UK: Working With The Menopause (Video)

With an estimated 13 million peri-menopausal and menopausal women in the UK workforce and the number of menopause related Tribunal claims rising, understanding its impact on women at work and your legal obligations as an employer is a must do. This on-demand webinar will walk you through the legal, practical and diversity & inclusion issues arising.

Transcript

Jane Fielding: Good morning. I am Jane Fielding and I am head of the Employment Labour and Equalities team here at Gowling WLG in the UK and I am delighted to welcome so many of you to this which is the second in our series of webinars when we take a look each year at what is coming down the tracks this year in 2022.

The topic for today is working with the menopause and obviously that cuts both ways. It is for people with the menopause trying to work and it is for employers trying to support people going through the menopause and at work. I think the fact that we are here today mentioning the word is a massive, massive progress from when I was growing up in the 70s and 80s when there were sort of dark mutterings about the change from older women which those of us knew, younger ones had absolutely no idea what they were talking about.

I am already engaging with my son and daughter about it and looking forward to the support I am going to get from them.

Things have moved on and that is a good thing and the fact that we have got 425 registered today shows it is clearly a very topical issue for all of you.

I am delighted to introduce our speaker for today who is Vivienne Reeve, one of the principal associates in our team who does a lot of work in this area for clients but also she runs our internal menopause cafés so she is very well placed to talk about this.

She is going to talk for about 25 minutes. We will leave time at the end for questions. As ever if we do not get to all of your questions we will come to you after the webinar so you will get an answer one way or another.

If you want to ask a question please can you use the Q&A function which is at the bottom of your screen? I normally say if you have got a technical question, pleased could you use the Q&A function too but as it typical of these things, our technical support today has some technical issues of their own so please do use it but you may be relying on me to help out on the technical aspects and as the team will tell you, that is not my strength but we will do our best anyway.

The only other thing I wanted to mention is at the end. We will circulate by email a feedback form. It only takes a couple of minutes to fill in. Please do that. I will flag it again at the end but we do use your input to work out what we are going to cover at future sessions so I will now hand over to Vivienne and go mute.

Vivienne Reeve: Thanks Jane. Hi everyone, I am going to talk to you about the menopause today - my favourite topic, and we are going to start off - hopefully you can see the agenda slide there - we are going to start and I am going to explain what the menopause is. Then we are going to look at the impact it can have at work. The legal backdrop and then how to lead as an organisation on the menopause.

The first thing I wanted to just flag is that the menopause is not one event. It is a kind of series of a phase that changes a woman's life so it is made up of the perimenopause, the menopause itself and then the post-menopause phase. It is part of the natural aging process for women and usually starts between the ages of 45 and 55. For most women it starts after having 12 months of no periods but, it can be triggered medically and suddenly by treatments like Chemotherapy or Endometriosis, or surgically induced if you have a hysterectomy. It can either be quite gradual or it can be very sudden. The impact on one woman can be very different to another and overall the main menopause phase can last up to about 10 years.

The perimenopause which comes before, is the transition period leading up to the menopause (the main event) and this perimenopause usually lasts around seven years starting in a women's mid-forties. Oestrogen and progesterone hormone levels start to change as you produce fewer eggs as a woman. I just wanted to flag as well the premature menopause which is something different and this is just to flag that one in 100 women under 40 will go through a premature menopause so it is not very common but it is not super rare either.

I wanted to walk you through some of the symptoms of the menopause. This was my very first lesson in understanding what the menopause was about when I went to my first menopause café two years ago. It is really not just about the hot flush as many women and partners and colleagues will know. There are 34 recognised symptoms which is way more than I had anticipated and they cover mind and body. The mind's part first in purple; brain fog is very commonly cited and brain fog if you have not experienced it is a bit like trying to pull your thoughts out of a barrel of treacle. It means that your brain is just going so slow you know that you need to be thinking about something and you cannot think what it is but you know that you are not quite there.

Then I think the next two most common or three common are depression, anxiety and loss of confidence. All of the support groups that we have run and experts that I have spoken to and heard from, these three are really key and often they come hand in hand with the physical symptoms but often they are the more challenging to deal with.

