Menopause at Work: What We Don't Say Out Loud

Menopause at work notepad trick · MD

Nobody talks about the notepad trick.

You know the one. You are sitting in a meeting, you feel the flush starting and you quietly pick up a notepad and fan yourself just enough to take the edge off hoping nobody notices. You have timed where you sit in the room. You know which windows open. You have worked out exactly how to get through the day without drawing attention to how you are really feeling.

You are still doing the job. You are still showing up. But it is taking everything you have got and nobody around you has any idea.

This is what menopause at work actually looks like for some women. Not dramatic. Not obvious. Just relentless, quiet, exhausting effort, every single day.

Why this is not a niche issue

I think about the women behind these numbers a lot and what a working week actually feels like for them, underneath the numbers.

Menopausal women are the fastest-growing demographic in the UK workforce. CIPD research from 2023, surveying over 2,000 working women aged 40 to 60, found that 73% had experienced menopause symptoms and of those, 67% said the symptoms had a mostly negative effect on them at work, touching concentration, confidence, attendance and career progression. Around one in six women told CIPD they had considered leaving their job because they felt unsupported, and 6% already had.

Sit with that for a moment. One in six women, quietly deciding some days more seriously than others whether staying is worth what it is costing them. Most of them will never say so out loud.

That career impact is not abstract here either. Women in Northern Ireland already report fewer opportunities for career progression than men and a persistent gender pay gap. A gap that tends to widen in the very age bracket where menopause hits hardest. I find myself wondering how much of that gap is simply women managing symptoms in silence rather than asking for what they need.

This is not a small problem. It is a significant workforce issue that most organisations are only just beginning to take seriously.

And yet the women living it are often the last ones to say anything. Not because they are not struggling, but because they do not want to seem dramatic, unprofessional or like they are making a fuss. Many have not yet connected what they are experiencing to menopause at all and that delay in understanding can cost months of unnecessary suffering.

What menopause at work can actually look like

It does not always arrive with a fanfare. Often it creeps in gradually, in ways that are easy to attribute to stress, age or just having a lot on.

Sleep disruption is frequently the first thing women notice. Night sweats can wake you repeatedly and even when you drift back off the sleep is light and fractured. Over time and research confirms this poor sleep affects memory, concentration, patience and resilience in ways that are very difficult to separate from your performance at work.

Brain fog is real, it is frustrating and it is one of the most commonly underreported symptoms. Losing your thread mid-sentence. Forgetting a familiar name. Struggling to focus in a meeting in ways that feel completely unlike you. Research suggests these changes are linked to hormonal fluctuation during the menopause transition they are not imagined and they are not a sign that something is seriously wrong. But they can feel deeply unsettling when you have built a career on being sharp and dependable.

Confidence takes a quiet knock. Some women become more hesitant in meetings, less likely to put themselves forward, more anxious in situations they used to navigate without a second thought. Others describe a low-level background unease that is hard to articulate to anyone who has not experienced it.

And underneath all of it the invisible management. Knowing where to sit. Planning what to wear. Timing when to take a break. Carrying extra water. Calculating, every single day, how to get through without anyone noticing. That effort is real and it adds up.

The moment things often shift

For many women, there is a moment sometimes years into managing symptoms when someone finally says the word menopause and everything clicks into place.

That moment of recognition matters more than it might sound. When you have a name for what is happening, you stop blaming yourself. You stop wondering whether you are just not coping well enough. You start looking for support rather than just trying harder.

If you are reading this and something is resonating that is worth paying attention to.

What actually helps

Let me be honest with you about something. There is a lot of generic advice out there about menopause at work. Carry a fan. Dress in layers. Stay hydrated. And yes, those things have their place but they are coping strategies, not solutions. They manage the surface without addressing what is underneath.

I keep coming back to a question, though: why do we ask women to manage this alone, with tips, when there is a structured, evidence-based way to change how the symptoms are experienced in the first place?

