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  1. Welcome to our webinar today on how being mindful of menopause can help create a truly inclusive benefits strategy. Although menopause is a significant phase of life that affects about 20% of the workforce at any given time, it is seldom given any attention by employers. Today, we’ll talk about how employers can create an inclusive environment for those experiencing menopause and help improve productivity, wellbeing, and employee retention.
  2. [speaker note: this slide is OPTIONAL. No need to go through agenda slide if you would prefer to jump straight into content] Here’s what we’ll be discussing today: Hear results from a new survey on how menopause symptoms are impacting today’s employees Understand the economic impact of reduced productivity and increased turnover among some of your most valued employees  Learn actionable tips on how your company can create a more menopause-friendly workplace If you have any questions, please feel free to [ask them in the chat / ask us at the end] and we’ll aim to get to as many of them as we can today.
  3. I wanted to start at a very high level: What is menopause? As you’ll see in our survey results, there isn’t a lot of awareness around the details of menopause, though it is an inevitable part of aging.  Perimenopause: When people talk about "going through menopause," they usually are referring to a transitional stage called perimenopause. Beginning four to eight years before menstrual cycles end, perimenopause is a phase when hormone levels start fluctuating, often causing symptoms. While these symptoms generally are temporary and not dangerous, many people find them uncomfortable, and they can cause significant disruption to daily life. Others may have no symptoms or mild symptoms. Menopause: Menopause is when people stop having a menstrual cycle for 12 or more months in a row. The ovaries have stopped releasing eggs (oocytes) at this point, and it is no longer possible to get pregnant. Each person experiences the menopause journey differently, with different causes, symptoms, timelines, and treatment decisions.
  4. While menopause is a natural part of aging, it has a significant impact on people’s health and daily life.  And in fact, because it is not a “disease” it is under researched and often not discussed in society and in the medical community. The director of the North American Menopause society is the first to say that the medical industry hasn’t figured out how to provide proper care during or after this transition, or even which kind of doctor should do so.  Health impacts: From peri-menopause to post-menopause, women can experience at least 34 symptoms including hot flashes, night sweats, sleep problems (40-60%), migraines, mood swings (40%), trouble concentrating, recurrent UTIs, and more.  These symptoms are the result of changes in fertility hormones, particularly estrogen and progesterone, that impact the reproductive system, the brain, and more.  Menopausal symptoms significantly reduce mental and physical quality-of-life scores, negatively affect personal and intimate relationships, decrease occupational productivity, and impair daily activities (Journal). According to a recent analysis, the adverse psychological impact of moderately and severely bothersome menopausal symptoms on general well-being is comparable to that experienced with housing insecurity. 7% of women experience early onset menopause, which carries with it additional risks of osteoporosis, heart disease, etc. Chemo/radiation, surgeries can also lead to early onset menopause. For people experiencing menopause early, other fertility care will also be paramount such as considering preservation.   Most women reported the need to take time off or faced other serious challenges in the workplace during menopause and perimenopause, with 54% sharing that they have encountered at least one menopause-driven work challenge, including loss of work time and job security concerns. [supporting info below] Medical system impacts Significant frustration and confusion around trying to find a provider. No one medical specialty “owns” medical management because it affects so many systems in the body. And there is a lack of dedicated providers - there are only 1100 providers officially certified by the North American Menopause Society (vs. 100k IM/ Gyn physicians), but they vary across OB/GYNs, PCPs, internal medicine, midwives and more. If you were a member, how would you know where to start? — or worse, they suffer silently assuming this is just ‘how it is’  Lack of education - conflicting research on the value of hormone therapy. Challenging for members to make informed decisions on their own.  As a society we are at a critical juncture. People are starting to talk about this, medical researchers are conducting long-term trials across multiple specialties, and women are pushing for better care and recognition of the symptoms in the workplace.  Sources here.
  5. Today we’ll be talking about how to create a more inclusive environment for employees experiencing menopause symptoms. If your company offers any support for menopause, chances are, it’s through your regular healthcare coverage. But as we’ll discuss, simply being able to go to the doctor to discuss symptoms doesn’t mean employees are actually pursuing care or getting the support they need. 
