Improvement of menopausal symptoms and the impact on work ability: A retrospective cohort pilot study

The impact of a specialist-led digital health application on menopause symptoms in the workplace: A single-arm, longitudinal evaluation

OBJECTIVES

The aim of the study was to evaluate the change in menopause symptoms and work impairment among a cohort of UK working women who utilised an employer-provided digital menopause health application offering education and personalised support.

STUDY DESIGN

We adopted a retrospective, single-arm, longitudinal approach by analysing data from 11,870 users of the Peppy Health menopause application. Users reported their menopause symptoms and work impairment on day 0 and after 90 and 180 days of application use.

MAIN OUTCOME MEASURES

Menopause symptoms were measured by the Menopause Rating Scale, while work impairment was measured by a single question.

RESULTS

A significant decrease in the severity of menopause symptoms was observed in users across menopause stages, except for premenopausal users who saw lower severity and no change over time. Improvement in menopause symptoms was positively associated with the degree of application engagement. Work impairment also significantly reduced over time for menopausal users, and a significant association was observed between a reduction in menopause symptoms and a decline in work impairment.

CONCLUSIONS

Our findings show that engaging with a digital menopause application is associated with an improvement in menopause symptoms, which lends initial support for the use of personalised digital solutions to help working women through the menopause transition.

Menopause in the workplace: Challenges, impact, and next steps

INTRODUCTION

Menopause is a natural part of a woman's life that coincides with a time when many women play significant roles in the workforce. Menopause symptoms, such as hot flashes, fatigue, and difficulty with concentration and memory, can have a negative effect on work productivity and efficiency.

OBJECTIVES

This paper summarizes the impact of menopause in the workplace, with an emphasis on the impact of symptoms on employed women and how the workplace influences their experiences. It highlights economic implications, promotes awareness, and suggests potential next steps.

METHODS

A search for papers was conducted between August and November 2023 in the PubMed and Medline databases. Papers were selected based on personal experience and interpretation of the findings. Recommendations for managing menopause symptoms in the workplace and guidance on an optimal workplace intervention strategy were provided.

RESULTS

Women experiencing severe menopause symptoms are more likely to report adverse work outcomes, including absenteeism and job-related decisions such as quitting, retiring early, or declining promotions than women experiencing few symptoms. Factors such as a lack of awareness about menopause, inflexible work conditions, and high-stress jobs can exacerbate the severity of these symptoms. Additionally, unaddressed menopause symptoms contribute to both direct and indirect economic costs, including medical resource utilization and lost work productivity, resulting in a substantial economic burden.

CONCLUSION

Menopause symptoms impair women's work experiences and productivity. In addition to dismantling the stigma associated with menopause, it is critical to create and implement menopause workplace policies and interventions aimed at supporting women in this universal life stage.

Policies, Guidelines, and Practices Supporting Women's Menstruation, Menstrual Disorders and Menopause at Work: A Critical Global Scoping Review

(1) Objectives: This paper presents a scoping review of global evidence relating to interventions (i.e., policies, practices, guidelines, and legislation) aimed at supporting women to manage menstruation, menstrual disorders, and menopause at work. (2) Methods: Databases including Medline (Ebsco), CINAHL (Ebsco), Scopus, Web of Science, APA PsychInfo (Ebsco), Humanities International Complete (Ebsco), Academic Search Premier (Ebsco), HeinOnline and OSH Update, and Google Scholar were searched in May 2022. (3) Results: Of 1181 unique articles screened, 66 articles are included. Less half of the articles (42%, 28/66) presented/reviewed an intervention related to women's workplace health. A total of 55 out of the 66 articles are set across 13 countries with the remaining 12 articles described as multi-country studies or reviews. Half of the articles presenting/reviewing an intervention were grey literature, with several undertaken in UK and EU member countries. Interventions focusing on supporting women with menopause at work were the most common (43%, 12/28), followed by menstruation (25%, 7/28) and menstrual disorders (7%, 2/28). Across the reviewed articles, recommendations were categorised as adjustments to the physical work environment, information and training needs, and policy and processes. Few articles explicitly presented or affirmed a design-process and/or evaluation tied to their intervention. In lieu of design-process, this review categorises the rationales driving the development of an intervention as: pronatalist, economic rationalism, gendered occupational health concern, cultural shift towards gender equity objectives, and efforts to reduced shame and stigma. (4) Conclusions: There is a growing body of evidence aimed at understanding women's experiences of managing their menstrual and reproductive health in the workplace and how this impacts their work/career trajectories. However, little research is explicitly concerned with exploring or understanding interventions, including their design or evaluation. Most articles report menopause guidelines and are typically confined to the UK and EU-member countries. Despite the prevalence of menstrual disorders (e.g., endometriosis and polycystic ovarian syndrome (PCOS)) there is limited literature focused on how women might be supported to manage symptoms associated with these conditions at work. Accordingly, future policies should consider how women can be better supported to manage menstruation and menstrual disorders at work and recognise the importance of co-design during policy development and post-intervention evaluation. Further research needs to be undertaken on the impact of workplace policies on both employers and employees.

