What Is the Burden of Menopause on Female Physicians?

Carolyn Crist

August 26, 2022

Women in medicine who are experiencing menopause are potentially at the peak of their careers, yet there has been little discussion of the effect and potential burden of menopause on physicians, according to a recent commentary.

Establishing measures to consider and accommodate physicians who are experiencing menopause should be an urgent priority, the authors write.

Dr Lindsay Shirreff

"Menopause can bring debilitating symptoms for some people, and for women physicians, this can happen during a formative and potentially peak career time," Lindsay Shirreff, MD, an assistant professor of obstetrics and gynecology at the University of Toronto, told Medscape Medical News.

Dr Marie Christakis

Shirreff penned an editorial with Marie Christakis, MD, an obstetrician and gynecologist at St. Michael's Hospital in Toronto whose focus is on menopause and mature women's health.

"The proportion of menopausal women in medicine is going to increase," they say. "Our goal with this piece was to start conversations with healthcare institutions, encourage future research, and promote knowledge translation."

The commentary was published August 15 in CMAJ.

Need for Accommodations

Natural menopause typically occurs between the ages of 45 and 55. At this life stage, physicians may expect work productivity to increase, and they may seek promotions and move into leadership roles, Shirreff and Christakis write.

However, menopause symptoms can be disabling, and 80% of those experiencing menopause may have common symptoms that persist for an average of 7 years. Although treatments are available, about 28% of women between the ages of 40 and 55 years and 15% of women between the ages of 55 and 59 years may experience moderate to severe vasomotor symptoms, as well as abnormal uterine bleeding and changes in mood, sleep, cognition, and sexual function.

Studies of the impact of menopausal symptoms on work performance in fields other than medicine have shown that women face a higher likelihood of poor to moderate ability to work, as well as decreased productivity. Those with symptoms were eight times more likely to report low ability to work than their asymptomatic peers, and they were more likely to report prolonged absences from work.

In these studies, data were derived from self-reports. They show that women with symptoms may experience an altered perception of their ability to work, even if job performance isn't altered. Women have also reported having difficulty managing their symptoms when they perceive stigma associated with discussions of menopause at work.

The unique experiences of symptomatic healthcare providers haven't yet been well researched, Shirreff and Christakis write, but understanding the experience of physicians who are going through menopause is important and warrants discussion and future research.

Despite the lack of data, healthcare institutions should consider the effects of menopause on physicians, they write. An increasingly large proportion of the physician workforce will soon enter menopause. In 2019, about 25% of women physicians were between the ages of 45 and 54 years. This represents 11% of all Canadian physicians. These providers bring knowledge and experience to the table that can be of benefit for patients, hospital administration, and public policy.

In addition, corporate research has revealed substantial costs to employers associated with menopausal symptoms and has shown that organizations with more gender equity in leadership positions derive financial benefits. Supporting and accommodating physicians during menopause could help optimize patient care and financial efficiencies, the editorialists write.

Public discourse has highlighted the importance of age and gender equity, which are relevant to menopause, according to the editorialists. Women physicians often delay starting families and may establish their careers later than men. They may take longer to achieve promotion, and they may earn less than their male counterparts. Ignoring their experience of menopause could further disadvantage them in a field that has traditionally valued high productivity.

"Menopause is an important and sometimes bothersome life stage that can happen to people at the peak of their careers," say Shirreff and Christakis. "Workplaces should consider and accommodate women in menopause in an effort to optimize their health and career goals, as this will potentially mitigate valuable resource losses."

Encouraging Inclusivity

Shirreff and Christakis supported the 2021 recommendations of the European Menopause and Andropause Society (EMAS), which aim to make the workplace environment more supportive of menopausal women in the wider context of gender equality and reproductive and postreproductive health.

These guidelines recommend that workplaces create an open, inclusive, and supportive culture regarding menopause. This could involve occupational health professionals and human resource managers working together to reduce discrimination, marginalization, and dismissal due to menopausal symptoms.

In educating medical faculty and others about issues of workplace inclusivity, information about menopause should be part of the discussion, Shirreff and Christakis say. Women experiencing menopause should be encouraged to seek treatment for bothersome symptoms.

Healthcare leaders should receive training on how to conduct sensitive and practical conversations with physicians experiencing menopausal symptoms, as well as recognize that people experience different symptoms, they write. Rather than provide predetermined accommodations, healthcare managers should foster a destigmatized environment in which physicians can express their needs and feel confident that they will be accommodated. Discretionary leave or altered work patterns could help those who experience severe symptoms.

"We hope EMAS recommendations can be reviewed by more institutions and incorporated into healthcare settings," Shirreff and Christakis say. "As medicine seeks to address issues of equity, diversity, and inclusion, menopause should be part of the conversation."

Gender equity in medicine is a key part of the conversation. For the past 25 years, there have been more women than men in Canadian medical schools, yet that hasn't led to gender equity with regard to leadership roles or equal pay. The inequities are even more stark when race and ethnicity intersect with gender.

Dr Nazia Peer

"Clearly, simply increasing gender parity in medical school is not enough. Targeted systematic intervention and behavioral change must take place at various critical career transition periods in a woman's career, for example, when they undertake postdoctoral studies, fellowships, or residency," Nazia Peer, MD, director of public health emergencies at the Peel Public Health Unit in Toronto, told Medscape.

Peer, who did not contribute to the editorial, wrote a 2021 CMAJ editorial about advancing gender equity in medicine.

"These transitions typically align with pregnancy or raising children, which can impede or disrupt their careers," she said. "Supportive, nurturing environments that encourage and promote equity at various stages of a woman's career are key to achieving equity for women in medicine."

Christakis and Shirreff are members of the medical advisory board of the Menopause Foundation of Canada. Sherriff has received a Quality Improvement Competition grant from Pfizer Canada. Peer has disclosed no relevant financial relationships.

CMAJ. Published August 15, 2022. Full text

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.

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