There can be a loss of concentration, reduced self-esteem is also quite common. Irritability, mood swings and insomnia and then, the more physical, if you want, manifestations can be anything from painful joints, headaches, vaginal, urinary and gastro problems, thinning hair, change in skin condition, new allergies, all sorts of things, change in body odour and so it made me wonder how does it affect all of these things and the reasons that there are oestrogen receptors all over a woman's body and as you go through the menopause your oestrogen level declines and so what was previously nourishing the brain, all of your essential organs, your bones, your thermostat, all of that starts deteriorating so that is why it affects so many different things.

How does it impact you at work? Well it directly affects half the population, just over half are women and it indirectly affects the rest. Women over 50 are the biggest growing demographic at work and there are estimated to be around 4.9 million menopausal women in the workplace and counting because that demographic of over 50s is increasing.

There are a number of really interesting menopause at work or menopause studies. CIPD did one just over two years ago which reported that 59% of women felt that the menopause impacted them negatively at work which is a lot of people. Obviously the number of women in any organisation is going to vary depending on the industry and what it is that you do but that is a high proportion of your workforce.

There is also a study called the Newson Study which rather depressingly recorded that only 14.5% of women felt that they received any support or advice at work, but as Jane said things are on the up and are improving so I think we have got cause for hope that that will be improving shortly.

What I thought I would do is just take a couple of common symptoms and talk through a couple of common areas of people management. The first one is a question about how your symptoms or how a woman's symptoms might impact on performance.

Let us imagine you have got brain fog. It is something that menopausal women have. You might have experienced it if you have a chronic disability, it is incredibly frustrating. At best you can get through it and it might just be a phase of a couple of hours or a day or it might be much longer where you just can't get your brain to work, you can't remember things very well and you can become quite forgetful.

It is a really challenging thing to have to deal with. It can mean a loss of concentration because your concentration is even more fleeting sometimes than normal so if you get an email pinged up or someone calls or the postman comes and you are working at home, all these things can completely interrupt your train of thought which was already a bit sketchy.

That understandably can lead to a loss of confidence and then it can impact on your day to day work. It might mean that you are making more errors because you are not able to think completely and immerse yourself in what you are doing. It might mean that you are working slower because your brain is taking longer to get through an exercise, but also you might be trying to double and triple check things because you are anxious that you are not quite working at par, or it might be that you are just not engaging properly with work because you just cannot get through the fog.

I have chosen brain fog because we have talked about this a lot in our networks and menopause cafés and what women have said is that it really impacts their perception of their value at work, their chances if they have got enough energy to go for a promotion and that links into the gender pay gap because it is relatively well accepted that the gender pay gap is not too bad until it is about late 40s and then it drops off a cliff somewhat and it is no coincidence that that is the age that many women are maybe struggling with the perimenopause or the menopause.

We have got all of that, then if you add into that the worry and insomnia, you can see how that can really impact on your performance at work.

If we have a look then at conduct, let us pick another symptom, let us say irritability on top of a couple of other things. It might be that you are usually perfectly able to deal with communication and the people you work with but, let us say that you have not been sleeping and you are feeling particularly irritable over something that you would have taken in your stride it leads to an outburst so you lose your patience.

It might be however out of character and then that is dealt with as a misconduct issue as we will see in a minute when we look at some of the cases and, rather than trying to get to the bottom of it you could see perhaps that that might lead to a warning or something worse depending on what the outburst was and who was listening etc. That then adds to your pain, your physical pain perhaps, but also your mental pain. You are just trying to deal with this and the fact that you have been perhaps sanctioned for something that you do not really feel is your fault.

The last thing I wanted to look at then is absence which is a very common issue with menopausal symptoms. Let us pick some of the really embarrassing symptoms of incontinence which is a fairly common symptom. Itchy skin; we have some women in our network who is not just a bit like having a bit, it can feel like your skin is really burning. It is very difficult to concentrate and not scratch your skin and body odour because body odour can change and I think everybody is, most people are, quite conscious of body odour anyway so to feel it has changed and you are not quite in control of it is really difficult.

These kind of embarrassing symptoms might mean that when we get back to work more commonly in the office or perhaps when you are supposed to be in the office rather than working from home that could be something that means that you do not feel confident enough, you do not know if you are going to be near a bathroom, it is just too much so you take some time off.