  6. First, I’m going to walk you through results from a survey Carrot conducted this summer. We surveyed 1,000 people currently experiencing perimenopause or menopause or who completed menopause in the last five years to capture a snapshot of how their symptoms impacted every part of their lives, with an emphasis on work. We also asked about how supported — or unsupported — they felt by their employers and what resources would have improved their job satisfaction during this time. Our results show that not only do most employees going through menopause lack support at work, but many also don’t seek support from family or even doctors.
  7. First off, we found in our survey that few people feel prepared for the challenges of menopause.  Only 8% of survey respondents say they were very prepared and informed for the overall experience of menopause. 47% say they were either not prepared or completely unprepared. We also asked how their level of preparation for menopause felt compared with other significant life events. 59% of parents say they felt more prepared for childbirth than menopause, while only 18% say they were more prepared for menopause. So you can see right away that the lack of conversation that exists around menopause means that individuals do not know what to expect when the process starts. [Option to add a personal experience here if you’re open to it]
  8. One reason so many respondents felt unprepared may be that nearly half of respondents did not seek help from a doctor. Other surveys have shown similar or even lower numbers. And even for those who have sought care, the experience may be lacking — most OB/GYNs lack specific training in menopause. In fact, only 20% of OB/GYN residency programs offer training in menopause care, most of which are elective. You can see that around the same proportion of people are getting support from internet searches and forums and friends and relatives as they are from their doctor. 
  9. As we discuss the impact menopause symptoms have on employees, it’s worth pausing and considering what those symptoms are and which symptoms respondents considered to be the most challenging. Hot flashes are probably the first symptom you think of, and in our survey, they were the most commonly experienced symptom. Hot flashes are followed closely by trouble sleeping (77%), fatigue (75%), night sweats (74%), and weight gain or slower metabolism (71%).  Mood changes (68%) and anxiety (62%) are the most commonly reported emotional and mental health symptoms. It’s also important to note that these symptoms don’t just last for a few weeks; they typically last for years. Imagine having trouble sleeping for a year and how that would impact your daily energy levels and overall mood.  59% said the physical symptoms, including hot flashes and trouble sleeping, are very challenging, or the most difficult challenge of menopause. 
  10. Managing those symptoms during the workday takes a toll. The average woman enters menopause at 51. In the survey, 46% of respondents said their 50s have been the most difficult time in their career, well ahead of second-ranked 20s, chosen by 25% of respondents as the most difficult.  79% describe menopause as a challenging work-life stage, more than starting a new job (75% challenging), starting a family (70% challenging), or getting a promotion (62% challenging). So compared to all of these other significant milestones in the workplace, including just starting out in your career, managing menopause at work ranked as the most challenging time.
  11. We found that employees often make changes to better manage symptoms at work. Most respondents have to take time off or face other serious challenges in the workplace during menopause and perimenopause. More than half (54%) of respondents have dealt with menopause-driven work challenges, among which, “Took time off… but concealed the real reason,” was the most common. Of those who took time off, 71% lost more than 40 hours (1 full week) of work time, and an astounding 30% report losing more than a month of work time altogether. Respondents also considered making significant changes to their work life in order to better manage symptoms. 70% of respondents have considered at least one type of major employment-based change due to menopause. 47% have considered remote or hybrid work, and 1 in 5 have even considered changing jobs for better menopause support. And nearly a quarter have considered retiring early due to menopause symptoms.  The employees managing these symptoms and making these decisions are likely some of your most valued employees. On average, it costs a company 6 to 9 months of an employee's salary to replace them. And especially when we’re talking about senior leaders, that can add up very quickly. [Source: SHRM]
  12. It’s clear that menopause symptoms impact employees and make getting through the workday more challenging. But workplace support for menopause is limited. While menopause symptoms are disruptive for many, just 8% say their employer has offered significant support for menopause, with 59% reporting no support at all. Among the 21% whose employers have offered significant or minor support, flexible scheduling is the most common (40%).  The majority of respondents also did not feel comfortable talking about these challenges with their employer. 77% of women felt uncomfortable talking with executives about the problem, and 63% didn't feel comfortable talking to human resources about the issue. More than half (58%) didn't want to discuss it with their immediate supervisor.  Menopause is a private, personal experience. And ageism in the workplace towards women is no secret. If no one has approached you about this issue, that certainly doesn’t mean that no one in your office is experiencing these challenges. 
