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Menopause health checks

1. Menopause Health Checks.  Key Features.

CONFIDENTIAL

60 minute menopause health consultations with the ~23% of your employees who are women aged 40-60.

RELIABLE

Biometric measures taken with clinically validated and regularly calibrated equipment.  NICE accredited calculation of physical and mental health risks.

ADJUSTMENTS

Identify and adjust for the effects of menopause symptoms on the performance of ~6% of your employees.

LIFESTYLE

Help your employees to help themselves make lifestyle adjustments to better manage their menopause symptoms.

TREATMENT

Help your employees to obtain the most effective menopause treatments from their GP.

2. Menopause Health Checks.  Why Invest.

 

Promote:

The menopause is a major clinical event experienced by all women.  On average, 23% of all employees are women aged 40 – 60 and likely to value the education and awareness provided by a Menopause Health Check.

  • The importance of lifestyle in determining the severity of menopause symptoms cannot be underestimated.  Menopause Health Checks can be an excellent opportunity for your employee to review their lifestyle.
  • Menopause Health Checks can equip your employee with the knowledge they need to obtain the most effective treatment from their GP or an alternative menopause specialist.

 

Protect:

Knowing.  Menopause symptoms are severe enough to affect the job performance of between 44%1 and 99%2 of UK menopausal women (other surveys report at the mid- to upper- end of this range3,4,5). So on average, menopause symptoms are affecting the performance of between 4.4% and 9% of your entire workforce6, and you are expected to know this when you could reasonably have been expected to do so.   However;

    • 70% of employees with menopause symptoms will not have discussed their symptoms with you5 mainly because of fears that they would be admitting to being incapable of doing their jobs properly3.
    • Where menopause symptoms are the direct cause of sickness absence, just 7% of GP fit notes state menopausal symptoms (whilst 66% state stress, anxiety and depression)2.

Where you do not know, you may be ineffectively managing the wrong problem.  Menopause Health Checks can help prepare your employee for a balanced and objective conversation with you about:

    • Their menopause and how menopause symptoms are affecting their performance.
    • What adjustments might reduce the effects of their symptoms and / or reduce the extent to which the job is aggravating their symptoms.

Controlling.  You are expected to take all reasonably practical steps to adjust for menopausal symptoms and to control for any related health risks.  In doing so you can significantly improve all measures of employee productivity including; job performance, hours worked2, staff turnover and career development.

All publicly available survey results suggest that appropriate controls should focus on adjusting for, and protecting, your menopausal employee’s mental health and cognitive functioning to a far greater extent than physical functioning5.

Job adjustments are requested by just 11% of menopausal employees and 43% of these request flexible working5.

The compliance cost of not knowing and controlling.  The severity of menopause symptoms affecting the 6+% of your employees is likely to be substantial enough to meet the Equality Act definition of a disability.

In such situations, you have a legal obligation to consider adjustments for those symptoms.  Of 78,968 cases reaching employment tribunals during the period February 2017 to August 2021, menopause was pertinent to 27 and 6 of those found in favour of the employee7.  The costs to employers for professional advice and representation at employment tribunals averaged £8k in 20088 and menopause related awards ranged between £19k and £28k (plus claimant’s legal fees).  Recent anecdotal evidence suggests that the number of menopause related cases is rapidly increasing. As always, tribunal awards are the tip of the iceberg, hiding a much larger number of compromise agreements and out of court settlements.

3. Menopause Health Checks.  Step by Step Guide.

Click on a step below to view more detail.

The Work Wellness practitioner will assess your employee’s prior knowledge of:

  • The cause of menopause, stages of menopause, menopause symptoms and their method of diagnosis.
  • The possible longer-term health risks of:
    • Failing to adequately treat the cause of menopause
    • The treatments themselves.

The Work Wellness practitioner will seek to raise knowledge levels where this is important to your employee.

