Petra Stute, this year you conducted the first Switzerland-wide survey on menopause in the workplace. Your study shows that one in three women reduce their work hours, takes an extended break from work, or even quits as a result of their menopause symptoms. What could be causing such a high rate?

Petra Stute: On the one hand, it’s down to the physical and mental struggles relating to menopause, which can begin to set in several years before menopause itself hits. Almost everyone we asked reported trouble sleeping, physical and mental exhaustion, irritability, depressive episodes, and hot flashes. Two thirds said they found it harder to focus at work as a result, while many said they now needed more time to complete the same amount of work they were doing before – and more breaks as well.

“There’s still so many people out there who think the menopause is nothing more than a few hot flashes.”

Petra Stute

But there are other factors involved, too. It could be that a mixture of health complaints combined with a lack of communication, awareness and support in the workplace is what’s causing women to cut back.

Could you give us an example?

Petra Stute: I once had a patient whose employer had told her she was no longer being productive enough due to her menopausal issues. The employer brought in a labor psychologist to look over her workflows with her – at a job she’d been doing for 30 years, mind you.

This kind of discriminatory action – not to mention derogatory comments from colleagues and superiors of all genders – can make a woman in this phase of life start to think she’s no longer wanted, or that they can’t cut it anymore. These thoughts are amplified by the way that many women’s hormone levels drop during menopause, leading to lower self-worth and greater levels of anxiety and insecurity.

“Thirty percent of women in menopause take the lonely decision to reduce their work hours, to quit their jobs, to turn down leadership positions, or to take early retirement.”

Petra Stute

On top of that, these women might be dealing with other burdens, such as caring for elderly parents or children in puberty. Out of a desperate sense of “I just can’t do this anymore!”, over thirty percent of women take the lonely decision to reduce their work hours, to quit their jobs, to turn down leadership positions, or to take early retirement. This can have severe financial consequences. Worst of all, in my opinion, is that there’s no discussions with employers on what can be done to enable these women to continue working – because there are solutions out there!

What can employers do to make sure they don’t lose their female employees during menopause?

Petra Stute: One important consideration is awareness and communication. Managers and employees should receive training to explain what the menopause entails and how to talk about it. There’s still so many people out there who think the menopause is nothing more than a few hot flashes. Communication is also needed in order to evaluate concrete ideas to help these women.

There are several easy-to-implement practices that can help, though they can take different forms depending on the type of work in question. Where possible, working from home or flexible working hours with flexible breaks are great ways to help these women. Regulations regarding uniform and work attire should be loosened so the women don’t sweat as much. However, I have to say that there is – on a global scale – a lack of scientific research into potential options for intervention.

What’s the state of international data on this issue?

Petra Stute: We’ve received reports from many different countries on how women in going through menopause are doing at work. The results are equally bad wherever you look: Women are suffering from a range of symptoms that are holding them back at work, most companies don’t care, and so the women are cutting back on how much they work. What’s missing in every country are scientific intervention studies on different measures that could be implemented in the workplace. This kind of research would give us a solid base of data to show employers the impact that different measures could have.

Where is there room for improvement on the medical side?

Petra Stute: Where we’ve been lacking in recent decades is putting the knowledge from research in this area into gynecological practice. This tied to a study on hormone replacement therapy published in the USA in 2002, which claimed that such therapy increased the risk of breast cancer, heart attacks, and strokes among women. Subsequent analyses of this study showed that these risked didn’t apply to all women or hormone types. Nevertheless, the negative headlines on hormone replacement therapy struck dead any discussion regarding gynecological endocrinology – it was avoided as a topic of discussion.

“From a medical perspective, the great thing about menopause treatments is that they have a very high success rate.”

Petra Stute

As a result, education in gynecological endocrinology ended up being neglected when training new medical staff. Gynecological endocrinology covers everything relating to hormones in women, from premenstrual syndrome to polycystic ovary syndrome, dysmenorrhea (severe period pain), and menopause itself. Medical training and education in this field today focusses mainly on obstetrics and operative gynecology. But when gynecologists set up their own practices, they find themselves speaking to a lot of patients with symptoms relating to hormonal issues.

Is your book, “Management der Menopause” (“Managing the Menopause”), which was published in May, a response to this lack of knowledge in practices?

Petra Stute: Among other things, yes. On the one hand, this is obviously the field I’ve been working in for many years, and a topic that fascinates me. But at the same time, I did want to create a practical guide for gynecologists who aren’t as familiar with the menopause as a field of study – a recipe book they can follow in their work.

Many people see endocrinology as an area of impenetrable, occult knowledge – especially when it comes to the menopause, where women often come to their practices with a huge range of different symptoms. With that in mind, I’ve broken down the fourteen most common symptoms one by one, and provided both hormonal and natural therapy options for each one. My aim is to make doctors say “Oh, it’s not that complicated after all!”. After all, from a medical perspective, the great thing about menopause treatments is that they have a very high success rate. Even when the patients I speak to think it’s all over, I can tell them: “No it isn’t! Things will get better again, and sooner than you think!”. There are a lot of therapy options available to us, both with and without hormones.

Menopause isn’t the only time women suffer at work – those who are still menstruating can struggle, too. Christine Bigler, you conducted a study into this on behalf of the City of Zurich. What were your key findings?

Christine Bigler: The first thing we noticed was the sheer number of people who took part in the online survey and described their situations in detail in the open answers – all in all, over 9,500 of the City’s female workers responded. This clearly showed us the need these women have to share their stories.

