Taking the taboo out of the menopause - how dentistry is grappling with 'the change'

Caroline Holland learns what steps dental practices and clinics can take to become menopause friendly.

©Roger Moody

'I am sitting here, on main clinic, PPE on, and I am literally dripping in sweat, my glasses steam up, I look around, the windows are open and everyone else seems content so I know it's me and my body. I feel really uncomfortable now but there is nothing I can do until the patient has left the chair and I can take the plastic apron off.'

A dental nurse shares above what it is like to have menopausal symptoms at work - sadly her distress is not out of the ordinary. For too long, in most workplaces around the UK, there has been little or no recognition that discomfort from menopausal symptoms should warrant a compassionate approach.

But thanks to a progressive approach by Manchester University NHS Foundation Trust (MFT) and a menopause advice sheet and specimen policy¹ just launched by the British Association of Dental Nurses (BADN), managers and employers in hospital, clinic and practice settings now know what a menopause-friendly dental workplace might look like.

A chat following a paediatric dental clinic was the catalyst for change in Manchester where the dental hospital, along with nine other hospitals, is run by Manchester University NHS Foundation Trust. Joseph (Joe) Bell - at the time a dental core trainee - was being supervised by Professor Claire Stevens, a Consultant in Paediatric Dentistry, who recalls the all-important interaction. She said she made a comment about brain-fog and once patients were out of hearing, Joe asked if she might be peri-menopausal.

Claire [main picture] says: 'I encouraged him to explain why he had made the association with the menopause. He told me his mother worked for HSBC bank which has been one of the pioneers² of the menopause friendly workplace. In his home, the menopause was far from being a taboo topic and Joe understood so well the challenges that women have to face'.

Because of the taboo around the menopause, it is not discussed or understood. For instance, says Claire, the perimenopause is not limited to older women. She is in her forties and she has one colleague who is in her twenties with symptoms.

Claire continues: 'As Joe and I discussed the issue, the dental nurses who are part of our team shared their own experiences. I gained an insight into the challenges that some of my women colleagues were facing'.

Claire and Joe took their concerns to senior management who not only responded positively but instigated change. Among the immediate steps taken were:

• 1. At the first available Audit and Clinical Effectiveness (ACE) session, Joe gave a talk to clinical teams on what a menopause friendly workplace might look like

• 2. Emergency boxes containing products which might be helpful, such as spare underwear, pads, tissues, deodorant, camomile tea, paper fans were made available

• 3. A lunch-time webinar for staff led by an expert in the field

• 4. Training from the consultancy, Henpicked, which advises on menopause in the workplace, in order to roll out 'train the trainer' sessions so the new approach reaches the entire workforce.

With Claire's encouragement, Joe prepared a paper for the BDJ of which she and Deborah Garlick, Director of HenPicked, were co-authors. Entitled It's time to talk about the M word, the paper was published in the BDJ³ in January of this year and in BDJ Team⁴ in April.

Stella Kenny is an HR officer for the dental and eye hospitals and embraced the work programme enthusiastically. The menopause was in her sights already, she said, and Prof Stevens and Joe Bell were the catalysts.

Stella says: 'Our work is in its infancy but I think it will snowball as we roll out the initiatives that we have planned'. She hopes the 'train the trainers' programme, due to start at the time of writing, will inspire managers to learn what needs to be done to change the culture of the workplace. Stella's work dovetails with initiatives already taking place at MFT to support staff, such as Menopause Awareness Sessions and a staff guide on the MFT intranet as the trust progresses towards becoming a recognised Menopause Friendly Workplace.

For too long, in most workplaces around the UK, there has been little or no recognition that discomfort from menopausal symptoms should warrant a compassionate approach.

Stella's senior colleague, Gill Porter, MFT's Director of Human Resources and organisational development, says that an important step was to get the menopause identified as a reason for sick leave. 'If you have to badge menopause as something else in order to be able to take time off work or see a doctor, it will remain taboo. By having a recognised definition, it opens so many doors.'

Another was to make it easier for team members to ask for lightweight scrubs and for spare sets for those occasions when there is no time to wash and dry your uniform to wear for work the next day.

Tact and compassion are as important as openness. Gill says: 'It's about getting managers to have those conversations. Don't wait for someone to go absent. Keep an eye out for people who are struggling, perhaps because they are not sleeping or can't cope with the heat. We need to look after our employees and create a positive workplace'.

This year, a menopause advice sheet and specimen policy¹ was launched by BADN. Jacqui Elsden, President of BADN, believes that the challenges women can face in the menopause were brought to a head in dentistry in 2020. COVID helped shine a light on just how difficult it is to suffer with symptoms such as a hot flush or heavy bleed at work. Difficult enough in normal times, but in the hot summer of 2020 when clothed in heavy scrubs and full PPE and with air conditioning banned, it was near intolerable for those who worked through lockdown.

