Take This Hot Flash and Shove It! - The New York Times

Hot flashes, mood swings and other signs of menopause can cause women to quit their jobs. Here's how some handle symptoms while working.

Menopause — and the years leading up to it — can disrupt women's lives in so many ways, including, new findings suggest, by upending their livelihoods. A British survey of 2,000 women between the ages of 45 and 67 reported last week that one in four women experiencing symptoms of menopause were unhappy in their jobs because of a lack of support, and that nearly one in five were considering quitting because of it.

These concerns are probably shared by women around the globe. Each year, an estimated 1.3 million U.S. women, typically those in their early 50s, enter menopause — meaning that they have not had a menstrual period for at least 12 months. Millions more each year begin perimenopause, the period before menopause when a woman's body begins producing less estrogen.

It is during perimenopause — which can last for four to eight years — that many women experience potentially debilitating symptoms, such as changes to their menstrual cycle, hot flashes, sleep problems, migraines and mood swings, which are driven by hormonal changes and can make women's lives in the workplace more challenging.

"It's definitely very hard to work with symptoms," said Dr. Wen Shen, a gynecologist and the co-director of the Women's Wellness and Healthy Aging Program at Johns Hopkins Medicine. The implications are dire, she added, considering that there are over 60 million women over the age of 50 in the United States, according to the U.S. Census Bureau.

Other research backs up the new survey findings. In a study that has not yet been published, Dr. Stephanie Faubion, director of the Women's Health Clinic at the Mayo Clinic, surveyed more than 5,000 women between the ages of 45 and 60 who receive primary care from the Mayo Clinic. "We were shocked by the number of women that said they reduced their hours because of menopause symptoms, or were missing workdays because of menopause symptoms," she said. "Think about the women's lost wages. Think about the companies' lost profits. This is an economic problem."

Experts and women who have had menopause or perimenopause symptoms clash with their work duties shared workarounds and potential job accommodations that may help women stay in the work force while experiencing these common changes.

What menopause looks and feels like

As the coronavirus pandemic has endured, many women have said that they prefer to maintain some of the workplace flexibility that came with it, such as remote work, for reasons related to parenting, health and productivity. It makes sense that women who are having menopausal symptoms in particular would consider leaving their jobs if they're now required to resume working in-person, Dr. Shen said.

"When you're home, nobody sees that you've got three fans pointing at you while you're on Zoom or that you have shorts on under the desk," she said.

In the workplace, on the other hand, women have to come up with creative solutions: Laura Lindberg, a scientist who works for a nonprofit institute, said she used to stick her head in the company freezer when she had hot flashes. "How sad was I when they switched to a fridge with a bottom freezer — didn't work the same," she said.

At home, women also have more time and space to compose themselves after experiencing something emotionally triggering. Mood-related issues — which affect about 40 percent of women in perimenopause — can pose problems at work. "I'll have patients tell me, 'It's really impacting not only my personal relationships, but my professional career, too, because I am responding in a way that I would not have before, and it's not appropriate,'" said Dr. Monica Christmas, the director of the Center for Women's Integrated Health at UChicago Medicine.

Menopause can also affect women's sleep, and the ensuing exhaustion can lead to mood swings, too. Symptoms such as hot flashes and night sweats can drastically reduce how much sleep women get at night, with sleep loss affecting an estimated 40 to 60 percent of menopausal women. "Patients are just totally fatigued," Dr. Shen said, "by not having gotten a full night of sleep for months, if not years."

Jeannine Ouellette, 53, a writer from Minneapolis who is in perimenopause, is grateful that she gets to work from home most of the time because she often sleeps poorly at night and benefits from short cat naps during the day. "If I just close my eyes for 10 minutes, I can come back to that task and get it done three times faster than trying to struggle through it on a sleepless brain," she said.

Another major problem is that menstrual cycles change in perimenopause, so women don't always know when they will start bleeding, Ms. Ouellette said. "To have that, combined with potentially very heavy bleeding, is very stressful in a professional environment," she said. "That feeling that every woman knows — that gush — you're like, oh my God, how am I even going to get out of this room?"

How employers can help

Nicola Green, a consultant in Britain who advises employers on how to support workers going through menopause, recommends that workplaces provide free menstrual products in their bathrooms and access to cold drinking water. If workers are required to wear uniforms, employers should have extra uniforms available so that people can change if necessary. She also advises workplaces to allow employees to work from home, or have flexible hours, when they are experiencing menopause symptoms.

People who "are completely sleep deprived, or may be suffering from the most horrendous periods that make them really struggle to leave the house, they can manage that so much better by working at home," she said. When workers aren't given these accommodations, she added, they may instead call in sick.

Fran Poodry, 51, who works in customer service at an educational technology company in Portland, Ore., recalled a time several years ago when she woke up and couldn't stop crying. "I explained to my supervisor that it was perimenopause since I was not sad or upset," she said. "I just was helpless to turn off the tears and snot due to hormones,."

She told her supervisor that she might need to come into work late or work from home when symptoms were bad, and he told her that was fine. "I really am very lucky that my workplace is so accommodating," she said. "Nowadays, with Zoom, I can attend a meeting from home if I needed. Or I can work from home entirely."

Ultimately, employers should educate themselves about menopause and communicate that they want to be supportive to staff going through life transitions or other health issues, experts said. "A more flexible schedule allows room for the employee to work when they're most attentive and productive, which benefits both the employee and employer," said Emily Klover, an organizational psychologist in Sacramento. "It really does work well for all."

How women can find relief

Dr. Faubion, from the Mayo Clinic, said that one of the biggest tragedies of menopause was that many women — and even many doctors — didn't realize that there are lifestyle changes and treatments that can ease their symptoms. During perimenopause, for instance, a low-dose birth control pill can control bleeding issues and ease hot flashes and night sweats, she said. Simple dietary changes — like avoiding alcohol and caffeine — can also reduce hot flashes in some women, Dr. Faubion noted, while cognitive behavioral therapy and mindfulness meditation have been shown to make hot flashes more tolerable and improve sleep quality.

Women who don't get relief through lifestyle changes might want to consult a qualified menopause practitioner, Dr. Shen said. Prescription medications also could help, such as antidepressants for mood issues and antiseizure medications, such as gabapentin, for hot flashes.

After menopause, low-dose hormone replacement therapy helps many women, too, Dr. Faubion said. Although the therapy can increase cancer risk, the risks are minimal among women under 60, she added. "For the majority of women who are under the age of 60 and within 10 years of their last menstrual cycle, the benefits outweigh the risks," she said.

Thankfully, women today may be more comfortable than women in past generations talking to their doctors about symptoms and asking their employees for accommodations, Dr. Faubion said. Women who are menopausal now "want to talk about it," she said. "They're not going to shove it in the closet."

Melinda Wenner Moyer is a science journalist and the author of "How To Raise Kids Who Aren't Assholes."