An evaluation of demographic characteristics and workplace experiences of UK employees using an employer-provided menopause application

OBJECTIVES

The aim of the current study was to determine the demographic characteristics and workplace experiences of users of a menopause application in the UK.

STUDY DESIGN

A retrospective observational study of data extracted from the information submitted by 21,555 users of the Peppy Health menopause application during registration.

MAIN OUTCOMES MEASURES

Menopause symptoms were measured using the Menopause Rating Scale. The other questionnaire items assessed workplace impairment, work absence, thoughts about reducing hours or leaving work, feelings of support and disclosure confidence.

RESULTS

Users were predominately peri- and postmenopausal women between the ages of 40 and 60. The users reported menopause symptoms that were more severe than in the general population. Symptom severity was associated with work impairment and wanting to reduce hours worked or leave employment, and feeling supported was associated with less impairment.

CONCLUSIONS

The menopause application is reaching women in the workplace who are experiencing severe symptoms and who are likely to benefit from targeted support. Among the users of a menopause application, the presence of severe menopause symptoms can have a significantly negative effect on work and future participation in paid employment. The results also indicate the potential role of support to mitigate some of the negative impact.

Working well: Mitigating the impact of menopause in the workplace - A narrative evidence review

INTRODUCTION

In recent years there has been a much greater recognition by some employers of the need to support female employees experiencing the menopause. However, despite an increased awareness of the need to reduce the impact of menopause on the workforce, employers rarely have the opportunity to implement evidence-based interventions.

OBJECTIVES

This evidence review aims to provide an insight into the effectiveness of workplace programmes supporting women experiencing menopause symptoms, and to identify knowledge gaps as drivers for future research.

METHODS

A search for papers published in English between 2012 and 2023 was carried out on the PsycINFO, Medline, and Embase databases. Abstract review was used to screen initial returns before a subsequent full-text review determined the final studies included.

RESULTS

Twelve studies were selected for in-depth review: four conducted in the UK, seven in continental Europe and one in South America. The findings of the papers fell into five categories: work ability, improved symptom management, mental wellbeing and empowerment, increased openness about menopause in the workplace, and the impact of management/leadership. None of the included interventions were reported to give a significant improvement in measures of work ability. However, there were improvements in women's wellbeing, and their ability to manage symptoms. Interventions to improve workplace openness and managers' skills were well received by participants.

CONCLUSIONS

The evidence for effective workplace interventions for women experiencing menopause symptoms is currently lacking. There is considerable need for further high-quality evaluations of interventions designed to support women in the workplace.

Perimenopause: Symptoms, work ability and health among 4010 Dutch workers

OBJECTIVE

In this study we examined the associations between menopausal symptoms and work ability and health among a general population of Dutch female workers.

STUDY DESIGN

This nationwide cross-sectional study was a follow-up of the Netherlands Working Conditions Survey 2020. In 2021, 4010 Dutch female employees aged 40-67 years completed an online survey on a variety of topics, including menopausal symptoms, work ability and health.

METHODS

Linear and logistic regression analyses were performed to investigate the association between the degree of menopausal symptoms with work ability, self-rated health and emotional exhaustion, after adjustment for potential confounders.

RESULTS

Almost one-fifth of participants were in the perimenopause (n = 743). Of these women, 80 % experienced menopausal symptoms: 27.5 % 'often' and 52.5 % 'sometimes'. Experiencing menopausal symptoms was associated with lower work ability, poorer self-rated health, and more emotional exhaustion. These associations were most pronounced among perimenopausal women 'often' experiencing symptoms.

CONCLUSIONS

Menopausal symptoms threaten the sustainable employability of female workers. Interventions and guidelines are needed to support women, employers and (occupational) health professionals.

Evaluation of a workplace educational intervention on menopause: A quasi-experimental study

OBJECTIVE

To evaluate the effects of a workplace educational intervention on menopause on self-efficacy regarding working during the climacteric.

