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From hot flashes and heart palpitations to chronic insomnia and brain fog, menopausal symptoms may affect roughly 25% of the US working population at any given time — and now a growing number of employers are stepping up to offer more support.

The 39-million-plus working women in the United States in their 40s and beyond will discover that the symptoms of perimenopause and menopause are a real thing, and will intrude on their workday. Yet the symptoms often are not adequately acknowledged or treated by the medical community and are usually considered something to be hidden at work.

But hiding them can be hard — especially in open-plan work sites and meetings.

As one 63-year-old office administrator put it, “Coworkers [are] giving me weird looks because I’m sweating like a guilty perp being interrogated.”

However, a small but growing percentage of employers say they’re starting to change the way menopause and its symptoms are dealt with in the workplace. Fifteen percent of large organizations, up from just 4% last year, indicate they are either currently offering or plan to offer benefits intended to help women experiencing menopausal symptoms, according to a survey from HR consulting firm Mercer.

That may help begin to break the stigma attached to being menopausal at work.

But, for now, it’s still a sensitive topic for women to speak about publicly. For that reason, CNN has decided not to include the names of the women who were interviewed for this piece, nor that of their employers.

Where symptoms and work intersect

A recent study by the Mayo Clinic found that 13% of women reported having at least one adverse work outcome due to menopause symptoms in the past year. Adverse outcomes include missed days at work, reduced hours, being laid off or fired or choosing to quit.

“The very topic of menopause has been taboo, particularly in the workplace, potentially further exacerbating the psychological burden of menopause symptoms,” the Mayo researchers noted.

(Their study is the largest of its kind, but since the vast majority of respondents were White, the researchers recommend that it be conducted across a more diverse population.)

Many working women try not to draw attention to the fact that they’re experiencing symptoms for fear of ageism.

A 48-year-old woman who works in digital marketing said she feels more accepted as a person of color at her company than as an older woman.

“I’ll have pregnant colleagues make jokes about having ‘pregnancy brain’ when they stumble on calls, but how do I say, ‘Sorry, menopause fog’ when I’m struggling to find a word?” she said. “That wouldn’t just out my health issues but more significantly, would reveal my age, which is way more terrifying.”

A 53-year-old woman who works in data analytics told CNN she is very grateful she can work from home full time these days. “If I still had to make the 40- to 45-minute commute each way and be in an office all day while I deal with my symptoms, I don’t know how I would handle it,” she said.

Of course, many jobs can’t be done from home. A 57-year old woman who has worked for years in the construction industry said she first experienced severe menopausal symptoms in her previous job.

“I worked in a non-climate controlled warehouse. This is where the hot flashes, mood swings and crying for no reason started,” she said. When she got promoted to an office position, the temperature situation improved but she found she had episodes of brain fog. “My boss, who was a woman younger than me, didn’t believe me when I told her that I am not normally like this and it was menopause kicking in.”

She ended up losing that job, she said. And she believes her symptoms, for which there was little understanding at work and for which she had just begun treatment before she was let go, undermined her performance.

Where is the medical community?

Menopausal symptoms might not be as troublesome at work if women could access more reliable information and care from their regular doctors.

“There is a menopause management vacuum,” said Dr. Stephanie Faubion, who is medical director for The Menopause Society and director of the Mayo Clinic’s Center for Women’s Health.

Only 7% of medical residents training in family medicine, internal medicine, and obstetrics and gynecology said they felt adequately prepared to help women patients manage menopause, according to a 2017 Mayo Clinic survey.

“Just because you’re a physician in obstetrics and gynecology doesn’t mean you learned about menopause and hormones,” Faubion said.

So, many women find they’re on their own to experiment with what (and whom) they can find to help. But many also just assume nothing can be done, with a majority going untreated, she noted.

How one company is seeking to help

The Menopause Society plans to introduce next year a consensus recommendation of what employers can do to help employees contending with menopause, Faubion said.

In the meantime, some are acknowledging the issue, and expanding their benefits options.

One is Organon, a health care company that was spun off from Merck in 2021 and focuses on women’s health and developing medicines and products for a range of issues affecting women.

On top of its traditional paid time off benefits, it started offering a new Global Care Leave plan about six months ago, according to Aaron Falcione, the company’s chief HR officer. The plan lets any employee take up to 10 days off to address self-care issues of any kind, which the company notes can include dealing with menopausal symptoms. Employees can claim their self-care days without specifying the reason, Falcione said.

It was an attempt to find a way to help employees deal with their symptoms in ways they needed, Falcione told CNN.

And, he believes, it will help the company retain women in the leadership pipeline. “There is a relevance for leadership and career development. We are aspiring to create more women leaders. And menopause comes at a time when women are at an inflection point in their careers, [often] at the point of ascendancy into leadership roles.”

What employers can do right now

Expanding benefits per se may not be necessary if an employer already has a good health care plan and generous work-flexibility and time-off options. However, being more knowledgeable about menopause and more flexible in other areas is necessary. So, too, is highlighting for managers and employees what benefits are already on offer that can help deal with certain symptoms.

Take anxiety. “Most corporations already have policies about mental health. So there is no need to create a ‘menopause’ mental health policy,” Faubion said.

For instance, many companies have Employee Assistance Programs that connect employees with therapists and subsidize the cost.

Giving women more control over the temperature where they work is also helpful, said Corina Leu, senior health and benefits consultant at Mercer. If controlling the thermostat isn’t an option, it could mean letting employees have fans at their desks.

For companies with a formal dress policy, it could mean being more flexible about what women are allowed to wear or not asking them to wear restrictive clothing. And for employees who must wear uniforms or certain garments for safety or sanitary purposes, it may mean being more thoughtful about the materials used so women will have cooler options.

Across the board, all employers can help employees better manage their menopausal experience by educating executives, managers and staff about the issue, and raising awareness about the symptoms, Leu said. That means training managers and providing communication to help employees recognize their own symptoms and learn to better navigate the care benefits already available.

The goal is not to require that employees confide to managers that they are in menopause or for managers to approach employees they just assume are menopausal. Rather, it’s to make everyone at work aware that menopause is a common health issue, and that various medical and mental health benefits exist that may help employees manage their symptoms.

And should an employee choose to disclose that they are struggling with menopausal symptoms, “the manager should be able to have a conversation that is culturally competent without making fun of it,” Faubion noted.

The best message employers can convey about menopause in their communications, she said, is this: “This is a normal life stage. We understand this period can be challenging, and we’re here for you.”