Jacqui Elsden

Jacqui is very proud of BADN's work. The advice sheet is detailed and highlights the compelling legal reasons why employers should be supportive of staff suffering with menopausal conditions - the Equality Act 2010, the Health and Safety at Work Act 1974 and the Employment Rights Act of 1996, to name a few - while the specimen policy outlines the steps employers can take to be compliant.

Gone are the days when people would refer to the menopause as 'the change' or refer to 'women of a certain age' in hushed voices. Now it's easier for women to speak up, says Jacqui, and they should. In addition to the legal imperative, there are strong practical arguments in favour of introducing a menopause friendly policy in your practice. Staff retention is already a challenge and employers who do not have a menopause friendly philosophy may find recruitment becomes more of a problem. Steps to improve the workplace for your staff are 'easy wins' she says and might include:

• Flexible working

• Improved ventilation or air conditioning

• Hydration stations

• Lighter uniforms

• Being mindful of staff needs.

Jacqui recalls seeing her GP when she first had symptoms in her forties and the doctor said to her: 'Go with it and when you feel like you want to kill someone, come back and see me!' Her doctor was sympathetic but did not prescribe hormone replacement therapy (HRT), meaning Jacqui had to find her own techniques for coping with hot flushes and sleeplessness.

Now as BADN President, she is wanting the specimen policy that BADN has published to be widely adopted so colleagues do not struggle as she had to. She is delighted that the policy has the backing of many dental organisations including the British Society of Hygiene and Therapy (BSDHT), the Dental Laboratories Association (DLA), Dental Technologists Association (DTA), and the Orthodontic National Group (ONG). All that is needed is for the British Dental Association (BDA) and the College of General Dentistry (CGDent) to offer support.

The BADN team took copies of the policy to the BDIA Dental Showcase in March and they flew off the stand. Male dental nurses were as keen to take the policy back to their workplace for their colleagues as their female counterparts.

COVID helped shine a light on just how difficult it is to suffer with symptoms such as a hot flush or heavy bleed at work. In the hot summer of 2020 when clothed in heavy scrubs and full PPE and with air conditioning banned, it was near intolerable for those who worked through lockdown.

Meanwhile in Manchester, there was a twist to the menopause narrative. Claire had to have a hysterectomy in the autumn which triggered a surgical menopause.

Claire says: 'I did not feel sorry for myself but there was something profound about waking up and realising that you no longer have those parts which define you as a woman. I knew I was going to be back at work but I did not know what state I would be in'.

As it turned out, she was not in a great state. Balancing hormone levels through wearing patches proved to be more challenging than she anticipated, and she suffered from anaemia caused by a dramatic blood loss during the surgery. She struggled to get the medication she needed from her local medical practice. 'I felt like I was managing the doctors and it was exhausting.'

Once back at work, a senior colleague (male) blithely greeted her with the question: 'All back to normal now?' She was speechless: she had never felt less herself. Fortunately, a brief meeting with Gill changed the course of a difficult return to work. Claire picks up the story: 'Gill asked me to pop in to see her in my first week back. She asked me how I was doing. "How are you emotionally?" she asked.

'Until that point, I had not really thought about my emotional needs. I found I was able to talk to her because she recognised what I was going through. I was very grateful she brought it up and I felt supported.'

Gill comments: 'Outwardly, she looked okay but what she was going through was emotional as well as physical'. Thereafter, Claire knew that she could turn to Gill for support, whether it was a fan for her office or understanding the challenges she was facing.

Stella says: 'Some women can have early onset menopause. There may be staff members having hormone therapy for gender reassignment or for cancer treatment. There can be a wide range of reasons for struggling. This is not just about women, this is a workforce issue and everyone, directly or indirectly, is affected'.

MFT now has menopause champions in place and Stella and Claire are among the first. Claire says: 'I have high standards for how we should be supporting each other. What I would love to come out of this is a new era of understanding and compassion.'

Since the menopause taboo was removed in Claire's workplace, many women have shared their stories with her, some of them heart-breaking. A number told how they felt they would have to give up work because they were not coping, others that doctors misdiagnosed the symptoms and suggested sleeping pills or anti-depressants.

She feels that while times are changing, with the 2015 NICE guidance⁵ on the diagnosis and management of the menopause an important step, progress is needed, including improved training for doctors.

Given the support that Claire has enjoyed from Gill she is optimistic about the transformation in her own workplace. And in the wider profession, along with Jacqui Elsden and the team at BADN, she believes that the 'M word' is losing its taboo.

We can only hope that employers, now they know what steps can be taken, will also move with the times.