METHODS

Quasi-experimental design, with one intervention and one control group. Women aged 40 to 67, working in one of the two participating departments of a large municipality in the Netherlands, were recruited to participate in the study. The allocation of participants to intervention or control group was done at the departmental level. The main component of the multifaceted intervention consisted of educational workshops on menopause and work. The primary outcome was score on the Self-Efficacy to Manage Symptoms Scale. Secondary outcomes were scores on other self-efficacy scales, knowledge about the menopausal transition, menopausal symptoms, beliefs and behaviours and work-related variables. Differences between groups were analysed with Pearson's chi-square, Student's t-test or Mann-Whitney U. Analysis of covariance (ANCOVA) was used to correct for baseline and potential confounders.

RESULTS

Data from 54 women were analysed, 25 in the intervention group and 29 in the control group. After 12 weeks of follow-up, the mean score on the Self-Efficacy to Manage Symptoms Scale was higher in the intervention group than in the control group: 6.52 (SD 1.45) versus 5.84 (SD 1.51), respectively, adjusted mean difference 0.75 (95 % CI 0.03-1.46, p = 0.040). The educational intervention increased self-reported knowledge (scored on the range 1-10) (adjusted mean difference 0.7, 95 % CI 0.26-1.15, p = 0.002) and resulted in a lower level of presenteeism (i.e., less impaired work performance) due to menopausal symptoms, measured by the Dutch Stanford Presenteeism Scale (adjusted mean difference 2.15, 95 % CI 0.13-4.18, p = 0.038), compared to the control group.

CONCLUSIONS

This educational workplace intervention study shows promising positive effects on self-efficacy regarding working during the climacteric, knowledge about the menopausal transition and presenteeism due to menopausal symptoms. This is especially true for women already experiencing menopausal symptoms, while premenopausal women were harder to engage in the intervention. A larger study, with longer follow-up, preferably a randomized controlled trial, is needed to investigate the clinical relevance of these findings.

Quality of life in menopausal women in the workplace - a systematic review

Menopausal women are a large and economically relevant group in the workforce. Yet their quality of life (QoL) and needs in the workplace have been neglected. Thus, the aim of this systematic review was to provide an overview of QoL of menopausal women in the workplace. Systematic literature searches were executed, yielding 1211 references. After abstract screening, 156 articles remained for full-text screening. Finally, 12 articles fulfilled the inclusion criteria and were included in this review. Age, educational level, type of work, working environment (e.g. crowding, confined spaces, noise, workstation design), permanent place of residency, mental factors (e.g. stress level, workload, work pattern), comorbidities, menopausal symptoms, time since menopause and physical activity have repeatedly been shown to affect QoL in the workplace in menopausal women. Low-threshold access to medical and psychological support as well as individual adaptation of the workplace environment are, among others, retrieved recommendations for employers from these findings. Further raising of awareness of special needs of menopausal working women as well as further systematic research programs are needed.

Menopause and work: A narrative literature review about menopause, work and health

BACKGROUND:

Menopause is part of working women’s lives. In Western countries, labour market patterns are changing rapidly: women’s labour participation has increased, the percentage of full-time working women is rising, and retirement age is increasing.

OBJECTIVE:

This narrative literature study aims to provide an insight in the state of the art in the literature about the relationship between menopause, work and health and to identify knowledge gaps as input for further research.

METHODS:

The search was conducted in PubMed, CINAHL, MEDLINE and ScienceDirect. The final set includes 36 academic articles, 27 additional articles related to the topic and 6 additional sources.

RESULTS:

Research on menopause, work and health is scarce. Results are grouped thematically as follows: Menopause and (1) a lack of recognising; (2) sickness absence and costs; (3) work ability; (4) job characteristics; (5) psychosocial and cultural factors; (6) health; (7) mental health, and (8) coping and interventions. Work ability of women with severe menopausal complaints may be negatively affected.

CONCLUSIONS:

Due to taboo, menopause remains unrecognised and unaddressed within an organisational context. New theoretical and methodological approaches towards research on menopause, work and health are required in order to match the variety of the work contexts world-wide.

Global consensus recommendations on menopause in the workplace: A European Menopause and Andropause Society (EMAS) position statement

INTRODUCTION

Worldwide, there are 657 million women aged 45-59 and around half contribute to the labor force during their menopausal years. There is a diversity of experience of menopause in the workplace. It is shaped not only by menopausal symptoms and context but also by the workplace environment. It affects quality of life, engagement, performance, motivation and relations with employers.

AIM

To provide recommendations for employers, managers, healthcare professionals and women to make the workplace environment more menopause supportive, and to improve women's wellbeing and their ability to remain in work.

MATERIALS AND METHODS

Literature review and consensus of expert opinion.