Depending on how much time you are taking, that could lead to an absence management process. You can then feel demoralised by that, or you could see how somebody could, then the relationship between employee and employer could deteriorate. That might lead to a grievance or worse so these are obviously the worst case scenarios. It is not going to happen in every situation but it leads into the tribunal cases that we are going to have a look at to explain how we get there.

The first case was from 2018. It is a tribunal case so it is not binding but it is guidance and I think there are relatively few cases that get all the way with menopause. I thought it was an interesting one to start with. Miss Davies was suffering from extensive menopausal symptoms. Maybe bleeding, anaemia, memory loss, stress, palpitations, anxiety, the list goes on for this poor lady. She worked in the Scottish Courts and Tribunal so she was working in the court setting.

She was taking medication for some of her symptoms and the medication she had to dissolve in a jug of water. She had left this on her desk. When she came back into the courtrooms she saw that there were two men who seemed to be drinking from her water jug. She panicked and thinking oh gosh that has got my medication in so she told them. They did not react well. One of them reacted very badly, lost his temper and ranted at her and her employer, the Scottish Courts, launched an investigation into her conduct and what had happened with this medication, and sadly and frustratingly they carried out an investigation and it came out pretty quickly that had the medication been in the water, it would have changed colour, it would have changed pink and it had not, so they were concerned about why it seemed that she had not realised now.

Now instead of perhaps putting it down to error, they had decided based on the investigation they did, that she had deliberately lied about it. She was dismissed for gross misconduct which is quite a concerning outcome. She brought a claim in the tribunal for unfair dismissal and disability discrimination and the tribunal found for her and they found that it was not a reasonable belief that she had lied during this investigation.

She had become confused and stressed and for the employer to focus on the belief that she had lied rather than accepting her evidence that she had become stressed and they acknowledged the fact that actually that her condition could cause memory loss and panic and they also found that she had been discriminated against not because of the disability itself with her condition but because she then had a tendency to forget and be forgetful and panic and have anxiety about this.

I think this is a good example. We would all hope it would not get anywhere near this far but unfortunately it did and it is a couple of years ago and I think things are moving on at pace with understanding the menopause but it was quite an extreme reaction I thought to something that could have quite easily been explained.

The second case was from last year so it is more recent and it is from the Appeal Tribunal which is helpful because it is binding to other tribunals in a similar situations. So the case was Miss Rooney and Leicester County Council. This lady was a social worker and, she had several periods of absence due to menopause related symptoms and stress. She had even more symptoms then our previous lady; insomnia, fatigue, dizziness, stress, palpitations, migraines, hot flushes; she had the works.

She was having treatment under a consultant and receiving help for that and her employers were trying to support her going through the occupational health at work as well. There were a number of things that led to the relationship breaking down one of which was that when she as going through the occupational health assessment process, the assessment was carried out by a man which she found very difficult because some of her symptoms were very personal and embarrassing and she had asked for somebody else but it was not possible. Her manager, she felt, was dismissive of some of her symptoms. She talked about having hot flushes and he said oh yes I get hot too and I think possibly he was trying to emphasise with her but that is not how it came across and she was given a written warning for her absence levels in front of four men which I think she found particularly distressing.

So the case history is a little complicated because there are two claims, one where she had Solicitors and then she put in a new claim herself but essentially the bit I want to focus on was the dismissal issue. So she claimed constructive dismissal and sex and disability discrimination. Her case was struck out initially by the tribunal because they said she was not disabled. They did not accept that her menopausal symptoms amounted to a disability and they thought that her sex discrimination claim did not have any prospects of success and they were reasonable prospects rather.

She appealed to the Employment Appeal Tribunal and they found for her and they said that the tribunal had not properly analysed her case because they acknowledged the fact that she had become really forgetful. She forgot to attend events, she lost things easily, left the iron on, left the cooker on, all these different things but they did not accept that all those things or even some of them put together amounted to a substantial impact. So for disability discrimination, remember we are looking at the definition it has got to a physical or mental impairment. It has got to have a substantial impact on day to day life and be likely - already lasted 12 months, it will be likely to last 12 months.

