Menopause May Cost Women Sick Days

Those with more bothersome symptoms are less productive at work, study finds

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Friday, March 16, 2012

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FRIDAY, March 16 (HealthDay News) -- Women who suffer the unpleasant and sometimes debilitating symptoms of menopause are more likely to miss days at work, a new Dutch study finds.

"If you have really bad menopausal symptoms, which could be insomnia, mood swings, irritability, you may be calling into work sick," says Dr. Jennifer Wu, an obstetrician-gynecologist with Lenox Hill Hospital in New York City.

Menopause, which typically occurs after age 45, marks the end of a woman's periods, when the ovaries stop producing the hormones estrogen and progesterone.

Although previous studies have looked at work productivity, this is the first to correlate menopausal symptoms with a broader concept known as "work ability." Work ability tries to take into account how well a person's abilities correlate with job demands while also attempting to predict future job performance, including how often a person will miss work.

The researchers, from Nij Smellinghe Hospital in Drachten, the Netherlands, enlisted more than 200 women, aged 44 through 60, who worked at the hospital or a nearby home-care organization.

Women filled out a web-based questionnaire asking about 21 symptoms potentially related to menopause, such as anxiety, depression, hot flashes and sexual dysfunction.

Participants also provided information on how often they called in sick, how they rated their current work ability vs. past ability and any diagnoses made by a physician.

Women who reported more menopausal symptoms were more likely to rate themselves lower on the work ability index, including reporting more days missed from work.

The findings, published in the March issue of the journal Menopause, probably won't surprise millions of mid-life women, their families and health-care providers.

"What they're trying to show intuitively probably a lot of people know," says Dr. Brooke Leath, a staff physician in the department of obstetrics and gynecology at Scott & White in Round Rock, Texas.

However, the physical symptoms most often associated with menopause -- hot flashes and night sweats -- did not affect work ability or sick days for women in this study.

"The majority of the questionnaire items associated with adverse effects on the work scale are pretty general, and I don't believe are truly specific for menopause," said Dr. Jan Shifren, director of the Vincent Menopause Program at Massachusetts General Hospital in Boston.

They included depression and anxiety, as well as "somatic" symptoms such as headaches, muscle and joint pain and dizziness. Somatic symptoms are physical manifestations of mental states such as anxiety.

"I think [the authors'] true conclusion is that mid-life women who are experiencing increased anxiety and depression and somaticize a lot are more likely to have trouble at work," said Shifren, who is also on the board of the North American Menopause Society. "This is not necessarily true of all menopausal women and should be reassuring to women having hot flashes and night sweats."

Anxiety and depression do tend to peak at mid-life, Shifren pointed out.

"You can see that probably any depressed person, male or female, would have trouble with work ability," Leath added.

Also, the researchers only took into account women's own perceptions of their work ability, which is not an objective measure, Shifren said.

The authors themselves pointed out several limitations of the study, including the fact that the study design could not establish cause-and-effect. Also, participants were all in a similar field of work, which may have biased the results.

And Leath pointed out that only 24 percent of women contacted actually responded to the questionnaire.

The good news is that there are treatments for anxiety and depression as well as ways to alleviate symptoms of menopause.

The antidepressant Effexor (venlafaxine), for instance, is sometimes used to help with hot flashes, Wu said. And mild sleep aids can help with insomnia.

Hormone therapy to ease menopausal symptoms remains controversial as it can increase the risk of breast cancer, heart disease and other problems. Its use should be discussed thoroughly with a doctor, said Wu.
Most doctors recommend using hormone therapy only if absolutely needed and, even then, as a little as possible for as short a period as possible.

SOURCES: Jan Shifren, M.D., director, Vincent Menopause Program, Massachusetts General Hospital, and associate professor, obstetrics, gynecology and reproductive biology, Harvard Medical School, and board member, North American Menopause Society; Jennifer Wu, M.D., obstetrician-gynecologist, Lenox Hill Hospital, New York City; Brooke Leath, M.D., staff physician, department of obstetrics and gynecology, Scott & White, Round Rock, Texas; March 2012 Menopause

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