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It’s the ultimate taboo.
Nobody talks about it.
Nobody understands it.
Defence needs to break the stigma.
There are over 16,130 females serving in the Defence and many female civilian employees that this may impact. It is now time for commanders to take notice of the menopause and how debilitating menopause can be. This article aims to break this stigma and create a Defence wide dialogue about it. Like all health issues, the menopause is a leadership issue we must understand and solve. This article will also provide information, guidance and signposting for all personnel. A number of servicewomen have voluntarily shared their menopause experiences with this writer which provides authenticity and credibility to the arguments within the article. As an open, diverse and inclusive organisation all commanders within Defence have a responsibility to provide support to personnel who may need it. This, in turn will enhance safety, value our female personnel, improve performance, and ultimately improve operational effectiveness.
Menopause affects everyone
Many people reading this will be asking why they need to take note of the menopause. It’s a valid question. It’s something that is rarely discussed. However, it is becoming highlighted more regularly as there are far more women in the workplace now than ever before. According to a UK Government report on menopause, “Menopausal women are the fastest growing workforce demographic”. In addition, with an ageing UK population this trend is set to continue. In a Defence context, this is supported with initiatives that Programme CASTLE are currently considering, such as service to 60.
For the purpose of this article, it is important to define what the menopause actually is. The menopause is a natural part of aging that usually occurs between 45 and 55 years of age as a woman’s oestrogen levels decline and periods stop. In the UK, the average age for menopause is 51. However, symptoms can start years before that, often referred to as the perimenopause, in the 40s and that is for women who go through the menopause at the average age. According to the NHS, nearly 1 in 100 women go through a premature menopause before the age of 40 either naturally or as a result of surgery or illnesses such as cancer, whereby the treatment can cause menopausal symptoms. MoD figures show that 30% of serving women in the Army are in the age bracket where this natural life stage may begin for them. So, in terms of timeframe we all need to adjust our mindsets, it is not something that purely older women experience. It is a health concern that impacts Defence.
All women experience perimenopause and menopause differently. Symptoms can be physical, such as hot flushes, weight gain, headaches, poor sleep, and heavy bleeding. Or psychological, such as anxiety, low mood, lack of confidence, memory loss and poor concentration. A 2019 study of 1,000 women aged 45 or over found that 63% of women stated their work life balance had been negatively affected by their menopause symptoms. Some women go through the menopause with little impact on their daily life. But others experience symptoms that can last for several years and have a negative impact on their performance and attendance at work. Poor sleep can significantly affect concentration, while heavy bleeding or hot flushes can be physically distressing and embarrassing. The psychological effects can also impact relationships at work. Some psychological effects are so crippling, it leads some women to think they have early onset dementia. These severe symptoms are due to menopause lowering brain energy levels caused by the declining oestrogen levels and therefore affecting reproductive health and other parts of the body. For some, the symptoms are so severe that they become debilitated and have no option but to leave their job altogether.
Men, you’re not safe!
Men reading this, you probably think you’re safe. However, this is not just something that women can experience. Men can undergo a similar process, often referred to as the ‘andropause’ whereby their testosterone levels drop, although this is usually a more gradual decline. Some men may experience (sometimes distressing) symptoms similar to those that women experience during menopause with certain medical conditions. Such symptoms in males can interfere with everyday life and happiness in the same way they do for many women during menopause. As with all health conditions, menopause is an incredibly personal topic. The task for commanders and managers is to depersonalise it and focus their people, much like any other health concern.
How this can impact servicewomen?
For servicewomen the impact of menopause can be significant. Firstly, although there is progression towards a gender balance, women make up a minority of service personnel. For example, only 10% of within the Army, and 11% across all services are women. Therefore, there is often only a handful of women within a unit. This means that having opportunities for supportive conversations about the menopause and other women’s health issues in general, are rare.
There is very little open dialogue within the chain of command about the menopause, and thus little psychological safety when trying to discuss this. When servicewomen feel their work life is being impacted because of the menopause, and when women feel confident enough to open up to their chain of command, the consensus seems to be there is a distinct lack of both understanding and empathy from both male and female commanders. This demonstrates a need for discussion and awareness.
This is echoed when women visit military medical centres sometimes finding that there few military medical doctors have expertise in this area. This results in a distinct lack of professional advice or signposting. Many women who shared their experiences for this article discussed having to speak to several doctors before obtaining any form of treatment or seek counsel outside of the military medical system. This seems to be especially apparent for women experiencing the premature menopause, sometimes in the early 20s.
Impact on the team
Silently suffering psychological symptoms is also a common trend. Low mood, loss of self-confidence, anxiety, memory loss and poor concentration are highlighted as real concerns, particularly as most women experiencing this will be Army leaders. This is both up and down the chain of command. Some of the women who shared their experiences were concerned about how they are perceived by commanders and want to perform well for their annual report. There was also worry about how this affects the personnel within their team and the performance of the team. When translated into an operational context this could hold a significant detrimental impact on leadership and the operational effectiveness of the team.
