Dear Agnes,
I’ve entered the lovely “M” stage in my life. I’m abbreviating it because that’s exactly how I use it at work with my close colleague who is also going through the same journey. It’s not a curse word, but it sure feels like one when it comes to bringing it up in the corporate world.
Yes, I’m talking about menopause. It’s a topic we still tiptoe around in this day and age, despite all the progress we’ve made in empowering women. I know first-hand that there’s still a big stigma attached to it, especially for those of us in the workplace.
I’ve been dealing with the typical symptoms – the hot flashes, the night sweats that often make it impossible to get a good night’s sleep, and the constant fatigue that seems to have settled in. I haven’t been able to concentrate, and my energy levels have dipped tremendously.
There have been quite a few days recently when I had to call out of work just to manage these symptoms. I wish I could just power through them, but sometimes staying home is the only option.
The higher-ups at my company have started to raise eyebrows at my performance and absenteeism, and they’ve already called a meeting with me to discuss it. I found myself chalking up everything to “one-time” illnesses, mentioning that I’ve been catching stuff from my school-age grandchildren that I often spend time with. This seemed to go over okay since everyone knows how germs spread like wildfire in school.
I’m afraid to tell them what’s really going on. I worry that they might perceive it as weakness and a sign of aging and decide to let me go. I’m holding onto hope that these symptoms will soon pass and I’ll go back to being the reliable, engaged worker they’ve known.
Agnes, if you were in my shoes, would you keep this a secret and let the natural process of life run its course, or would you share it with higher-ups in hopes that they’d understand?
Sincerely,
Menopausal
Dear Menopausal,
I used to believe that the glass ceiling was entirely down to sexism in the workplace, but having gone through menopause myself, I’ve revised my opinion. It’s a terribly inconvenient time in one’s career to feel debilitated, and the symptoms can creep up on us so incrementally that by the time we’re in the throes of it, the consequences are already serious. I feel your pain. I remember many mornings weeping in the kitchen as I tried to get my abjectly sleep deprived self together to face another day of work. And like you, there were some days I just couldn’t.
I would absolutely advise you to inform your employer that your absenteeism and lapses in performance are due to your menopausal transition, and I suggest you do so with a supporting letter from your family doctor or better yet, your OB-Gyn. Menopausal symptoms are no more a weakness than diabetes is. They are both hormonally based conditions. I see so many midlife women in my practice convinced they have an anger problem, or an anxiety problem, or a depression problem, or an insomnia problem. If the onset was recent, it’s quite often a hormonal problem!
There are a few compelling reasons to disclose your struggle, Menopausal. On a practical level, it’s much more difficult to terminate an employee who has disclosed a medical condition that’s impacting performance than it is one who’s making one-off excuses. It also opens the door to discussions about possible accommodations while you navigate this transition. On a psychological level, speaking into something one is trying to hide usually has positive impacts. Every feeling drives us to actions, and shame drives us to hide. Coming out of hiding often dispels shame we didn’t even know we were carrying. Finally, on a social level, it’s about time that workplaces be made aware of the challenges faced by women in midlife, and adopt more menopause-friendly policies. Many women, for example, benefit greatly from being able to work from home and/or set their own hours. The standard 9-5 just doesn’t work well when you may well have spent 5 hours of the night (typically in the middle of the night) awake from hot flashes.
I would also highly recommend talking to your doctor about the possibility of hormonal treatment. While there are some small risks associated with hormone therapy, I think we tend to negate the very real and substantial risks of long-term sleep deprivation and elevated stress levels we might incur by trying to tough it out. Sleep is fundamental to health, both mental and physical. For women who can’t take estrogen, there are other emerging options.
You don’t mention where you are in the transition, which can last upwards of a decade, so please forgive me if I indulge in a bit of a public service announcement regarding the stages of change as they pertain to The Change. For women who experience symptoms (and most women do, with sleep disturbances being the most common and most impactful on quality of life), perimenopause, or the years leading up to the cessation of menstruation, is actually the more difficult time. Sleep disturbances will usually start around the menstrual cycle, but tend to become more pervasive the closer a woman gets to menopause.
Endocrinologist Dr. Jerilynn Prior, a leading expert in perimenopause research, maintains that heightened symptoms in perimenopause happen because estrogen levels are fluctuating wildly, and can swing from much much higher than they are in our 20s and 30s to much lower. On average, they’re about 20% higher during perimenopause than in our twenties. For some women, they’re orders of magnitude higher. Progesterone, however, which happens to have significant anti-anxiety effects in the brain, drops off before estrogen, due to the increasing number of anovulatory cycles the closer a woman gets to menopause. Not surprisingly then, the mid to late 40s is when women are most susceptible to abusing alcohol, or being prescribed medications for anxiety and /or depression. Rage is not uncommon. I often advise women to wait out perimenopause, or at least treat the symptoms, before making any life-altering decision. I also advise them to educate their partners about the process. Once a woman graduates to menopause, a year after her last period, things start to stabilize, and symptoms generally decrease considerably. However, many women continue to experience insomnia from hot flashes, sometimes for years.
Unfortunately, research on perimenopause is scant compared to that on menopause, so if you’re actually in perimenopause and suffering, you may find yourself in the awkward position of having to educate your doctor about treatment options. To that end I suggest consulting this page of Dr. Prior’s website for up-to-date information about concerns and solutions for every reproductive stage of life, as well as this page. I’d also highly recommend her books, Estrogen’s Storm Season: Tales of Perimenopause, and The Estrogen Errors: Why Progesterone is Better for Women’s Health.
In loving support,
Agnes