So although they acknowledged all these symptoms which were quite serious - they then did not follow through and accept that she was disabled. But they did not explain why. So it has gone back now to a new tribunal and it is due to be heard next week. We are all looking out to see what happens.

There was another case that came out just this week which is quite exciting - about a lady - less dramatic - but, interesting I thought so I will share it with you quickly. This lady Miss Best worked in a pet shop and there was a customer who came in and at the tills she talked about having a hot flush. I imagine because she was trying to find her wallet or remember what day it was or any of those things that go along with hot flushes.

Afterwards, after she left there was a conversation between staff about this and Miss Best said I do not want to hear about it, I do not want to hear about it. I do not want to talk about menopause, I just do not want to think about it.

But her manager kept talking to her about the menopause and then asked her if she was being menopausal, which she did not take particularly kindly to and it was found - so she complained and to his wife who was also there, another boss said 'you took that very badly' and then told her off for making trouble and to just get on with life.

And the tribunal found that that amounted to harassment because she had made it very clear she did not want to talk about it and they kept talking about it and then asked her if she was menopausal.

So I thought that was an interesting update and I think really/probably? Most of us would know not to push that button. I do not know why they did really, but anyway.

I wanted to just talk then, through about these legal obligations that are relevant when you are considering workplace menopause issues.

So the first one is health and safety. Employers have a duty to protect the health, safety and welfare of employees and any other people who might be affected.

The second one is the duty of trust in confidence which sits between employees and employers and it works both ways, but you have a duty as an employer not to breach that trust that your staff place in you and then the third and most relevant one which are going to talk about in most detail is, protecting from discrimination.

The question is, what kind of discrimination?

Last year, the government opened an enquiry into the impact of menopause at work. Which was really good news because it really does need to hear and consider whether women are properly protected.

The issue at the moment is that there is no clear route to use if you consider that you have been discriminated against because you are going through menopause. There is no menopause characteristics.

So, women have to rely on a combination or any of: sex, age or disability discrimination. None of which, really work. Why do they not work? Well, because if you are going to bring a sex discrimination case and it is most likely going to be a direct discrimination - so I have been treated less favourably than you because I am a woman going through the menopause and you are a man, then you have to choose a comparator if we are talking, let us say, go back to our example about being sanctioned or dismissed for absence because of menopausal symptoms, well your comparator would likely be a man with a health condition with similar absence levels.

Would he also have been dismissed? Probably, in those circumstances he would. That does not get you anywhere.

Age is difficult because women go through the menopause at all different stages of life, although the second part of a woman's life, as you see from the beginning, perimenopause can be seven years, the menopause can be ten and then you have got postmenopause so it is difficult to get the right age group.

Most of the discussion, is about whether you can fit a claim into disability discrimination and I was part of the employment lawyer's association working group that put in a really detailed response to the government and we looked at tribunal statistics, the practicalities of how women cope at work, all sorts of things.

I thought it was relevant to just pinpoint a couple of those bits for you today. As you can see on the slides, we looked at the period 2017 to 2021 and out of nearly 79,000 tribunal claims at that time, there were only 44 decisions that talked about menopause - had the word menopause in.

In some of those, it was just mentioned in passing. There are 27 relevant decisions where it is talked about in a bit more detail and there are, of the ten cases out of that where disability was properly looked at as an issue, only three cases did symptoms amount to disability.

You might think, well why are we getting worried about this if there is only a handful of cases, it is a drop in the ocean. The reason is, that all of the evidence - CIPD surveys, the Newsome survey, the Leicester survey, there is lots of research been done in the last couple of years, they all show that the tribunal numbers do not show the full picture at all.

There are a lot of issues/workplace issues and there are a number of reasons why that number is so low for tribunal claims.

Partly it is because there is no clear path, you cannot just pick the menopause characteristic and although we are doing brilliant work now as a society I think, Mariella Frostrup's all over it, she has got a new book out. Davina McCall - fantastic programme on TV last year, it is still quite embarrassing? Some of these symptoms are so, so embarrassing and it is still quite taboo and I think there is a fear of how you are seen. Do you really want to bring a claim and be cross-examined possibly by a man in front of other men in a tribunal. There is lots of reasons why those tribunal numbers do not reflect the issue.