  13. Before I get into the next section of our survey, I wanted to pause and share a few headlines from other surveys and sources to demonstrate that our survey results were hardly outliers.  Menopausal symptoms do not only impact employees. The burden also impacts their employers through medical costs, productivity loss, and turnover.  Productivity: In one recent survey conducted by the Mayo Clinic, researchers found that the average menopause symptom severity score indicated a severe level of menopause symptoms. Researchers surveyed women who were employed full time, so most likely had access to medical care, but still experienced this level of symptom burden.  They also looked at adverse outcomes from menopause symptoms, defined as one that directly caused women to miss a day from work in the past year or, within the past 6 months, to cut back on work hours, to experience a layoff or job termination, or to quit, retire or change jobs. Those with the most severe symptoms (top 25%) were 15x more likely to experience an adverse work event than those with the least severe symptoms. So as symptoms go unchecked, these problems at work can get worse and worse.  Turnover:  A British study found that one in four women experiencing symptoms of menopause were unhappy in their jobs because of a lack of support, and that nearly one in five were considering quitting because of it.
  14. We’ve walked through some of the challenges employees managing menopause face in the workplace. In the next few slides, we’ll explore a few ways employers can create a more comfortable environment for those experiencing menopause symptoms, improve productivity, and reduce turnover. 
  15. Improving symptom management starts with education. Because 51% of people get support for menopause through internet searches — about the same percentage as those who seek support from a doctor — providing access to expert-vetted resources can help close knowledge gaps through reputable guidance. We talked about the challenges of accessing menopause experts. Providing Telehealth access to experts on-demand is one way to help employees get answers and support on their own schedule.  We also talked about the fact that specific training in menopause is limited for OB/GYNs. So providing access to a database or provider finder of menopause experts that’s been vetted can help employees find expert care and support. 
  16. As we’ve discussed, most people don’t feel prepared for the experience of going through menopause. Connecting with others who have a shared experience can help. In Carrot’s survey, 66% of respondents were interested in working with a “menopause mentor,” and 69% would find menopause support groups helpful.  A menopause mentor is someone who’s been through menopause and can help someone who’s currently going through perimenopause or menopause navigate this experience.  Through a menopause benefit, experts can facilitate and guide these groups. Relevant employee resource groups (ERGs), such as those for women or those 40+, can also host support groups and provide resources, and potentially make connections for those interested in menopause mentorship.
  17. In our survey, 47% of respondents have considered changing jobs for hybrid or remote work to manage symptoms better. Of course, remote work isn’t possible for all companies and roles. One in-office option respondents expressed interest in were “menopause rooms”: dedicated spaces for managing symptoms. 58% of survey respondents thought menopause rooms sounded like a helpful resource.  One concern about rooms designated specifically for menopause, though, is privacy. Someone might want to take some time for themselves but doesn’t necessarily want to broadcast why. A more general wellness room for comfortable breaks is another option. 
  18. To recap, here’s an overview of resources respondents expressed interest in. Overall, 82% of respondents said menopause benefits would be valuable.  [Read through top choices]
  19. Among the 92% of respondents whose employers have not offered significant support, 55% say such a benefit would result in an increase in their own job satisfaction. Overall, 92% have at least one reason for believing menopause benefits should be provided by employers, led by 62% who said having access to benefits would lead to increased productivity and 61% who said menopause benefits would increase their job satisfaction. Diversity, equity, and inclusion are more important than ever for many companies, and age diversity is part of that. You can see that 52% of respondents said that menopause benefits would help create a better workplace culture, and 34% said they would help foster fairness in the workplace. 
  20. I know one common concern from HR leaders is that you’re not necessarily looking for another point solution that only supports a certain portion of your population. In the next few slides, I’ll share a few ways menopause support can slot into other resources and how you can ensure you're offering inclusive support for your entire workforce. 