SUMMARY RECOMMENDATIONS

Workplace health and wellbeing frameworks and policies should incorporate menopausal health as part of the wider context of gender and age equality and reproductive and post-reproductive health. Workplaces should create an open, inclusive and supportive culture regarding menopause, involving, if available, occupational health professionals and human resource managers working together. Women should not be discriminated against, marginalized or dismissed because of menopausal symptoms. Health and allied health professionals should recognize that, for some women, menopausal symptoms can adversely affect the ability to work, which can lead to reduction of working hours, underemployment or unemployment, and consequently financial insecurity in later life.

Using Digital Health Technologies to Manage the Psychosocial Symptoms of Menopause in the Workplace: A Narrative Literature Review

Many women experience vasomotor, psychosocial, physical and sexual symptoms during their menopausal life-stage. Specifically, the psychosocial symptoms of menopause can include loss of confidence, issues with self-identity and body image, inattention and loss of memory, increased levels of stress, and a higher risk of developing anxiety and depression. In the workplace, such symptoms can impact the woman's capacity to perform to her optimal levels. Even so, many women do not seek help to manage their symptoms due to feelings of embarrassment, the possibility of experiencing adverse reactions from others, or the cultural taboos that are attached to the condition.Digital health technologies, including virtual consultations, therapeutic interventions, and participation in online communities of support, provide an important means by which women can obtain information about menopause. In the field of mental health, digital technologies have an increasing evidence base. This paper considers how mental health practitioners can adapt, utilise or recommend digital health strategies to support older women in occupational settings to manage their psychosocial symptoms of menopause.

"I Get That Spirit in Me"-Mentally Empowering Workplace Health Promotion for Female Workers in Low-Paid Jobs during Menopause and Midlife

During menopause and midlife, female workers, particularly those in low-paid jobs, experience more occupational health problems than other groups of workers. Workplace interventions are often lacking, however. In the Netherlands, a workplace health promotion intervention—the work–life program (WLP)—has been developed to support female workers. Here, we tailored the WLP to the needs of female workers in low-paid jobs working at Amsterdam University Medical Center. In an exploratory mixed-methods study with a convergent design, among 56 participants, we used questionnaires before and after the intervention and semi-structured, in-depth interviews to address the following research question: What is the impact of the WLP on the women’s health and work functioning? Our quantitative data showed that menopausal symptoms improved significantly after the WLP. Our qualitative data, derived from 12 participants, showed that the WLP initiated a process of mental empowerment that initiated positive changes in four domains: behavior, physical health, mental wellbeing, and in the workplace. Taken with caution, our findings suggest that the WLP mentally empowers female workers to make choices that enhance their health and wellbeing, both at work and in their private lives, as summarized in the quote of one participant: “I get that spirit in me!”.

Prognostic factors for future mental, physical and urogenital health and work ability in women, 45-55 years: a six-year prospective longitudinal cohort study

BACKGROUND

Impaired health due to stress is a common cause of long-term illness in women aged 45-55 years. It is a common cause for visits to primary health care (PHC) and may influence work-ability. The aim of this study was to investigate prognostic factors for future mental, physical and urogenital health as well as work-ability in a population of average women aged 45-55 years.

METHODS

This longitudinal cohort study initially assessed 142 women from PHC centers in southwestern Sweden. One houndred and ten accepted participation and were followed for 6 years. They were assessed using the self-reported questionnaires: the Menopause Rating Scale (MRS), the Montgomery-Asberg Depression Rating Scale (MADRS-S), the Short-Form Health Survey (SF-36). Descriptive data are presented of health, education, relationships and if they are working. Multicollinearity testing and logistic regression were used to test the explanatory variables.

RESULT

Severity of symptoms in the MRS somatic and urogenital domains decreased while they increased in the psychological and depressive domains. Having tertiary education was associated with decreased overall mental health, vitality and social role functioning. Living with a partner was associated with increased physical role functioning, social role functioning and emotional role functioning.

CONCLUSION

Quality of life seems to be enhanced by a good relationship with the partner, social support and work/life balance. Therefore, to improve women health women should early discuss ways in which these issues can be incorporated as they pursue their academic or career goals. Hence, we emphasize the importance of supporting women to gain increased awareness about a healthy life balance and to have realistic goals in work as well as in their social life.

Safety of Immune Checkpoint Inhibitors in Patients With Pre-Existing Inflammatory Bowel Disease and Microscopic Colitis

PURPOSE

Enterocolitis is among the leading adverse events associated with immune checkpoint inhibitors (ICIs). There are limited retrospective data regarding the safety of ICIs in patients with inflammatory bowel disease (IBD; ulcerative colitis, Crohn's disease) because they have been generally excluded from clinical trials testing ICIs. Furthermore, there are no outcome data available in patients with microscopic colitis, a leading cause of chronic diarrhea. We aimed to study the safety of ICIs in patients with cancer with pre-existing IBD or microscopic colitis.