In summary, the menopause is caused by a reduction in the production of hormones such as oestrogen, progesterone and testosterone.  These hormones play an important role in protecting your employee’s:

  • Cardiovascular health.  Menopause has been found to double the risk of cardiovascular disease in some women.  These lost hormones have been:
    • Allowing blood vessels to relax and widen so that blood can flow through them easily.
    • Reducing the levels of ‘bad’ cholesterol, thereby reducing the build-up of fatty plaque in your blood vessels.
  • Musculoskeletal health:
    • These lost hormones have been helping the body to metabolise vitamins and minerals (e.g., calcium) which maintain bone mass.
  • Mental health:
    • The reason(s) for the effects of menopause upon mental health have yet to be medically established.

Reliable health assessment can be affected by:

  • Misunderstanding the questions being asked.
  • Typically, overly optimistic recall of exercise and activity levels, diet, family health history and alcohol consumption (surveys find a tendency towards optimism).
  • Typically, overly pessimistic disclosure of mood.

To ensure reliable health assessment, we encourage accurate disclosure of health risk factors by:

  • Establishing trust and rapport.
  • Careful positioning of questions and further explanation where needed.
  • Listening without judgement and acknowledging your employee’s feelings.
  • Helping the employee take a balanced view of their mood during the weeks leading up to the day of the assessment.

Your employee’s cardiovascular health risk is calculated using accurate measures of:

  • Height / waist ratio (body shape) and height / weight ratio (Body Mass Index).
  • Blood pressure, pulse and atrial fibrillation.
  • Oxygen saturation level (less than 95% may indicate impaired lung function or circulation or iron deficiency).
  • Good and bad cholesterol and glucose (involving a small skin prick).

All measurements are taken in compliance with clinical best practice guidelines using regularly calibrated medical equipment.  For example:

  • Work Wellness Cholesterol Testing Quality AssuranceThe Cholesterol Analyser is calibrated every month by CPA (UK) Ltd (the accredited Laboratory Medicine department at Bolton NHS Foundation Trust).
  • The blood pressure monitor is clinically validated by the British Hypertension Society.

The measurements obtained in Steps 2 and 3 are input into our expert system which provides objective and quantified health assessments.

Anxiety is calculated using the GAD-7 tool for assessment of the four most common anxiety disorders:

  • Generalised Anxiety Disorder.
  • Panic Disorder.
  • Social Phobia.
  • Post Traumatic Stress Disorder.

Depression is calculated using the PHQ-9 tool for assessment of the severity of depressive symptoms, not explained by substance use or another medical or psychiatric condition.

GAD-7 and PHQ-9 are accredited by the National Institute for Health and Care Excellence for measuring the presence and severity of Anxiety and Depression in primary care situations (e.g., during GP consultations and Mind Matters Assessments).

Cardiovascular Health Risk.  Calculated using the QRisk2 algorithm. It is NICE recommended for a full formal assessment of the risk of developing cardiovascular disease in the next 10 years.

Type 2 Diabetes Risk.  Calculated using an algorithm developed by Diabetes UK in collaboration with the University Hospitals of Leicester NHS Trust. It is NICE recommended for use by GPs and other primary healthcare professionals to predict the risk of developing Type 2 Diabetes within 10 years.

Alcohol Related Health Risk.  Calculated using the AUDIT-C algorithm (Alcohol Use Disorders Identification Test). AUDIT-C is sponsored by the World Health Organisation.

The importance of lifestyle in determining the severity of menopause symptoms cannot be underestimated.  Lifestyle factors can include:

  • Healthy eating.
  • Keeping active.
  • Reducing alcohol consumption.
  • Stopping smoking.
  • Improving quality of sleep.

Two key clinical components of Menopause Health Checks encourage your employee to be open to discussing possible lifestyle changes:

  1. The objectivity of the health risk calculators helps to de-personalise the assessment and externalise any sense that the employee is being “judged”.
  2. We will have been:
    • Establishing trust and rapport.
    • Listening without judgement and acknowledging feelings.
    • Carefully listening for disclosure of underlying motivations, constraints and stressors.

