22 HOW TO TREAT: MENOPAUSE AND WORK ausdoc. com. au
19 SEPTEMBER 2025
22 HOW TO TREAT: MENOPAUSE AND WORK ausdoc. com. au
osteoporotic fractures). This can further add to increased risk of injury( or likelihood of a more serious injury) in the context of workplace falls, other accidents, or physically demanding tasks. This risk can be further compounded by more frequent reports of vertigo and falls in postmenopausal women( which has been attributed to decreased oestrogen levels). 35
Osteoporosis( see figure 11) in the menopausal period is managed with a combination of lifestyle management strategies( ensuring adequate calcium intake and vitamin D levels, encouraging weight-bearing exercise [ see figure 12 ], reducing alcohol consumption and smoking cessation), and medical therapy( menopausal hormone therapy, selective oestrogen receptor modulators, antiresorptive medications or anabolic medications). 36
WORKPLACE INTERVENTIONS
THE GP’ s management of the symptoms of menopause will vary because of the individual symptom profiles, and the impact of these symptoms on the patient. Treatment may include hormonal and non-hormonal options, or the use of additional modalities for the treatment for coexisting conditions such as depression, anxiety, sleep apnoea and musculoskeletal pain. The impact on work is individual and depends on a number of factors. However, there are a number of possible interventions that a workplace can implement to assist their workforce. A key aspect of this is education about and normalisation of the condition in the workplace. While menopause may lead to medical interventions, it is considered a normal part of the human reproductive journey and normalising the range of people’ s experiences helps to reduce stigma and improve understanding and access to assistance when required.
Company culture plays an important role in how this is implemented. While the GP may not be able to directly impact a company’ s culture, they may be able to influence and support the development of appropriate policy, assist with education and guidance, and advocate for individual patients.
Companies may have specific policies addressing menopause, or it may be included more generally in policy regarding worker health and fitness for duty, diversity or equality. 11
These policies may include information on the leave available for medical appointments and on symptom management. Education and training for employees and management helps to raise awareness of the possible options. Research has shown that simple actions at work( see box 1) can be valuable when supporting women during menopause. 11
Practical interventions can be useful for managing particular symptoms. For example, when looking at the management of hot flushes, considerations may include temperature control, the availability of fans( see figure 13), access to cold drinking water, uniform requirements, private areas to manage severe symptoms, and the proximity of windows or heat sources to workstations.
When considering vaginal bleeding and genitourinary symptoms, a workplace may need to review access to toilet facilities and uniform requirements.
Figure 5. Dysregulation of body temperature is most commonly experienced as flushing, skin reddening and sweating.
Figure 6. Vaginal atrophy. The left side shows female anatomy in a premenopausal state, the right side shows reduced blood flow and vaginal atrophy in a postmenopausal state.
Box 1. Actions to support women during menopause
• Shared information about menopause with staff( eg, via intranet or noticeboard).
• A support network for menopausal women.
• Senior leaders making statements about menopause to raise awareness.
• Introducing menopause training or a briefing session for managers.
• Introducing menopause training or a briefing session for all staff.
• A designated person to whom staff can speak about menopause.
• A policy for staff to take time off for menopause reasons. Source: The Fawcett Society 2022 11
For more troublesome symptoms or when company-wide interventions are not sufficient, the involvement of an occupational physician may be useful, as for any other health condition that is impacting work. In some cases, accommodations or adaptations to the role may be needed. This may include changing schedules and task modification or adjustment.
THE ROLE OF THE GP
DATA from the UK have shown that while many women have been unable to attend work due to menopause symptoms, fewer than one in five felt able to tell their manager the reason for their absence. 37 Other sources estimate that between 22 and 33 % of women disclose their menopause status at work. 38 The role of the GP is to provide the appropriate medical care, including ruling out other possible causes for the symptoms, to educate patients and try to reduce stigma about menopause. It has been shown that awareness, reduced stigma and open discussion can improve the experience for women
25, 39 in the workplace. A 2023 UK study of doctors in the NHS in general practices and hospitals in the UK suggested the modulating factors, listed in box 2, to a positive( or
Science Photo Library negative) experience in the workplace during menopause. 40
GPs are not usually in a position to change aspects of organisational culture and workplace autonomy( except within their own practices or healthcare organisations). However, they are perfectly positioned to increase awareness and education of menopausal symptoms, including how they may be experienced in the workplace, and the appropriate treatment; reduce the taboo surrounding menopause and, where relevant, engage with workplaces to assist with individual situations.
CASE STUDIES
Case study one
BELINDA is a 52-year-old woman working on a fly-in fly-out basis on a mine site in remote WA( see figure 14). She works as a machine operator, on rotating shifts. When not working, she lives with her husband and 21-year-old daughter in Perth.
She has been experiencing perimenopausal symptoms for the past three years, noticing increased sleep disturbance, some irritability and vaginal
Box 2. Modulating factors in the workplace
• Positive modulating factors:— Openness to discussing menopause in the workplace.— Awareness of menopausal symptoms.— Supported workplace autonomy.
• Negative modulating factors:— Taboo surrounding menopausal symptoms.— Gender dynamics.— NHS’ organisational culture including predominantly male leadership.
— Perceptions of a‘ superhero mentality’ among UK doctors.
Source: Adelekan-Kamara Y et al 2023 33
dryness. She has also had two recent UTIs. Over the past three months she has noticed a significant increase in her symptoms with hot flushes on most days and worsening genitourinary symptoms.
Belinda was initially reviewed by her GP. The GP determined that her symptoms were explained by menopausal changes, and there were no other potential causes for the symptoms that may respond to specific management. Belinda was offered lifestyle advice and started on hormone therapy after a discussion about its risks and benefits.
Despite therapy, the hot flushes and genitourinary symptoms continued to impact on her employment with regular hot flushes, persistent UTIs and increased genitourinary symptoms. She found being in the machine for long periods was very difficult and she was not managing the hot environment well.
After further discussions with her GP, Belinda contacted her workplace health and safety team. The team tried to implement modifications including checking the air conditioning settings on the machine and increasing her break times, but because of the need for protective clothing and the ongoing heat, the team decided Belinda would benefit from a short period of reduced onsite work. After four weeks of office-based work in Perth on a project, Belinda found that her medical therapy had been optimised and her symptoms were better controlled. She was able to return to her usual workplace while continuing to manage her hot flushes and urinary symptoms.
Close assessment of fatigue is also vital in any individual who is performing a safety critical role. This means a role( such as machine operating) where action or inaction on the individual’ s part may lead to a significant safety risk to themselves or others. Fatigue( from any aetiology) that is not appropriately managed can impact an individual’ s ability to perform safety critical duties, and there may be a need to consider temporarily avoiding such tasks until the fatigue has been successfully managed. Belinda’ s sleep improved with her hormone therapy and lifestyle interventions and there were no ongoing concerns about her fatigue symptoms on return to work.
Case study two
Miriam is a 38-year-old woman who lives in Brisbane. She works as a midwife in the community, attending