So coming back to disability, as I mentioned before, the disability definition is mental or physical impairment. The first thing that was talked about - so last week (this is a geeky thing, but exciting for me) the women in equality select committee had their live parliamentary session on this and Marian Bloodworth from ELA (Employment Law Association) was talking about our research that went back to the government.

And one of the things that was discussed was this very first definition, so mental or physical impairment. Do we really want to be using impairment when we are talking about the menopause? We do not use the word impairment when we talk about pregnancy and maternity. We have a separate characteristic for that.

If we are talking about disability, the first thing when you Google menopause and disability is it will say, whatever it is 'oh well menopause is not a disability, it is a normal part of a woman's life'. Well it is, but this is also part of the problem.

It can be really difficult to find the evidence to show that you have suffered from these symptoms and that they are long-term, as some of the cases does show. Partly because - there are lots of reasons - but partly because so many of the symptoms I think, I certainly have them, I think a lot of people do not naturally associate with the menopause so you would not necessarily go to your Doctor and say, I seem to be having a real incontinence issues and then say, 'oh do you think you might be aged with menopause' because it does not obviously link to it and also, because GPs, amazingly, do not have to actually study the menopause as part of their training at all.

It might be that you do not know to ask about it, it is too embarrassing to ask about, it might not be on your records because you have not been to your GP or because your GP did not think to put it down or ask about the menopause.

That is a real barrier I think, to being able to prove that you have got that evidence.

Before we move on, I just wanted to recap really, that the menopause is not a disability but it does not matter, because the symptoms of the menopause might be. Either on their own if they are really serious or when joined together with some of the other symptoms that people might have to deal with.

As a take away, what I think we need to be doing is, considering the impact of people's symptoms that could have on any aspect of the employment relationships - so whether it is attendance and time-keeping, whether it is how you have conversations and banter and true to everything about your performance, your productivity, whether you can remember things, your ability to do specific kinds of work even.

And I think the usual rule should apply, it is a bit like some of the conversations we have had about supporting with mental health in the last number of years, is that when you are looking at something - an employment issue - just bear in mind, could this be - because of a disability, could it be because of the menopause? And factor that in and then possibly think about whether you need to factor that into a conversation.

The good news is, it is not that difficult actually to help somebody who is suffering at work or working remotely. All of the conversations we have had, look at ACAS guidance and there is lots of information out there, it is the small things often that make a really massive difference and as with many kind of disability issues, often the reason the adjustments are not that costly at all, it just takes a bit of thinking.

What I put on the slides is what we have learnt over the last couple of years as a firm and also in running our networks and working with clients on menopause. The first thing is that it really needs to come from the top. It is not good if this is just an employment bit or a HR bit, it needs to be coming from the top in that management need to understand that this is a risk issue, just as pregnancy is an issue, just as an any other health issue due to health and safety. This is an issue that both management and risk teams need to be thinking about.

It needs to be part of equality training. I know not everybody has the benefit of having an HR team or an equalities team but there is lots of material and we can help with that sort of thing. It is not that difficult but the key is, it needs to come - people need to know it is not just a niche thing and it is not just a women thing. It is a firm. It is an 'everyone thing'.

The physical adjustments that we have talked about and we have put in place in our firm which seems quite commonplace are things like, thinking about where women sit? Some women need access to be able to go to the bathroom more easily, access to fans just to cool the air down, access to bathrooms and rest areas.

It is often what people need is just the ability to just go and be somewhere where they are not going to be interrupted, they do not want to be in a sick room and do not necessarily need to be. They just need to get outside from where they are working, perhaps take a few layers off, cool down or just power down to get rid of that brain fog for a while.

And then, adapting how we work - so processes, perhaps allowing more time for people, not giving people such short deadlines if you know that they need a bit of extra time around the site - a bit like support many of us are providing in terms of mental health.

I thought I would end with what is coming up. Hopefully, at some point, we will get a response to the government enquiry and the evidence that we and lots of other organisations put in about where the menopause is effectively managed and looked at at work.

One of the outcomes that was proposed is that we have a new menopause protective characteristic under the Equality Act. To recognise the fact that it is not just sex, it is not just age and it is not just a disability, it is about all three.