Other issues can be discussed in terms of physical safety. On exercise and deployments servicewomen spoke of the difficulties in keeping up with the operational battle rhythm of longer working days due to memory fog, poor concentration, and lack of sleep. The issue of accessible ablutions for heavy bleeding and hot flushes was another common theme. Many women spoke of lost fitness that they could not regain, coupled with increased weight gain, as a direct consequence of menopause. This led to pressure, and in some instances derogatory comments, from peers and commanders on professional appearance and bearing, compounded by annual body mass index testing.
What is distinctly clear is that those who had support from their chain of command on the matter felt more supported and although their working life was impacted, they had the psychological safety at work to be able to function effectively within their role. It is clear therefore, that this is an issue that can be helped through good leadership and the use of emotional intelligence by commanders.
Commanders don’t need to be menopause experts
Studies from civilian companies suggest many line managers don’t feel confident talking about menopause. They don’t know enough about it or how they can help.
Menopause is complicated because every woman’s experience is different. However, there is no requirement to be an expert. If commanders start by understanding the issue and actively listen to provide psychological safety to women who are menopausal, the dialogue is open. A supportive conversation can make a big difference and can provide the psychological safety to enable women to communicate their experiences.
The Chartered Institute for Professional Development provide best practice guidance for employers, on how they can help the menopause as a work place issue. This includes;
- Reviewing policy and guidance covering health and wellbeing. Highlight the menopause within policy documents, or developing menopause bespoke policy, would help to raise awareness of the challenges it can cause and the simple actions that can help women thrive in the work place.
- Creating an open and transparent environment. Menopause is a taboo subject with many women not feeling able to talk to line managers about their symptoms. By creating a working environment in which employees and managers alike feel comfortable having open discussions, organisations will be taking steps to protect their staff and themselves.
- Identify reasonable adjustments. Someone with menopausal symptoms should be supported in the same way as any other health condition. Small adjustments to role or working patterns can help people manage their symptoms and continue to perform well within their role. This could be something as simple as installing a desk fan or offering an extra uniform. It could also include considering flexible working, reallocating certain tasks, providing private rest areas, and ensuring there is constant access to water and toilet facilities.
Experience from the civilian sector proves that it is possible to bring this hidden subject out into the open relatively easily with the right approach. Many public and private sector organisations already are. Leading the way are Network Rail, HSBC UK, Sainsbury’s Group, Next PLC, Aviva, ATOS and many universities and NHS trusts have existing programmes to help women. They are seeing the benefits and how quickly a once taboo subject can be normalised. Aviva supports employees with a strong well-being culture; providing a menopause support group and free access to the “Peppy” app which provides employee sessions with a menopause nurse. Network Rail also changed their cultural mindset about the menopause by tackling the issue head on. As an employer, the benefits Network Rail have gained from this are in terms of reputation, recruitment, and retention, diversity and inclusivity, health and safety, and reduced absence within the workforce.
Changing our mindset
Currently, there is no Defence Guidance Note or specific policy on menopause. Defence is assessing this critical gap, and women’s health is being adopted as a new pillar, as part of the Health and Wellbeing Strategy (2021 – 2026) set to be published in late 2021 or early 2022. In terms of current guidance there is endorsement of the cross-government Menopause Network Guidance and Toolkit by the Health and Wellbeing Leadership Team. This is primarily aimed at Civil Servants within Defence but it is readily available to all. Additionally, there is a MOD Menopause Network and parts of the Ministry of Defence are working on this. The Menopause Network is a relatively new, closed networking group that aims to provide support and information to personnel on or those affected by a menopause journey.
In the meantime, as people are a capability which must be invested in, the onus falls on commanders to open the dialogue and create an environment where personnel can feel confident to raise issues about their symptoms and seek the support they need within the work place. Units who are more open, diverse, and inclusive will reap benefits in terms of enhancing safety and valuing personnel, which in turn will improve performance and retention of the best people. A cultural mindset shift with regards to women’s health more generally may also positively impact progression in other areas, such as the over representation of females in the service complaints system, as highlighted in the recommendations set in the Wigston Review. This really is a leadership issue that is currently in the hands of commanders. If embraced, this cultural mindset shift will break the stigma and present a persuasive vision for change and a strong case for future proofing Defence talent.
Editors note: This article forms part of a series we are running in 2021 highlighting women in defence. Check out our call for papers and get involved in the debate!
Useful websites for further reading and guidance:
Cross Government Menopause Network Guidance and Toolkit
The ‘male menopause’ – NHS (www.nhs.uk)
NICE Menopause: diagnosis and management
Hormone replacement therapy (HRT) – NHS (www.nhs.uk)
Early menopause – NHS (www.nhs.uk)
The Daisy Network – Information on premature menopause
Menopause Statistics 2019 – Menopause in the Workplace www.forthwithlife.co.uk
UK Gov Equalities Office Report (Jul 2017) Menopause transition: effects on women’s economic participation – GOV.UK (www.gov.uk)
Danielle Smith is a British Army Officer with just over a decade of experience of regimental duty and staff roles within the Royal Military Police. Her passion is people and she is currently undertaking postgraduate studies in Human Resource Management.