Dealing with menopause, Covid and work
As part of our series of Lunch and Learn webinars, we were joined by Kathy Abernethy of Peppy Health. She spoke to us about the connections between menopause and Covid, and how we can manage any symptoms as we return to work.
Henpicked: Menopause, Covid and work seems to be the perfect storm. Can you tell us more?
Kathy Abernethy: The menopause is my specialist subject. But in the last 18 months or so, like so many of us, I’ve had to learn more about Covid. And there’s been a real intersection between hormones and the Covid infection. We know, for example, that the immune system is affected by menopause. So does that aggravate risk for people going through menopause when they’re exposed to Covid?
Can I start with some reminders about menopause. This is the time when our periods stop, usually around the age of 50. But anywhere between 45 and 55 is normal. Around 1% going through menopause much earlier: 1 in 100 under 40, 1 in 1000 under 40 and a small number of teenagers go into menopause really really early.
But we know that menopause is about much more than periods stopping. We use the term to encompass the perimenopause, the time when symptoms happen. If you’re lucky, you might not get any at all. At the other end of spectrum it could be ten years or more before you see the end of your symptoms.
Fortunately, you don’t get all the symptoms all the time. Typical symptoms are hot flushes, sweats, headaches, tiredness, vaginal dryness, bladder symptoms, restless legs, dry mouth, dry eye, brain fog, memory loss, concentration issues etc. These are all clusters of symptoms which can happen at any time before your periods stop right up until they actually stop – menopause.
We know there are things you can do to help your symptoms. Lifestyle changes, over-the-counter products, stress reduction, exercise and Cognitive Behavioural Therapy (CBT) can all help. Many will try hormone replacement therapy (HRT), a very effective treatment for all menopause symptoms. Non hormonal treatments are available too, such as low-dose antidepressants, gabapentin and clonidine. These are usually reserved for those who can’t use HRT.
Henpicked: Am I more likely to get Covid because I’m going through menopause? And will my experience of covid be different because I’m in menopause?
Kathy Abernethy: This is really interesting and I’ve done a bit of research around this. We are seeing hormonal links with Covid. We know that men are more likely to die from Covid, and that women are more likely to suffer from long Covid, months of symptoms beyond infection.
Menopause itself is not going to affect whether you get Covid or not. But things that come along with menopause could. We are getting older, which makes us more susceptible. We might be carrying more weight, another risk factor. Some might have developed type 2 diabetes, or other conditions that make us more at risk.
Alongside that is the intersection between our immune response, inflammatory response, and hormonal effects. Menopause can impact all of these. It affects our immune response and the way that we can fight infection. We see a weakening of this response. Menopause can also cause inflammation changes. This, combined with potential inflammation due to Covid can cause some problems for women.
Henpicked: Are our hormones providing us with extra protection against Covid?
Kathy Abernethy: There is evidence that younger women using the combined contraceptive pill with high oestrogen levels and menopausal women using hormone replacement therapy seem to do better from a Covid perspective. By this I mean they seem to be not as badly affected. But we’re nowhere near the stage of being able to say that HRT absolutely protects against Covid.
Henpicked: What is long Covid?
Kathy Abernethy: This is likened to chronic fatigue or ME, absolute fatigue and exhaustion, headaches, foggy brain, temperature. Many of the similar symptoms of menopause. If you’re going through menopause and get Covid and end up with these symptoms, it’s hard to know if it’s menopause or if you have long Covid. There’s currently no test for long Covid, although this is being worked on.
There’s no test for menopause either. So it’s a case of being honest with yourself. If you’re of menopausal age and seeing these symptoms, it is likely to be menopause. You need to speak with your healthcare practitioner for advice. The likelihood is that you won’t necessarily know if it’s menopause or long Covid. There isn’t any treatment for long Covid, but you lose nothing by trying HRT. The lifestyle changes you’d be recommended for menopause symptoms also reflect the advice you’d be given for long Covid.
Bur for context, most people don’t get long Covid, it’s the exception rather than the rule. Treatment for long covid is much the same as for menopause symptoms in terms of lifestyle changes.
Henpicked: Many of us are returning to work. Any tips?
Kathy Abernethy: We’ve all been working under rather extreme circumstance for the last 18 months or so. And nobody will be going back into a workplace that’s exactly the same as before the pandemic. If you’re struggling with symptoms, I’d encourage you to think: what is it that you want? What do you want your manager to know, what do you want them to do? We’ve all also been amazingly resilient in our working patterns, and some of us have found strategies for working at home and managing symptoms – can these be reflected in the workplace?
Really, if you need support then you need to be the one to initiate the discussion at work. The worst thing is to not even broach it. Your manager isn’t there to fix your symptoms. But they are there to ease your way at work. As with any other health condition, talk to your line manager if you think you need a referral to HR or Occupational Health.
Henpicked: Are more employers open to conversations about flexible working?
Kathy Abernethy: Yes. A few years ago part of my job was to write letters of support to employers to explain why people might need to work from home. This was an uphill battle for many. But when Covid struck many of us had to work from home, almost immediately. It shows it can be done.
Henpicked: Has Covid impacted menopause symptoms?
Kathy Abernethy: There’s an interesting survey which looked back at how women found their menopause experience during 2020. Of the almost 2,000 respondents, 47% said emotional symptoms like low mood, anxiety and irritability, were all worse when working at home. Even physical symptoms were worse. Most worrying, 43% felt that in 2020 they were less supported with their menopause than they were before.
Some of us are anxious about returning to work or being expected to be in crowded places. If this is you, ask about Covid-secure practices. You can still choose to social distance and wear a mask.
Please don’t put off help because you think it’s hard to get an appointment, or that doctors are overworked. You can still ask for menopause support. Your initial appointment is likely to be telephone based but HRT is very easy to prescribe remotely. And if the doctor needs to see you, they still will.
Equally, if you’re already on HRT please don’t let yourself go short because you think it’ll be too difficult to get a prescription – it won’t be. And supply issues with HRT are now much improved.
Kathy has extensive clinical expertise as a menopause specialist, regularly seeing and advising women on all issues relating to menopausal health.
An independent prescriber with a Masters in Community Gynaecology and Reproductive Healthcare, Kathy is immediate past Chair of the British Menopause Society, the professional society for healthcare practitioners.
She’s also the director of ‘The menopause course’ an educational initiative for nurses, designing and running study days, courses and events relating to menopause, and director of menopause services at www.peppy.health.