METHODS

We retrospectively reviewed the records of patients with cancer treated at our institution who received at least 1 dose of either a programmed cell death-1 (PD-1)/ PD-1 ligand inhibitor, cytotoxic T-lymphocyte-associated antigen 4 inhibitor, or both between 2011 and 2018. We identified patients with pre-existing IBD or microscopic colitis.

RESULTS

Of 548 patients with solid tumor treated with an ICI, we identified 25 with pre-existing colitis (21 IBD; 4 microscopic colitis). An enterocolitis flare occurred in 7 patients (28%): 3 of 4 patients (75%) with microscopic colitis and 4 of 21 (19%) with IBD. All were treated with systemic corticosteroids, 2 required an anti-tumor necrosis factor agent, and one required an anti-integrin agent and colectomy for treatment of refractory colitis. ICI therapy was discontinued in all patients who experienced an enterocolitis flare.

CONCLUSION

In our cohort, exacerbation of enterocolitis occurred in a notable percentage of patients with IBD and a majority of patients with microscopic colitis, leading to discontinuation of ICIs. Although these data suggest that patients with cancer with pre-existing IBD/microscopic colitis may be treated with ICIs, additional studies are needed to validate our results.

Effects of six month personalized endurance training on work ability in middle-aged sedentary women: a secondary analysis of a randomized controlled trial

Background

To test the effects of guided endurance training on work ability in middle-aged female hospital workers of various occupations.

Methods

We randomized 265 healthy, sedentary, middle-aged women (45–65 years) to an endurance training group (EG 210 min/week) or a wait-list control group (CG). At baseline and at 6-month follow-up, we assessed work ability (Work Ability Index [WAI]), physical activity (Freiburger activity questionnaire) and peak oxygen uptake (VO_2peak) by cardiopulmonary exercise testing. To examine the influence of baseline work ability, participants were divided into poor-moderate (WAI 1, 7–36 points, n = 83), good (WAI 2, 37–43 points, n = 136) and excellent (WAI 3, 44–49 points, n = 46) WAI subgroups.

Results

Cardiorespiratory fitness improved significantly after 6 months in the EG but not in the CG. The WAI total score increased significantly in the EG (38.3 ± 5.0 to 39.8 ± 4.9 points) but not in the CG (39.4 ± 4.7 to 39.3 ± 4.9 points), with a significant difference between groups (p < 0.01). In the EG, only the poor-moderate subgroup (WAI 1, 33.0 ± 2.9 to 36.6 ± 4.8 points, p < 0.05) increased the WAI total score, with this increase being significantly higher compared to the good (WAI 2, 40.2 ± 2.1 to, 40.4 ± 3.7 points) and excellent (WAI 3, 45.6 ± 1.5 to 45.7 ± 1.8 points) subgroup.

Conclusions

A 6-month guided exercise training intervention significantly increases cardiorespiratory fitness with concomitant improvements in work ability in middle-aged previously sedentary hospital employees. Women with low baseline work ability seem to particularly benefit from the intervention, which implies that similar interventions may be particularly beneficial for this group of individuals.

Trial registration

German Clinical Trails Register Identifier: DRKS00005159. Registered 25 September 2013.

Work ability, functional exercise capacity and prevalence of obesity in perimenopausal and postmenopausal women with non-manual employment

Objective. This study aimed to evaluate work ability and functional exercise capacity, and their correlation to each other and to obesity, in perimenopausal and postmenopausal women with non-manual employment. Materials and methods. The study included 300 women aged 44-66 years. The following measures were used: work ability index (WAI), 6-min walk test (6MWT), body mass index (BMI), waist-hip ratio (WHR) and adipose tissue accumulation. Regression models of the WAI and distance in the 6MWT were estimated. Results. The examined women obtained WAI 39.0 ± 5.0, BMI 26.2 ± 4.6, WHR 0.819 ± 0.060 and adipose tissue accumulation 30.1 ± 6.1%, on average. About 19% of women obtained a very good work ability score, 55% good, 23% medium and 3% poor. About 17% of women were obese, 39% overweight and 44% normal body mass, 29% had abdominal obesity, 19% had elevated accumulation of adipose tissue and 21% had high accumulation of adipose tissue. These results did not differ significantly between perimenopausal and postmenopausal women The postmenopausal women obtained a significantly lower functional exercise capacity score than perimenopausal women. Conclusion. Work ability correlates positively to functional exercise capacity, which correlates negatively to adipose tissue accumulation in perimenopausal women with non-manual employment, but not in postmenopausal cases.