  21. Menopause support doesn't have to be a standalone benefit: It can be part of a comprehensive fertility benefits program. Why? Fertility hormones are at the center of fertility care. The same key hormones involved in IVF, preservation, and pregnancy also govern another important part of fertility care: hormonal aging. In addition to the resources we've explored in this presentation, other fertility care resources may be beneficial under certain circumstances, for example, when people experience menopause before age 40, this is known as primary ovarian insufficiency (POI). This means the ovaries stop working as well as they should at an earlier age than typical, leading to lower estrogen levels, menstrual irregularities, and other menopause-like symptoms. Individuals diagnosed with POI may choose to preserve their fertility through egg freezing.  That’s just one example of how menopause support can be integrated into a larger program that impacts all of your employees. A guide to the hormones on this slide: Typical reproductive hormones: Estrogen (E2/estradiol), AMH, Follicle-stimulating hormone, luteinizing hormone, testosterone, prolactin Other hormones that impact fertility: Thyroid stimulating hormone and insulin can also affect our fertility and pregnancy outcomes, so we have included them here as well 
  22. SPEAKER NOTE: THIS IS AN ANIMATED SLIDE  As we discussed on the last slide, fertility hormones are at the center of fertility care — and while menopause is one example of that, fertility hormones are at the center of fertility care for men, too. Low testosterone levels (or low T) are a natural part of aging – just as perimenopause and menopause are for females. In both cases, these important and in some cases, dramatic, changes in fertility health can cause negative side effects that impact people physically, mentally, and emotionally. After the age of 30, it’s normal for testosterone levels to decline 1-2% annually and, ultimately, 40% of males ages 45+ are considered to have low testosterone. While the majority of time it is age-related, chemotherapy, radiation, and underlying conditions can cause this to happen earlier in life. For these people in particular, the subsequent impact on fertility is critical to discuss. (Testosterone impacts sperm production) Symptoms include erectile dysfunction, decreased libido, infertility, reduced muscle mass, sleep disturbance, persistent fatigue, depression, and more.  Low testosterone can be caused by a multitude of factors: congenital conditions, injury, chemo, medications, a range of disorders, and more. Because it is a cluster of numerous conditions, a single therapy cannot be the same for all. There are also risks associated with prescription testosterone treatment Similar to the resources we discussed for menopause, access to educational resources, Telehealth, vetted providers, and support groups are all beneficial for this population as well. 
  23. Before we wrap up, I wanted to talk a bit about the overall impact fertility health is having on your company beyond hormonal aging. How big is this issue? It impacts nearly everyone in your organization. Egg freezing is now mainstream, and sperm preservation is following suit. Those facing menopause and low testosterone also need real support. Nearly everyone in your organization needs support 1 in 8 opposite sex couples face infertility, which is more than diabetes. (US stat)  In the U.S. fertility preservation is now mainstream 63% of LGBTQ+ say they intend to pursue parenthood, whether through fertility treatments or adoption.  Men make up 40% of our member base, and we hear from them all the time what a relief it is that there’s a product where fertility isn’t limited to women.  In the U.S, more than 30% of deliveries are c-sections, many of which are not necessary. This is an invasive procedure with additional recovery time. Access to ongoing prenatal care, educational resources, and Telehealth experts can really help here.  And, your most senior leaders are silently managing menopause or low testosterone and it’s hurting their productivity at a time when you can least afford it.  Comprehensive fertility benefits can support your entire population and help meet your DE&I goals related to age diversity, sex and gender diversity, and more. 
  24. We talked about the value our survey respondents saw in workplace menopause benefits. The same goes for fertility benefits overall: comprehensive benefits are a must for attracting and retaining your talent. 36% of people say they’re looking for a new job in search of better fertility benefits.  Considering that 88% of people in the U.S. would consider changing jobs for access to fertility benefits and 77% would stay in their current role longer if fertility benefits were offered, now is the time for employers to consider the role fertility benefits play in their recruitment and retention strategy.  Sources: (US survey data)  77% and 88%: 213%: 36%: 
  25. To close out this presentation before turning it over to you for questions, I wanted to go through a few questions you can consider asking as you explore menopause support resources.
  26. Carrot Fertility was built with inclusivity in mind, equally supporting all paths to parenthood for employees worldwide. Carrot is the only truly global fertility benefits solution with a network that includes 120+ countries and over 3,800+ clinics and 4,200+ agencies and attorneys, and we’re proud to work with over 750 forward-thinking employers worldwide.