We talk to Eve Lepage, a reproductive health specialist and fertility nurse who focuses on menopause and perimenopause research and education at Clue about what organisations can do to support employees through this life stage.
A few years ago, menopause in the workplace was barely discussed. Today, while there's been real progress, genuine structural change is at best inconsistent. Eve Lepage of Clue, the period tracking and reproductive health app, explains why menopause continues to pose challenges for women at work and what employers can do to help support them.
Q; Let's start with the scale of the problem - is it true that how menopause is handled actually impacts women's careers?
Eve Lepage: Yes, the numbers are quite striking. According to research from the Fawcett Society, which ran what I believe is the largest representative survey of UK women aged 45 to 55, one in ten women had left the workforce prematurely because of unmanaged menopause symptoms. That's a significant loss of talent and experience. The CIPD found similar results in their own research, where 23% of women had considered leaving their roles and 6% actually did leave.
Q; When women leave or consider leaving, is it always about feeling unsupported by their employer, or are there other factors at play?
Eve Lepage: It's multifaceted. Menopause sits in this grey area legally because it's not officially a protected category of its own, but it does overlap with both age and sex discrimination. Because only people assigned female at birth go through menopause, when symptoms are ignored or dismissed or not supported, it can be a form of indirect sex discrimination. And because it happens in one's forties and fifties, there's also age bias at play. For example, assumptions that women in this age group aren't as sharp or energetic as they used to be.
Additionally, women simply don't feel confident enough to continue. Without the right support, symptoms like sleep troubles, cognitive fog, anxiety, and hot flashes during meetings can really undermine confidence. These are physiological things that have real impacts. Whether it's employers discriminating or women feeling they lack adequate support and choosing to step back, the result is the same – talented, experienced women leaving the workforce during what should be peak career years.
Q; You mentioned that without the right support, symptoms can be quite disabling. But surely there are treatments available?
Eve Lepage: That's part of what makes this so frustrating. There are treatments that can help make symptoms less disruptive and improve quality of life, but many women don't realise this. The Fawcett Society found that 45% of women hadn't spoken to their GP about their symptoms. Even among those with the most severe symptoms, 29% still hadn't sought care.
And when women do seek help, 31% said it took multiple appointments before their GPs even recognised they were menopausal. Then only 39% were offered hormone therapy, which guidelines actually recommend as first-line treatment. It's quite shocking really.
Q; Why do you think there's such a gap between the support that's needed and what women are actually receiving?
Eve Lepage: I think there's a fundamental lack of knowledge about what menopause actually is and what experiences are associated with it. At Clue, our social media manager went around Berlin asking people basic questions about perimenopause and the lack of awareness was surprising. Compare that to a woman who's just had a baby and isn't sleeping well and is experiencing brain fog at work. Most colleagues understand immediately – small baby at home, sleep deprivation, it's temporary. They get it.
Menopause is more complex. I think there are something like 40 or 50 different symptoms associated with it. Yes, they have heard about hot flashes and night sweats, but they are far less likely to know that anxiety and depression risk increases quite significantly too.
Q; Let's talk about workplace policies. Many organisations have implemented menopause policies, but you suggest these aren't necessarily translating into meaningful support. Why not?
Eve Lepage: The real question isn't whether your workplace has a policy, it's whether your employees know about it and feel comfortable actually using it. You can have all the policies you want, but if you still don't feel comfortable talking about what you're experiencing, then that policy isn't going to do anything. It becomes a surface-level thing that looks good on paper but doesn't actually change the workplace culture.
We've seen this before with mental health support and parental leave. Real change didn't start until it moved from being an HR initiative to something that leadership actively championed and embedded into workplace culture. It needs to come from the top down. When leadership isn't visibly supporting these policies, they remain afterthoughts rather than integral parts of how the organisation operates.
Q; That's an interesting point about culture. Can you expand on what leadership involvement actually looks like in practice?
Eve Lepage: I watched a CIPD webinar recently where one speaker gave a powerful example. A company had someone from senior leadership give a talk about her own experience with menopause. Just having that conversation, explaining her own journey, allowed other people to share their experiences, ask questions, and start that dialogue. That's coming from the top. It signals that this is something the organisation takes seriously.
In some workplace cultures, particularly those that are quite competitive or sales-driven, that HR message alone isn't going to cut it. The culture has to fundamentally change, and that requires leadership buy-in.
Q; When you work with organisations, what practical guidance can you offer?
Eve Lepage: Flexible working hours often comes up as the number one workplace accommodation that women say would help. However, blanket policies don't work for every workplace. If you have an autonomous role, flexible hours might be easily arranged. But if you're working in a team, doing shift work, or in roles that require specific coverage, this approach may not be helpful in which case you have to think about other ways to provide support for that specific context.