And I do not think this is, as big a leap as it sounds because we do have one for pregnancy so we could recognise that and do something similar for menopause. There has been so much campaigning done over the last couple of years, I have forgotten her name - the M.P. there is a female M.P. who is doing amazingly well, she took the campaign to parliament a couple of weeks ago and HRT costs are going to be subsidised which is fantastic.

And I think more employers are being vocal about the support they are giving, so Kellogg's and ASOS and all sorts of other employers are offering paid menopause leave and support and I think this is great because the more it is talked about and the more it is just another workplace issue, the better we will be able to help people thrive at work and stop people being absent and feeling like they have got to leave work early when they have got plenty more to give.

So that is it!

Jane: Great, thanks Vivienne. Caroline Nokes was that lady, one of our guests has just put that on our chat so thank you very much.

Vivienne: Thank you.

Jane: Yes, I remember her talking too, yes, very very compelling. We have had loads of fantastic questions, I can see now we are going to struggle to get through all of them but we will do our best. One I can answer very quickly while you take a drink Vivienne, because you answered it which was, 'am I right that no extra protection in law exists yet but just using existing law regulations', so yes as you explained at the moment we are trying to shoehorn it into one of the existing characteristics and we will see what changes.

There is a question which I think we always get do we not? Do men have a menopause?

Vivienne: They have the andropause. So there is a change in men as well, from the age of about 30-40 their testosterone starts reducing about 2% a year on average but the difference is it is a very gradual - I hate the word decline, but - decline and there are not really any key symptoms that make/cause difficulty really. So it is not the same as the menopause really at all.

So they do similarly go through a change, but it is much less dramatic.

Jane: Yes, okay. We have got a few practical questions. The first one, if you have got someone in your team or your HR and somebody else has come to you and said I think this person is struggling a bit, I think they may be menopausal, how do you approach that conversation? And indeed, should you even link what is considered menopause?

Vivienne: Yes, that is a really good question. Thoughtfully but it is not that difficult actually. I think the first thing is, to bear in mind it is good that somebody has asked the question and noticed, that is brilliant. I think the thing to think about first is that it could be menopause, it could be nothing to do with it. And it might be that that person wants to talk about it and has been waiting for somebody to notice or it might be that they would just die inside slightly if somebody mentions it and they have got no interest in talking about it at all.

I think the way I would come at it, and having discussed it with one of the leading menopause experts, Diane who we have in to work with us sometimes, the best way to go at it, is sideways. So rather than putting your two feet in straightaway asking if somebody is menopausal, which is not likely to go well, I think it would be arranging a coffee or a chat or a walk even, whatever you can manage at the moment, to just say is everything alright? I have noticed that you have been off lately or you have not quite been yourself and just invite somebody to talk if they want to and I think it is unlikely - it is a bit like having conversations when you are concerned about someone's mental health, it is not that likely that you are going to get all the information and there is going to be this great chat the first time, it might be that you come back to it again in a few days' time or the next week or something like that or that they then go to talk to somebody they feel comfortable talking with.

And I think, a bit like mental health, you need to know, who is the best person to have that conversation? Because it might be that they are ready to talk about it and they are not bothered about how embarrassing it is at all, they have just not quite got round to it and it might be they really do not want to talk to somebody young or somebody male, they would like to talk to somebody who is more of that age who might empathise so I think coming at it from the side perhaps rather than putting your two hoofers in and just saying, is everything okay. Is there something I can help with and you then link them to somebody who can help them out.

Jane: Yes. So like you would with any difficult subject first and foremost you go to misc. , yes. There is a question from somebody who is obviously thinking about gauging how people feel about it and how it is affecting them in the workplace which is, how would you approach/conducting a study in the workplace to understand how menopause affects members, given it is a sensitive topic and, it may set the wrong tone, look intrusic to target particular people for their views?

Vivienne: That is really interesting. A really good question. I think the way to do it would be, and Jane would have a view on this as well, but I think my view would be, it is a good idea to try and get - turn the water and find out - because until you know, how many people it is roughly affecting and how it is affecting them, you might be putting in things to change something that does not need changing and focussing your energy in the wrong place.

