, “Oh, you can’t be hormonally deficient because you’re having regular periods”, you’re being dismissed and, they’re not fully understanding, and you need to find a different person to help you with your hormones because that is not true. It isn’t up until usually a year or two before the absolute menopause that period start to change, so you could be young, you could be having normal functioning periods and still have hormone deficiencies.
So let’s talk about the decline of the hormones and where they often play. So testosterone. Yes, I said testosterone. Women make a whole bunch of testosterone. It’s actually our most abundant hormone. Yes, I said that. Abundant hormone on a day-to-day secretion of hormones. We make more testosterone than we do estradiol day-to-day during our reproductive years, and it is a vitally important hormone for us. Believe it or not, it’s also the first one to go, so it’s usually the decline of testosterone occurs in our mid to late 30s. So if a patient presents to my office, for instance, with estrogen deficiencies, symptoms like hot flashes and night sweats, she is already testosterone deficient.
So what are those symptoms? Well. They present exactly the same in women as they do in men. We talk about testosterone deficiency causing libido issues and erectile dysfunction in men, but it causes libido issues, desire issues, and clitoral insensitivity in women, so we don’t feel like we want to have sex anymore. But when we attempt to, often our clitoris takes more stimulation in order to achieve orgasm. The orgasms aren’t as wonderful as they were before, and they’re just kind of lackluster. So you see those whole host of responses occurring in women. But testosterone does much, much more than actual libido and sexual health, which is, although a very important thing, it does a whole bunch of other things. Testosterone is essential for energy. It helps with muscle endurance and recovery from workouts. So we get really fatigued. And when we do work out, it just takes forever to recover. It’s just not as effective. Testosterone is Mother Nature’s serotonin, so we become irritable. We don’t cope with stress like we used to. We get new onset anxiety and panic attacks that we never had before. But most commonly, we get apathetic. We just don’t feel anything anymore. It’s just this lackluster way of going through life where he was like, “Oh, everything’s OK”, and it’s like you just expect that that’s where life is at. You’re not gonna have some significant impacts on your relationship because you’re thinking, “Wow, is this all there is?” and it really becomes a pretty sad state of living for women. And we just stoically move through it.
Testosterone is also essential for cognitive function, so we start to get mentally foggy or very forgetful, and we lose that killer instinct to want to go out and do things in the world, in particular, professionally, we may lose that drive to start new projects or take on new things. It is also essential for executive function thinking, so we it takes us forever to read a paragraph and retain the information. We just aren’t sharp anymore, and it’s testosterone’s role to keep us that way. It also kills our confidence, and if we think women have imposter syndrome now, wait till the testosterone deficiency symptoms kick in, because it’s going to exacerbate that and it can lead to also headaches. It puts us at risk for bone loss, which can lead to fractures and, most importantly, since I’m an internal medicine physician, the one thing I often think about is, “What is the most important physiologic role of testosterone?” Well, here it is: It helps us manage glucose. So when we eat a meal, everything converts to glucose, and it is testosterone’s job to move it from the bloodstream into the muscle so the muscle can use it cleanly for energy. If you lose your testosterone, that doesn’t happen anymore. So where does that sugar go? Well, now, the pancreas has to pump out a whole lot more of insulin in order to deal with that, and it then takes that glucose and converts it to fat, and it puts it right in the midsection. So women will often see their weight shift from their thighs and their buttocks into their midsection, and it’s almost impossible to get rid of, so those weight changes are occurring because of testosterone deficiency. And to make matters worse, when you start taxing that pancreas to make more and more insulin, it’s going to burn it out. It gets tired. So then we start to see creeping a blood level called hemoglobin A1C that doctors look at to see if you’re pre-diabetic or diabetic, so we start seeing those values go to the pre-diabetic levels. But instead of people being treated with testosterone to reverse that, they often get put on drugs like the GLP agonists, or metformin, or, horribly, if they keep going down that path to insulin eventually. But it’s all rooted in that testosterone deficiency. So you start to see marked changes of it, so I’m hoping you’re that there’s one thing you get out of this, this little series here, is understanding that testosterone is vitally important to women, and we need to be addressing its deficiencies in women because it’s impacting our health in a great manner.
