Women in the workplace

It is well recognised that women suffer from inadequate career progression and pay disparity in the medical workplace. Misogyny and overt sexism are significant contributing factors, however other drivers also exist that hinder women’s progress.

Historically pregnancy and being a parent have disproportionately disadvantaged women. We know that more equitable societies such as Norway and Finland have addressed this with progressive childcare and flexible working policies, subsidised childcare provision, and generous parental leave for both parents. The NHS, as an employer, has developed numerous polices and made significant adjustments to address the impact of pregnancy, maternity leave and being a carer; as such, some progress has been made to minimise the impact of motherhood on a woman’s career. These changes are by no means comprehensive and continue to warrant further advances, but the conversation at least now acknowledges this important barrier.

I would suggest that all women face gender pay disparity and issues with career progression, not just those with children

However, my ability to progress in a medical career should represent more than ensuring I can reproduce should I want or be able to. The average woman in the UK spends less than five years of her life being pregnant, yet more than 20 years being middle aged or older [1]. Focusing on a woman’s working life around childbirth and subsequent childcare responsibilities contributes to the goal of achieving an equitable workplace, but fails to consider women outside childbearing age or those who do not have children. I would suggest that all women face gender pay disparity and issues with career progression, not just those with children [2].

In contrast, the workplace is only beginning to address how the ‘normal’ physiology of being a women can impact on our working lives. It was after reading Crichley et al.’s thought-provoking article in 2021 that I seriously considered how menstruating and the menopause may impact on my ability to perform at work [3]. One in five women of reproductive age experience heavy periods [4]. Not only can this affect women by contributing to anxiety and depression, anaemia and absenteeism, but it may also impact on how they function within the workplace. Recently I considered where I could obtain period products in the workplaces in which I had trained. Currently there is a shop with limited opening hours where I can purchase these during the day; however I couldn’t identify where I could access any of them out-of-hours. It was announced in March 2022 that all Health Boards in Scotland would provide free period products for healthcare workers, following on from the Period Products (Free Provision) (Scotland) Bill 2020, but this reform has not been replicated elsewhere in the UK. Notwithstanding the need to always be prepared and to plan appropriately (as was so helpfully recommended by a man on Twitter responding to a BBC article on the changes in Scotland (Box [5]), unfortunately menstrual bleeding is not always entirely cyclical or predictable. The thought of being caught short whilst on a solo list, or having very heavy bleeding, referred to by Dr Jen Gunter, Canadian gynaecologist as a ‘supersoaker event’ [6], is something even the best planned coffee break cannot account for.

The average age of women working in the NHS is 43 years old, thus approaching menopause. The constellation of evolving symptoms that women can experience as part of the menopause extend beyond the impact of heavy bleeding. While some women do not suffer significantly during the menopause, one in four will consider leaving the workforce due to symptoms. A 2019 survey conducted by the Chartered Institute for Personnel and Development found that three in five menopausal women were negatively affected at work, with nearly two thirds reporting that they were less able to concentrate [7]. Thirty percent had taken sick leave for their symptoms, of whom only a quarter felt able to tell their manager the reason for their absence. Women of menopausal age are the fastest growing group in the workforce and, with a rising state retirement age and the government drive to keep us in the workforce for longer, this will only increase. As highlighted in a 2022 UK Parliament report, these women are experienced and skilled role models who often receive little support with menopause symptoms [8]. While the national conversation has moved forward to consider the impact of the menopause on working women, earlier this year the Government rejected this report’s recommendation to make menopause a protected characteristic as it was felt this could lead to “unintended consequences which may inadvertently create new forms of discrimination, for example, discrimination risks towards men suffering from long-term medical conditions” [9].

In order for women to truly succeed in the medical workforce, we need to be building the workplace around their needs as much as their male colleagues.

Instead, local organisations are starting to consider the impact of the menopause on their workforce. My own employer has suggested that it will offer reasonable adjustments and flexible working (although I am unclear how that works in anaesthetics), ensure menopause is recorded as a reason for being off sick to capture accurate data on the workforce impact, embed a culture of support rather than embarrassment or stigma, and ensure managers are trained to consider the influence of menopause in their workforce. While this is a start, I wonder how much local changes will have an impact on the burden aging working women face, especially in medicine.

So why have these issues not been addressed before now, when they significantly affect a considerable proportion of the workforce? I would suggest that this is in part a consequence of how raising these issues can be uncomfortable, especially in a workplace environment where these topics can be minimised or joked about. However, failure to deal with the impact of menstruation and the menopause on working women makes the NHS a more difficult environment in which to thrive. In order for women to truly succeed in the medical workforce, we need to be building the workplace around their needs as much as their male colleagues.

Helen Laycock
Consultant, Department of Anaesthesia and Pain Medicine
Great Ormond Street Hospital, London

Twitter: @hlaycock

References 

1. Royal College of Obstetricians and Gynaecologists. Better for women, 2019. https://www.rcog.org.uk/betterfor-women (accessed 29/4/2023). 
2. NHS Employers. Age in the NHS, 2019. https://www.nhsemployers.org/system/files/2021-06/Age-in-the-NHS-infographic.pdf (accessed 29/4/2023). 
3. Critchley J, Schwartz M, Baruah R. The female medical workforce. Anaesthesia 2021; 76 (Suppl 4): 14-23. 
4. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE Guideline [NG88], 2018. www.nice.org.uk/ng88 (accessed 29/4/2023). 
5. Twitter. Thread, 2022. https://twitter.com/ultimapaul/status/1484889772443250697 (accessed 29/4/2023). 
6. Huffpost. 7 menopause truths Jen Gunter want all woman to know 2021. https://www.huffingtonpost.co.uk/entry/facts-about-menopause-manifesto-jen-gunter_ uk_60a52ce1e4b09092480b563c (accessed 29/4/2023). 
7. Chartered Institute for Personnel and Development. Majority of working women experiencing the menopause say it has a negative impact on them at work, 2019. https://www.cipd.co.uk/about/media/press/menopause-at-work#gref (accessed 29/4/2023). 
8. UK Parliament. Menopause and the workplace. First report of session 2022-23, 2022. https://publications.parliament.uk/pa/cm5803/cmselect/cmwomeq/91/report.html (accessed 29/4/2023). 
9. House of Commons. Women and equalities committee. Menopause and the workplace: Government Response to the Committee’s First Report of Session 2022–2023, 2023. https://committees.parliament.uk/publications/33631/documents/183795/default/ (accessed 29/4/2023).

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