This is why it's so important to ask employees what would actually help them. Don't just implement a generic policy. Do workplace surveys, have group discussions, ask on both individual and organisational levels what accommodations would make a real difference. Wellness benefits like gym memberships or access to apps that support symptom tracking can be valuable. Some women might benefit from access to quieter, cooler spaces during the workday. The key is that it needs to be tailored.
Q; What about manager training?
Eve Lepage: Education about symptoms and how menopause affects people is obviously important. But I think the really crucial element is teaching managers how to have these conversations. Where should they take place? Who else should or shouldn't be there? What should prompt these conversations? Creating an environment where people feel psychologically safe to actually talk about their experiences is critical.
I'd also suggest to managers that the first thing they can do is simply ask their employees what would help. Not everyone needs the same accommodations. And I encourage employees to track their symptoms – their sleep, mood, energy levels or bleeding patterns. By doing so they actually have the data to advocate for themselves regarding what would genuinely help them.
Q; You work for Clue, which has developed a perimenopause mode. Can you tell us about that and the response you've received?
Eve Lepage: We released our Clue perimenopause mode in 2022 with perimenopause-specific tracking categories so users can really monitor how their cycles are changing and what they're experiencing. The app also includes educational resources about symptoms, managing symptoms, hormone therapy, non-hormonal therapies, and lifestyle tips. Since we launched, we've gotten tremendous feedback from users about how much it has helped them understand this stage of life.
We actually coined Perimenopause Awareness Month in September – not many people know that – and we've been really focused on this life stage because we want to be that companion from first period to last. A couple of weeks ago we co-hosted a free webinar on perimenopause and menopause, and we had 700 people register in just two days. We had to limit spots. There's huge demand just for basic knowledge – what is perimenopause, what is menopause, what are common experiences, what treatments are available, what lifestyle changes can help.
Q; There's been quite an explosion of awareness around menopause recently, but this is all fairly recent, isn't it? I also read recently that the FDA has announced the removal of "black box" warnings from hormone replacement therapy (HRT) products used for menopause, which had been in place for over 20 years due to concerns about risks like breast cancer and cardiovascular disease. This change aims to provide women with more accurate information about the benefits and risks of HRT, allowing for better-informed health decisions.
When it comes to HRT, what about women who are already post-menopausal and are likely to have missed out on support and treatment?
Eve Lepage: This is a really important point. You're absolutely right that there was research back in the 1980s that put the fear of God into women about hormone replacement therapy, and for a very long period, most women thought it wasn't worth the risk. That meant an entire generation of women simply endured their symptoms rather than seeking treatment.
But here's what's crucial to understand: even if you're officially post-menopausal, there's still a lot that can be done. While some narratives might suggest you've missed the boat, that's not really accurate. It's very individual. Things like brain fog, impacts on heart health, bone strength, preventing osteoporosis – all these things can still be addressed post-menopause. The hormonal changes that start during perimenopause have longer-term health impacts, but the changes you can make to support your health, like weightlifting to maintain bone strength and improve balance, can start at any point.
We shouldn't really separate perimenopause and menopause anyway. The things you can do in menopause can really be started in perimenopause, and vice versa. It's about having the knowledge to live your healthiest life and stay in tune with your body throughout these different life stages.
Q; So employers should be thinking about this as an ongoing health issue, not just something that affects women during a specific window?
Eve Lepage: Exactly. If a woman wants flexible working because she needs to go to the gym once a week to build strength and prevent future health issues, that's connected to menopause even if she's post-menopausal. Employers need to understand the whole picture and be sympathetic to the long-term health needs associated with this life stage.
It's also worth noting that hormone therapy isn't the only option. Many people cannot take HRT for various medical history reasons, but there are other medications and treatments available.
Q; Looking at the bigger picture, what needs to happen for real change to occur?
Eve Lepage: Awareness is improving as more and more people discuss menopause including celebrities and public figures who are sharing their experiences. But the real structural change hasn't quite happened yet. We need policies that are actually reflected in workplace culture, not just written in HR handbooks. We need leadership to champion this issue and managers who are trained on how to have supportive conversations.
It's also important to remember that menopausal women are in their peak career years and in leadership positions or on track for them. Losing them because of unmanaged, treatable symptoms is not just bad for the individuals, it's bad for organisations and the economy as a whole.
The good news is that when you look at what actually needs to change – better access to treatment, workplace flexibility, managers who can have open conversations, a culture where people feel safe discussing their health – none of this is insurmountable. It just requires commitment and the recognition that supporting people through menopause is not a perk, it's good business sense.