I think perhaps some kind of questionnaire is a good idea. I think probably something in anonymous or with the ability to be anonymous but also to everybody because as a said at the beginning it affects women directly but it also affects everybody else. One of the things that we found for the work we have been doing, is that there is so many men who know about it. They know something, they want to do something, they have not got a clue what to say, much like women but they do not want to say the wrong thing and actually they are having to deal with it indirectly because their spouse or their sister or their colleague at work is potentially going through it and they need some help as well?

I think I would have something that asked questions broad enough that you could get both perspectives? What do you reckon Jane?

Jane: Yes, no I agree with that because I think we also, right though it is that we are focussing on it and in many workplaces and society there is a greater willingness to talk about it, even though as you said rightly Vivienne earlier some of the symptoms are embarrassing to talk about and people would probably prefer not to, I think we have to remember that not everybody experiences it in the same way? In the same way as some lucky people have a very easy pregnancy, a very easy birth, some people go through the menopause very easily so we certainly do not want to get into stereotypical assumptions, which in itself would trigger a harassment claim if you are perceived to be menopausal and you were not.

I think it is having an open mind and sensitivity and emotional intelligence, like many of these difficult issues in the workplace.

Vivienne: Yes.

Jane: We have got time for a couple more and they are still coming in, which is great you have clearly struck a theme here.

Somebody has asked, whether in the consultation that is going on, I guess on the back of the women and equalities committee work, if endometriosis is also being considered, given that there is quite an overlap with the symptoms of the menopause? Do you know if that is being looked at?

Vivienne: I do not know actually. I will have a look at the submission that was put in. I know that there is some overlap and it is one of the reasons why/that can trigger a really sudden, fully difficult menopause but I do not know actually. I do not remember that coming up specifically but it might have done, so I am happy to look at the paper again and update on that.

Jane: And there is a sort of allied question, which is - would you advise employers to have a specific menopause policy or general guidance on how to deal with a range of medical conditions, including the menopause, endometriosis, so other gynaecological conditions that can impact any stage of life.

Vivienne: That is a good question. I think the most important thing - policies are definitely helpful because they show that there is an awareness and there is somewhere where you can go, for staff to look at something and you can see that it has given seriousness to warrant a policy. I do not think it matters too much whether it is part of a broader policy or not. I think the key is, that you have the support and have the learning available and what we all want to avoid is putting the effort into making policy and then maybe taking no notice of it, which would be the worst thing.

The things that we have found really have helped is, we have got a little - on our intranet - we have got a policy site. It is not a policy per se, in that it is five pages long but it is a site where we share guidance and there is an information section about a little summary about what we have started with today, about what the menopause is and how it can affect people so that people can very quickly see that it is really not just about hot flushes and it is a lot more serious than that.

I think there is definitely merit in having a policy and certainly something like whether it is - I do not know - the only thing about a policy encompassing other gynaecological issues is that whether that accidentally reinforces the view that it is a women's 'thing'. I do not know. But either way, either that or a wellness or wellbeing policy? That kind of thing I think? Because as your question suggests, the issue is the awareness and how to deal with it, because broadly it is whether it is disability or not, it is all the same sort of thing it is just that there are certain specific issues if it is the menopause. But yes, I think the learning point is absolutely critical, whether it is in a policy or otherwise.

Jane: Sure. And even if it is not a disability, it does not mean it should not be supported does it? We do not tend to try and get into that analysis in the early stages.

Vivienne: Absolutely, it does not really matter I think, as you say Jane, the important thing is, does somebody need help? Yes! Well, how can we do it? How can we give them the help that they need?

Jane: Okay. Great! As predicted, we have not got to all the questions and they are still popping up so we are going to have to draw it to a close now, but as I said, we will follow up with you if your question did not get answered and was not one of the ones we were able to pick up.

Thank you very much to you all for dialling in today, hopefully you have learned something and it was useful but please do fill in those feedback forms which you will get via email so we can gauge that for sure.

And please do join us next Tuesday, same time - 11 o'clock when we will be doing the third of our webinars, looking at the legal and other issues that arise from hybrid working.

Thank you very much to Vivienne, thank you all and have a good rest of the day.

Vivienne: Thank you.

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