“70 percent of women experiencing severe menstruation symptoms go to work regardless; 90 percent take painkillers.”

Christine Bigler

What also stood out was that so many were affected by severe menstruation symptoms, such as headaches and stomach aches: The figure for this was 84 percent for the under-20s, and 63 percent across all age groups. 70 of those affected go to work regardless; 90 percent take painkillers. Talking about these issues is often taboo; One in seven women receive negative reactions when doing so, with comments such as “It can’t be that bad” and “Don’t be so difficult” being all too common.

Your survey also asked whether the women would make use of menstrual dispensation, i.e. paid time off work for such problems. 52 percent replied “Yes,” 13 percent said “No,” and 34 percent were not sure. What’s your assessment of these numbers?

Christine Bigler: We need to be aware of the distinctions between different results here. For example, there’s a difference between the responses of different age groups. Of the younger women under the age of 20 who experienced severe pain, over 80 percent said they would take menstrual dispensation. This percentage drops consistently as we go up in age. Women in professions that require a lot of movement or standing up were more likely to take menstrual dispensation than those who work sitting down. This is also linked to the fact that, in seated jobs, it is easier to adjust one’s working hours, take a break, or put a warm compress on one’s stomach than when working as a carer, for instance. 34 percent is a very high number for “undecided” votes. These women said that they would be afraid of negative reactions if they accepted menstrual dispensation.

A menstrual dispensation has already been introduced in Spain and a few Swiss cities. What are the pros and cons of this measure?

Christine Bigler: It’s important to note that there haven’t been any scientific evaluations on the impact of a menstrual dispensation as yet. Spain became the first EU country to introduce the measure in 2023, and Swiss cities such as Yverdon and Freiburg have followed suit, but the impact of this measure hasn’t been the subject of any scientific assessment so far. However, we do have some insights from scientific literature – theoretical considerations that provide controversial discussion on the topic of menstrual dispensation. These texts argue, for example, that menstrual dispensation could lead to increased discrimination in the job market, as it could create the impression that women are more likely to take time off work, and aren’t able to perform at the same levels as men. There are also concerns that women could abuse their ability to take time off work, and that the situation could lead to issues regarding privacy, as it would require them to disclose when they are menstruating.

“The acknowledgement that workers are not bodiless – that they have certain needs, which can be different depending on their gender – is a recent phenomenon.”

Christine Bigler

In terms of the pros of menstrual dispensation, one example is that it would lead to the recognition of menstruation as a part of reproductive health. This could destigmatize and normalize the issue, as such talk would no longer be swept under the rug. Incidentally, that was also a side-effect of our study among workers in the City of Zürich: It triggered a process there where employees and management could speak openly about periods. That’s an important first step.

Other countries have guidelines and labels to help establish a menstruation-friendly workplace. What do these look like?

Christine Bigler: Yes, the UK does have labels for menstruation-friendly workspaces, and in Sweden there are three level of guidelines for menstruation-friendly practices in the workplace. In terms of the physical work environment, workers need to have sufficient access to bathrooms that have menstruation products and sealable waste bins. When it comes to organizing workload, it’s important to ensure that workers can take regular breaks, or days off if necessary. And then in terms of awareness, there are training courses that workers of all genders need to take. Of course, certain professions require specific solutions. For female bus and tram drivers, for instance, there is the question of whether they have sufficient time to change their menstruation products when they get to the end of the line – And whether there are even enough bathrooms for them to do so. The City of Zurich has now written to restaurants, asking them to allow tram and bus drivers to use their bathrooms for this purpose.

Worldwide, 1.8 billion people menstruate every month. And half of the population goes through the menopause. Despite this, both topics are often considered taboo, at least in the workplace. Why would you say this is?

Christine Bigler: One explanation can be found in the work of sociologist Joan Acker, whose analyses showed us what the ideal worker looks like. According to her theory, the ideal worker is generally bodiless, completely independent (i.e. has no care obligations), and thus able and available to work at all times. The acknowledgement that workers are not bodiless – that they have certain needs, which can be different depending on their gender – is a recent phenomenon.

What approaches do you think we can take to solve this problem?

Christine Bigler: One interesting approach is currently being tested in Australia. The country’s parliament is soon going to reach a decision on whether to introduce “reproductive leave” for everyone, so employees of every gender can take up to twelve days per year off for a prostate check-up or PAP test, menopausal symptoms, vasectomies, and similar issues and procedures. The key here is that the worker would not need to specify the exact reason why they’re taking the day off. I think it’s an interesting approach, because this “reproductive leave” would be available to everyone.

There was actually a comment recently in a daily newspaper claiming that hiring women isn’t an attractive proposition for employers, because they could be absent from work firstly due to menstruation, then for parental leave, and eventually because of the menopause, too. What’s your take on that?

Petra Stute: If the idea of women constantly being absent of work becomes the prevailing impression, that really would be counterproductive.

Christine Bigler: That’s why we recommend always introducing menstrual dispensation in tandem with a destigmatization campaign, for example. Our survey data provided interesting results concerning menstrual pain: In spite of their pain, women don’t call in sick from work. Most of them take painkillers and go into work as normal.

Petra Stute: The other thing we can't allow to happen is the opposite extreme: forced medicalization. We need to make sure we never go so far that employers start forcing women with menstrual or menopausal issues to receive therapy to ensure they won’t be absent from work as a result.