Menopause and work performance: A systematic review of observational studies

Importance: Most Australian women will experience menopause while in paid employment, and many workplaces are introducing menopause-related policies. However, the quality of the evidence for the impact of menopause on women's work outcomes is unclear. Objective: To systematically review the published literature that has examined the impact of menopausal status and symptoms on work ability and productivity. Evidence Review: A systematic review of English-language peer-reviewed literature. Data sources included Ovid MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases searched from inception to 14 November 2024, Google Scholar, and reference lists of included articles. Eligible studies included a formal process to identify menopausal status; a robust questionnaire or validated tool for assessing menopausal symptoms; a comparator group by menopausal status, symptom presence or severity; assessment of work outcomes by a validated tool; and a sample size of at least 100 women. Two authors selected the articles for inclusion and extracted the data from the included studies. The risk of bias was assessed using the modified Joanna Briggs Institute critical appraisal checklist for cohort studies and the modified Hoy tool for cross-sectional studies. Findings: Of the 40 articles retrieved for full-text review, 10 met the inclusion criteria. Nine studies were cross-sectional and one was longitudinal. Menopausal status was not consistently related to work ability. The presence and severity of VMS and other menopause-related symptoms may impact work outcomes, but findings were mixed. A number of adverse employment, socioeconomic, and personal factors were independently associated with lower self-reported work ability in studies that examined such factors. Each included study was limited by a high risk of bias in at least one assessed domain, and only 6 of the studies adjusted for confounders. Heterogeneity in study design and analysis precluded a meta-analysis. Conclusions and Relevance: Menopausal status alone was not consistently associated with work outcomes. Evidence for an adverse impact of menopausal symptoms on work ability is mixed and may be confounded by other factors impacting on women's work outcomes at midlife. Rigorously designed studies that assess the potential factors impacting work ability in midlife women are needed to ensure robust evidence underpins menopause-related workplace policies.