What is menopause – and how does it impact women’s health and work life?

Menopause is a significant life milestone. It is something everyone born with a womb goes through – marking the end of their reproductive years. Yet, despite affecting roughly half the world's population, it remains a misunderstood topic, surrounded by misconceptions and sometimes stigma.

There has been an uptick in recent years in the number of companies recognizing the health and wellbeing implications for women going through this change, with some businesses introducing specific policies and support programmes. But in general, the impact of menopause on women’s health, as well as the wider societal and economic implications, often remain underappreciated and undervalued.

Indeed, the ‘Closing the Women’s Health Gap’ report, published by the Forum’s Global Alliance for Women’s Health in collaboration with the McKinsey Health Institute, finds menopause is among the conditions with high unmet need and economic potential.

Menopause is the gradual process where a woman's body transitions out of its reproductive years. It’s not a medical condition or an illness – rather a natural part of ageing.

Technically, it's defined as the point when a person has gone 12 consecutive months without a menstrual period, and generally happens in their 40s or 50s. However, the journey to this point – often called perimenopause – can span several years.

During this time, the ovaries slowly decrease their production of two key hormones: oestrogen and progesterone. This hormonal shift is responsible for the various changes and symptoms associated with menopause. The onset of the menopause, as well as the symptoms experienced, are also influenced by factors like genetics, lifestyle and certain medical conditions.

Alongside the gradual stopping of periods, fluctuating hormone levels may also cause a number of other symptoms. It’s worth noting, though, that women may experience multiple symptoms, while others might experience none.

These symptoms may include hot flushes and night sweats, mood changes, sleep disturbance, weight gain, changes to skin and hair, and headaches. And for some people these symptoms may have a substantial impact on their quality of life.

Three-quarters of women say that the menopause has caused them to change their lives and more than half say it has a negative impact on their lives, according to a UK survey.

This can be particularly problematic in the workplace, where the most commonly reported symptoms include lack of concentration, tiredness, poor memory, feeling low or depressed and lowered confidence.

The fluctuations in hormone levels during the menopause can have wider implications for women’s health more broadly.

For example, oestrogen in particular is important to maintaining bone density. As oestrogen levels decrease during menopause women become increasingly prone to osteoporosis, a condition where bones become fragile and more susceptible to fractures. Half of post-menopausal women will have osteoporosis, and most will suffer a fracture.

Cardiovascular health is also affected. Before the menopause, women in general have a lower risk of heart disease compared to men of the same age. Oestrogen helps to control cholesterol levels and reduces the risk of fat building up in arteries. As it declines this protective benefit goes, increasing the risk of developing heart disease, heart attack or stroke.

Post-menopause the body is also less able to control glucose levels, which increases the risk of diabetes, high blood pressure and weight gain.

Urinary tract infections and urinary incontinence are also more likely following the menopause.

There is a significant care gap around menopause health. The quality and consistency of care is often patchy, healthcare professionals often lack adequate specialized knowledge, and accurate information is not always easily accessible. Similarly, medications to manage and treat health impacts, including hormone replacement therapy, are not consistently available.

This can result in women having to visit doctors multiple times before getting the right help, causing delays in care, distress and an additional burden to healthcare systems. Doctors often take longer to recognize menopause symptoms in non-white women.

There is also a cost burden for the women themselves – peri-, post- and menopausal women typically spend significantly more on clinical services and prescriptions.

Stigma and embarrassment have a role to play, making women less likely to seek help.

The World Economic Forum’s latest Global Gender Gap report finds that the health and survival divide is one of the most closed, at 96%. The Forum’s Global Health Equity Network brings together governments, communities and the private sector to target the root causes of the health inequity to ensure all people have equal opportunity for health and wellbeing.

The wide-ranging impacts of the menopause have a significant impact on worker absenteeism, productivity and lost opportunities for career advancement.

In the US alone, the cost of lost work time is estimated at $1.8 billion annually – rising to $26.6 billion when medical expenses are added, according to a study by the Mayo Clinic; 10% of women aged 45-60 reported taking time off work due to menopause symptoms.

Despite this, the majority of workplaces offer no basic support for menopause, including absence policies. People taking time off work for menopause symptoms often cite other reasons to their employer, with the perception that menopause is not taken seriously or has even become a joke in the workplace.

However, a small but growing band of companies are waking up to the silent cost of this lack of awareness and support. In the UK, over 500 companies have committed to being ‘menopause friendly’, under an accreditation system launched in 2021. These range from technology company Fujitsu, law firm Clifford Chance and pharmaceutical company Bristol Myers Squibb, to government departments, healthcare trusts and police forces.

Elsewhere, companies including AI technology company Nvidia have signed up to digital menopause health tools as part of their wellbeing support package, and others including Bank of America are actively encouraging workplace conversations about menopause to try to break down the stigma.