Not just hot flushes

Three years ago, when I was 42, I had to call 999 when one of my periods went from a normal monthly occurrence, to heavy bleeding that constituted a medical emergency. There were no ambulances, so my partner drove me into A&E, a towel on the passenger seat to protect the car upholstery. At the busy London hospital, a nurse asked how many cups of blood I had lost in the past two hours. I had no idea, so she asked how many tampons I had used in the same time. “Seventeen”, I replied (easy to answer, as there was only three left in the box of Superplus I’d bought that afternoon). The look on her face spoke volumes. Then I fainted and was put on an IV drip.

If there is a stereotype of a menopausal person, it’s someone with hot flushes and brain fog, but much more disabling health issues often accompany this phase of life. One in five women, trans men, intersex or non-binary people will experience extremely heavy periods due to hormonal changes in perimenopause. That’s one in 10 people. Yet, due to the twin taboos around periods and menopause, still no one wants to admit that they are going through anything of the kind. We are so much more comfortable talking about our gender or our ethnicity, our sexuality, or the trials of being a working parent, than this.

Yet the effects of perimenopausal heavy periods on working life can be severe. You can lose 500–750ml (or more) of blood a month; losing more than 80mls a month is the medical definition of a heavy period, and itself presents a risk of anaemia. I personally was anaemic and exhausted, and it took a very long time to get the right treatment combination and resolve the issue.

These kinds of periods can be excruciatingly painful, not dissimilar to labour pains—as in, you need to hold onto something (a tree, a bench, as I found out once when walking in the park with a friend) to get through the pain. The loss of the sense that I could trust my body was terrifying. They left me physically shaky from the cramps; they made me faint. Some women also experience sleep issues, and obviously your sleep is very interrupted when you are getting up several times a night. I was lucky to have a partner to take on the lion’s share of the childcare and cooking at these times; I cannot imagine what it would be like for a single parent or someone experiencing additional life issues.

I was anxious each month as that time approached and I was worn out from the hypervigilance associated with avoiding flooding in public, and I felt fear in anticipation of the pain. Workplaces should also be aware that heavy periods affect how long you can travel on a bus or Tube: for me, this was at the very worst times 10–15 minutes or less. As Sam Baker describes in The Shift, this can make a difference between being able to get into work or not. Such disabling heavy bleeding also affects what length and type of meetings or events you can attend. Or at any time, you might need to interrupt an important conversation to rush to the bathroom.

Raise awareness, tackle stigma

In the end I had to talk about my symptoms at work because they were affecting my working patterns, but I never once felt comfortable mentioning perimenopause in those discussions. There was at the time no menopause or periods policy in place. The team who supported me were cis women, and much younger than me. They were very kind and I received the practical support I needed, but they had no relevant personal experience. Our conversations were often embarrassing and awkward, codified rather than direct. I believe that a lot of people in these circumstances—especially before lockdowns and the rise in home-working—would have left their jobs to avoid the embarrassment and physical and mental toll of continuing. They may well still do so.

My workplace has since released a menopause policy, but no periods policy, despite menstruating people making up such a high proportion of the publishing workforce. In the policy, heavy periods are not listed as a perimenopausal symptom, nor are changes to (rather than cessation of) periods mentioned at all. For me, during the earlier phase of perimenopause, this issue was totally debilitating.

So what can workplaces do? They can raise awareness, tackle stigma. They can release periods policies. They can establish a culture where people are encouraged to identify as menopause allies. And they can do their best to deal with age-related gender discrimination, and take steps to ensure that they have women (and other menstruating people) over 40 in positions of the highest responsibility, in equal numbers to cis men.