The "In Her Prime" CBT informed programme I deliver is recommended by NICE Guidelines and based on the research of Professor Myra Hunter and Dr Melanie Smith at King's College London. The same NHS-funded trials that formed the basis of the national guidelines. It is not a talking therapy and it is not generic wellbeing advice. It is a structured, six-session skills programme that helps you understand what is happening in your body, helps you to interrupt the cycle that makes symptoms more distressing and build practical strategies that work in real life including at work.

The breathing technique alone which I introduce early in the programme can make a significant difference in the moment a flush starts in a meeting, a presentation or any situation where you need to stay composed.

What strikes me most, working with women through this, is how early the shift happens. For many, it starts within the first few weeks not because the flushes have disappeared, but because they have less power. That distinction changes everything and it took me a while to fully understand why: it is not really about eliminating symptoms. It is about no longer being ambushed by them.

At the moment I deliver the programme in person, because I believe that for something this personal, face-to-face matters. It creates a calmer, more private space where women can talk honestly and feel properly heard and that environment is part of what makes the programme work.

What employers can do — and why it matters to your organisation

If you are an employer or manager reading this, I want to say something directly to you.

Before anything practical, there is a question worth asking yourself honestly: if a woman on your team were struggling right now, would she feel able to tell you? Not "would your policy allow it" would she actually feel able to.

You do not need to have all the answers. You do not need to become a menopause expert overnight. What you do need is to create the kind of environment where a woman feels she can tell you she is struggling without fear of being seen as less capable, less professional or less committed.

Practical adjustments are often simpler than organisations expect. Flexible start times. Access to a cooler workspace. Permission to take short breaks when needed. A private space to go when symptoms are at their worst. None of these things require a major overhaul. They require a manager who takes the conversation seriously.

This is not just good practice it is a legal responsibility. Employers in Northern Ireland have a duty of care under health and safety law to ensure menopausal symptoms are not made worse by workplace conditions and to make reasonable adjustments where needed. Where symptoms are severe enough to substantially and persistently affect someone's day-to-day activities, this can meet the threshold for disability under the Disability Discrimination Act 1995 as amended for Northern Ireland. The Irish Congress of Trade Unions, the Equality Commission for Northern Ireland and the Labour Relations Agency have jointly produced guidance and a self-assessment checklist specifically for NI employers wanting to review how their policies measure up.

But policy only goes so far. Beyond that, bringing professional health awareness into the workplace through talks, education and structured support sends a message that matters: that the health and wellbeing of your staff is not a tick-box exercise but a genuine organisational priority.

I offer workplace health talks and CBT support for organisations across Northern Ireland — both one-to-one and in groups. Where menopause awareness is already being supported through another trusted contact, I am very happy to work collaboratively to make sure women are guided towards the support that best meets their individual needs.

As a nurse and as a woman

I want to end with something personal.

I have been a nurse for over thirty years. I understand the clinical picture, the hormonal changes, the evidence base, the research. But I also understand what it feels like to sit in a meeting and will yourself to hold it together. To lie awake at three in the morning and dread the day ahead. To wonder, quietly, whether this is just going to be your life now.

I have been that woman.

Which is why I do not offer this work from a position of detached clinical authority. I offer it from a place of genuine understanding professional and personal and with the absolute belief that no woman should be managing this alone when practical, evidence-based support exists.

Fiona Brown is a Registered Nurse with over 30 years of clinical experience and specialist training in CBT for menopausal symptoms through the British Menopause Society, of which she is a member. She holds a BSc (Hons) in Occupational Safety and Health and a PG Cert in Practice Nursing. Alongside her professional training, Fiona brings her own lived experience of a challenging menopause to her work. She is the founder of Aroma Therapie Suite, a nurse-led women's health and wellbeing practice based in Dungannon, County Tyrone.

The information in this article is provided for general educational purposes only and is not a substitute for individual medical advice, diagnosis or treatment. If symptoms are affecting your work or wellbeing, please speak to your GP or another qualified healthcare professional.

References

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