This is a non-judgemental and motivational conversation supported by:

  • Fact sheets which have evolved over hundreds of plain English, jargon free conversations. They cover subjects such as: the Menopause, Anxiety & Depression, Sleep, Diet, Alcohol, Smoking, Keeping Active, Walking, Blood Pressure, Diabetes, Cholesterol.
  • Our unique expert system automatically recalculates health risk scores based upon positive lifestyle change intentions. In this way we can have a “what if” conversation, modifying lifestyle change intentions and testing their impact on health scores before gaining lasting commitment to a final set of achievable lifestyle changes.

Our Work Wellness practitioner will recommend links to additional self-help resources, sign-posting to local contacts and referrals to specialist practitioners if they are likely to help.

Employees identified with:

  • Health risks exceeding national primary care thresholds are offered a referral to their GP supported with a personalised letter to hand over at the GP appointment.
  • Health condition(s) which may be caused or aggravated by their job or which may be affecting their attendance or job performance can be referred back to Work Wellness for a formal Occupational Health Assessment.

The Work Wellness practitioner can also help your employee to obtain the most effective menopause treatments from their GP by:

  • Providing them with knowledge and advice so that they can have an informed conversation with their GP.  Demonstrating that they are  informed, are able to articulate the benefits that HRT is likely to provide, balanced with the associated risks, is likely to achieve a better outcome from their GP appointment.
  • Help them to understand what they should reasonably expect from their GP, for example, by enquiring after a practitioner in the surgery who takes a special interest in menopause and / or asking for a double appointment.

Alternatively, the Work Wellness Practitioner can signpost your employee to alternative menopause specialists such as:

  • Private GPs who specialise in menopause.
  • A NHS menopause clinic (NHS and private accredited menopause specialists can be found on the British Menopause Society (BMS) website.
 

By the end of the Menopause Health Check we will have discussed a lot of information, answered many questions and your employee will be feeling positive and motivated.  We don’t want them to lose that feeling once they’re back at their workplace.

So they’ll be able to take away a personalised report containing 15 pages of; the measures we’ve taken, the lifestyle changes we’ve discussed, their impact on health risk scores, where to find self-help resources and referral routes to get further help.  That’s a lot of information to digest, so the report carefully structures it alongside plain English guidance.

The Menopause Health Check may not have identified any significant health risks.  Alternatively, as a result of lifestyle changes and specialist treatments your employee’s menopause symptoms and overall mental and physical health may have improved.

In any event, we encourage your employee to come back for a follow-up employee health assessment every year.  Our Expert System remembers them and re-presents their previous and latest information side by side, thereby freeing up time for a conversation about progress, any issues and next steps.

Work Wellness employee health assessments use Health Diagnostics software

We are proud to partner with Health Diagnostics to deliver health checks.  The Health Diagnostics expert system:

  • Calculates health risk factors based upon the bio-metric measurements we have taken and the information disclosed by your employee.
  • Encrypts and securely stores all of this information.
  • Uses NICE accredited; Cardiovascular Disease, Type-2 Diabetes, Alcohol, Anxiety and Depression health risk calculators.
  • A simplified version is widely used across the NHS.
Sources:
  1. Menopause and the Workplace.  The Fawcett Society. 2022[]
  2. Menopause at Work: a survey to look at the impact of menopausal and perimenopausal symptoms upon women in the workplace.  Newson Health.  2019[][][]
  3. A Guide To Managing Menopause At Work.  CIPD.  May 2021[][]
  4. A Study of Menopause in the Workplace.  Forth. February 2019[]
  5. UK Parliament.  House of Commons Women and Equalities Committee.  Menopause and the workplace survey results.  February 2022.[][][][]
  6. 51% of UK employees are women x 20% of women are transitioning through the menopause x 44% to 90% of these women report that menopause symptoms are affecting their job performance[]
  7. Menopause and the Workplace: Parliamentary Committee Call for Evidence.  Response from the Employment Lawyers Association. 16 September 2021[]
  8. Findings from the Survey of Employment Tribunal Applications 2008.  Department for Business Innovation and Skills. Employment Relations Research Series No.107. March 2010[]