So that starts first ladies in their 30s and that’s where we usually get labeled depressed. You’re not depressed. Well, some of you might be, and you may be depressed by the symptoms you’re having, but you need your testosterone to help you balance that out. Then, usually in the 40s, we get to the symptoms of the estrogen deficiency. Now those are more commonly known. That’s the hot flashes, night sweats. You just don’t sleep like you used to. Your skin and hair start to change. Your skin gets saggy, more yellow, instead of that pink hue that we like to see. You also start to see your hair is thinning out. Also impactfully, we get significant vaginal dryness, which can lead to painful intercourse, and I’ve even had some women say just the act of sitting down was so painful because of the vaginal dryness. And then that can lead to urinary symptoms like urinary incontinence, a lot more urinary tract infections. So estrogen deficiency is also really important in the aspect that when you become estrogen-deficient, your cardiovascular risk goes up. So with testosterone, the cardiovascular risk goes up because of the insulin resistance and diabetes you can develop. But with estrogen, it hardens our arteries and we’re deficient, so we get high blood pressure. It negatively impacts our cholesterol panels when we’re deficient in estrogen. Which leads to hyperlipidemias or hypercholesterolemia and those cardiovascular problems of high blood pressure and lipid disorders, and you guessed it, if you throw in things like poor diet, smoking, lack of exercise, all just becomes this huge problem toward events of heart attack and stroke. So it’s women who are on estrogen have lower risks of cardiovascular disease than those who are not, and it’s important to catch those women early as they’re moving through perimenopause and menopause to make sure that that’s balanced so that we keep that risk nice and low.
So you can imagine if you’re feeling all of these different symptoms that you’re not only being affected in your personal life, but in your professional life. I hear this all the time. Women leaving their professions or going part-time, or end up having to take more time off, and their productivity drops because of these problems they’re experiencing at work, and unfortunately, the workplace is not necessarily very sympathetic, often to women, and we’re very self-critical and self-conscious about this. So really, it’s important as a society that we start to educate more workplace personnel who can help us make changes to advocate for women in the workplace, so that we can understand what’s happening to them, build systems and priorities to take care of those women, so that they can get their mojo back. So it’s really hormonal education resources to get proper hormone balancing and understand the time to do so.
So hopefully this information will give you some food for thought and help you maybe figure out ways you can advocate for yourself and others in the workplace, because it’s going to make some significant changes if we can make the workplace and our professional lives obviously much better. So I hope you find this information helpful. I hope you find it empowering and really just go out there and know that you’re not crazy. This isn’t all in your head, and what you could be experiencing is very, very real. And there are ways to help it with proper bioidentical hormone replacement therapies. Have a great day.
Prof Petra Stute: Thanks for listening. If you enjoyed this episode, don’t keep it to yourself. Share it with a colleague, a friend, or someone in your workplace who might need to hear it. To discover more about menopause at work and how to take action, visit emas-online.org and explore our resources, events, and educational tools. Let’s keep the conversation going.
Prof Petra Stute: Welcome to the EMAS Menopause in the Workplace Podcast, a special series celebrating World Menopause and Work Day, held every year on September 7. This Global Awareness Day was launched by the European Menopause and Andropause Society (EMAS) in 2021, following the publication of our Global Consensus Recommendations on Menopause in the Workplace, to spark conversation and action around an issue that affects millions, yet is still too often overlooked.
I’m Professor Petra Stute, president of EMAS, and here’s what we know: menopause impacts work and work impacts menopause, but too often, no one’s talking about it.
In this episode, Menopause in the workplace: A toolkit for HR leaders, we hear from Claire McCartney, Policy and Practice manager at the Chartered Institute of Personnel and Development (CIPD), the UK’s professional body for HR and people development. Claire shares research, practical insights, and a clear message: supporting menopause in the workplace isn’t just good for women; it’s good for business too.
Claire McCartney: I’m Claire McCartney, policy and practice manager at the CIPD, the professional body for HR and People development, and it is a real pleasure to be contributing to this podcast series organised by EMAS on Menopause in the workplace. At the CIPD, we have around 160,000 members worldwide with offices in the UK, Ireland and the Middle East, and we all work together to champion better work and working lives. So I think it’s quite clear to see that our work relating to menopause and women’s health at work is closely linked to that purpose. Now, in my short podcast today, I’m going to be talking specifically about menopause at work and developing an HR leader’s toolkit to help create menopause-friendly workplaces.
And the starting point for any HR professional is understanding the business imperative to create menopause-supportive workplaces. Now EMAS estimates that around half of the 657 million plus women aged 45 to 59 worldwide are in the workforce during their menopause years. Now this is therefore a key recruitment and retention issue to tap into female talent, often at the peak of their skills, their knowledge and their experience. And it is also a strong compliance case. In many countries, employers have a duty of care for employees’ health and well-being, and not to discriminate on the grounds of things like areas like age, sex and even disability, where symptoms are severe and ongoing. And if you’re a responsible employer who cares about your people, then it’s the right thing to do.
So after establishing the business case, the next step for HR and organisations is to develop a supportive framework around menopause and ensure that all employees, regardless of level, are educated and aware of the support that’s on Offer. And this is very much needed because in our own CIPD research, we surveyed over 2000 women aged 40 to 60, in employment in the UK, about their experiences of menopause and work. And our findings showed that a lack of support can have serious consequences for career progression. Over a quarter of women in work with menopause symptoms said that menopause had had a negative impact on their career progression. And actually, if you scale this up to the labour market as a whole in the UK, then it’s estimated to be around 1.2 million women. Almost one in four have also considered leaving work or left work due to a lack of support for their menopause symptoms. And our findings also show that individuals who feel unsupported by their employer are significantly more likely to report an increased amount of pressure and stress.
So what are some of the overall principles that organisations can adopt to promote awareness and good practice for menopause and women’s health? And what are some of the things that should be in HR’s toolkit?
Well, first of all, I think one of the first key pillars is building an open and inclusive culture, and this will help to normalise women’s health issues in the workplace, such as menopause, but other areas as well, such as menstrual health. And I think you can do this by holding supportive discussions and creating an open dialogue. For many of the organisations that we’ve worked with, having those open conversations as a starting point really helped to kick start and further develop support throughout the organisations, and that ability to talk about these issues openly and to ensure that women were able to get the support that they needed.
Secondly, the second pillar is around creating awareness and tackling any stigma. So, for example, you could communicate positive messages around menopause or women’s and reproductive health and support. Also, demonstrate that leaders and managers take these issues seriously. You could include references to menopause and maybe other areas like menstrual health, fertility support and pregnancy loss across your policies and guidance. And you might want to have a dedicated section for information and resources on women’s health on your company intranet. Or perhaps physical copies of support or posters for those in frontline roles.
The third important pillar is developing a supportive framework, and this could include policy provision, support pathways, guidance and training. You need to make sure that you have support in place and that you’re proactive in making sure that employees know that support is there. So you might want to look at your people management policies, your equality, diversity and inclusion policies. If you’ve got occupational health in place or employee assistance programmes, or health and well-being provisions. And also review all of these in the light of what support they’re providing around menopause. Review your working conditions and environment, which elements are relevant to supporting women’s health and what perhaps needs to change. It’s also very important to make sure your absence management system is fair and flexible enough so that it doesn’t unfairly penalise someone who’s experiencing ongoing menopause or even menstrual health symptoms.
The final pillar for us is really very important. It’s around training and supporting people managers. They’re a crucial part of managing women’s health effectively, fostering a supportive culture and making sure women are supported practically as well. So we need to make sure that they’re educated and aware that they understand their organisational policies, and also some of the practical workplace adjustments that might be helpful. And our own CIPD research found that some of the most highly appreciated types of adjustments include planned flexible working, ability to control local temperature, last last-minute or unplanned late starts after sleep disturbances, more breaks when needed and also access to areas like occupational health support. Now support should be tailored to the individual, and people will experience and have very different symptoms, so it’s really important for managers to have regular one-to-ones with their teams to understand the importance of sensitivity and discretion. And it’s also not about making assumptions, but taking your lead from the individual and tailoring support wherever possible.
So thank you, once again, to EMAS for having the chance to contribute to this Menopause in the workplace series and do head to our CIPD website if you’re interested in seeing more of our research on menopause and women’s health and our practical guidance for HR and organisations. And of course, there are lots of resources that are particularly helpful on the EMAS site.
Prof Petra Stute: Thanks for listening. If you enjoyed this episode, don’t keep it to yourself. Share it with a colleague, a friend, or someone in your workplace who might need to hear it. To discover more about menopause at work and how to take action, visit emas-online.org and explore our resources, events, and educational tools. Let’s keep the conversation going.
Discover the multilingual animated video series on menopause, created by the CoMICs team at Birmingham University and supported by EMAS and the European Society of Endocrinology. Available in 11 languages, these educational resources aim to break down language barriers in patient education. Visit the website to access the videos!
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