Reproductive health and menopause at work

This advice guide is designed to help all members who are nurses, midwives, nursing associates, and health care support workers across the UK and in any health care setting. This guidance provides information on your rights, managing work alongside your wellbeing and when to contact us. 

The RCN recognises and embraces our gender diverse society and encourages our guidance to be used by and/or applied to people who identify as non-binary, transgender or gender fluid. The RCN also recognises that not all those born female, or male will identify with the same gender nouns, but for ease of reading use the term woman/man and where appropriate acknowledge non-binary terms.

Information about maternity and related issues such as adoption and breastfeeding can be found in our Having a family toolkit.

The RCN believes that our members have a right to access support at work on women’s reproductive health concerns such as:

• fertility care
• menstrual health
• miscarriage
• maternity care and
• menopause care

to enable them to continue in employment and ensure they maintain their health and wellbeing.

Many women throughout their lives can experience a reproductive health problem that impacts on their working life. This may cause sickness absence, performance issues, and even lead to women considering leaving due to a lack of support at work.

The degree of impact on a woman’s quality of life and the symptoms experienced with regards to reproductive health concerns are very individual. The symptoms can be physical, emotional and psychological, which can lead to vulnerability at work. 

There are many reproductive health conditions that can have an adverse impact on working life. Many of these can be long term conditions - such as endometriosis and polycystic ovary syndrome, amongst others. The impact of such conditions can be physical, emotional and psychological. Our Women’s health page (you will need to be logged in to view this) provides more information about individual conditions, such as endometriosis. 

Employers have a duty of care to their employees, which includes providing safe and healthy working conditions, increasing awareness and having robust women’s health friendly policies that include options such as reasonable adjustments when needed. Supportive policies covering leave and sickness absence contribute to a work environment that enables individuals to better manage their reproductive health issues.

This duty applies to all women, and our Having family toolkit gives additional information on employers' duties relating to pregnancy, miscarriage, still birth and premature births.

Our position statement on Women’s reproductive health at work provides a summary of evidence-based resources that relate to work, including recommendations for best practice. This includes information for those experiencing reproductive health concerns, including fertility, menstrual health, miscarriage and pregnancy loss and gynaecological health.

 Undergoing fertility treatment can be stressful for many people.

Whilst undergoing treatment, you are likely to require multiple appointments, which may be during your working week. You may also experience side effects during treatment. There is no legal right to take time off for IVF treatment or related sickness. 

Your employer should be sensitive to your situation. Check your policy and contract for provisions on medical appointments and time off work. Any related sickness will be treated under your employer’s normal sick policy process.

It may be helpful to discuss the situation with your manager in advance, if you feel able to. There may be a special leave policy, or you could arrange flexible working during weeks where you need appointments, or unpaid and annual leave could be used. A plan of action agreed with your manager may help relieve any stress related to taking time off work.

Our Having a family toolkit has more on taking time off and protection from discrimination if you are treated unfairly.

The symptoms of menopause can adversely affect the performance of some women at work, so it is crucial that women receive workplace support around this time if needed. This needs to be balanced as some women do not wish for - or need - help. 

Some may worry that disclosing menopause may cause active discrimination, so workplace policies need to be sensitive to the needs of all. The impact of the symptoms relating to menopause can also lead to some women considering leaving their workplace.

The symptoms of perimenopause and menopause vary enormously in range and intensity between women, and it is important that symptoms are fully assessed and acknowledged. A list of symptoms can be found in our Menopause position statement at Annex 1.

Many women may not realise early symptoms as being that of the menopause and this can delay access to support. This is why it is important to have an open and understanding work culture. Not everyone will experience the same symptoms, and some may not have any problems, so it may be that a single workplace policy won’t fit everyone’s circumstances.

As a professional body and trade union, we recommend that menopause-related absence is taken out of sickness absence triggers, so that individuals are not taken through a formal capability management process.

If you work in the NHS, NHS Employers Menopause and the workplace contains advice and links to a wide range of resources and examples of good practice.

The Health and Safety at Work Act 1974 and the Health and Safety at work (Northern Ireland) Order 1978 require employers to ensure the health, safety and welfare of all workers.  Employers are required to undertake risk assessments, which should include specific risks to women if they are employed.

Employers should consider exposure to hazardous substances, shift work and unsafe working environments. Measures should be put in place to reduce harm to general and reproductive health.

The Equality Act 2010 (Disability and Discrimination Act 1995 in Northern Ireland) prevents discrimination on the grounds of specified protected characteristics. These protected characteristics include disability, age, sex and pregnancy and maternity. 

Flexible working 

Check if there is a written policy for where you work. If there isn’t one you can follow the statutory process.  Our flexible working guidance explains eligibility, your options and how to prepare a flexible working application.

Examples of flexible working can include flexible hours, remote working or compressed working weeks. 

In the NHS, and in independent health and social care in England, Wales and Scotland, the statutory right to flexible working begins at day one of employment. In independent health and social care in Northern Ireland, the statutory process states that you must have worked for your employer for 26 weeks before applying.

We have guidance regarding working time if you are concerned about your working week, breaks and working night shifts.

Medical appointments and time off work

If you need to take time off, you should first check your contract and any local policy to see if it covers the arrangements you need to make. There is no legal right to time off work for a medical appointment, however, if it is not within your contract/policy, your manager may agree for you to make the time up or take unpaid time off.

Anyone who is disabled or has a long-term health condition is likely to be able to take time off for medical appointments related to the disability or health condition. This may be included in your absence policy or, if you have had a number of related absences, a reasonable adjustment to attend appointments could be agreed. If your employer will not let you take time off for a medical appointment connected with your disability, they could be breaking the law. 

Our time off work guide gives further information. 

If you are pregnant, you are allowed paid time off work for ante-natal care. Read more about this in our Having a family toolkit, which also has further information on fertility treatment and time off work.

Sickness absence 

Sickness absence policies should be supportive of women experiencing sickness due to an underlying reproductive health problem that may fluctuate or cause unpredictable absences. In addition, delays in treatment and diagnosis may lead to increased absence from work.

If you are off sick your employer should follow the policies in place. We have guidance on sickness that includes long term sickness absence, sick pay, returning to work and redeployment. 
The guide also advises when to contact us for support.

Discrimination 

Some health conditions meet the criteria of a disability automatically and other long-term conditions may be considered a disability depending on individual circumstances. Therefore, some reproductive health conditions may amount to a disability. See our guidance about disability discrimination for more information on the definition of disability and how the Equality Act 2010 (Disability Discrimination Act 1995 in Northern Ireland) can protect you.

The menopause is not a specified protected characteristic under the legislation, but if you are treated less favourably, for example, because of symptoms of menopause, it may be discrimination if it relates to a protected characteristic. These may include, age, disability, gender reassignment and sex. 

ACAS also have helpful guidance on disability and work and managing the menopause at work.

Health, safety and adjustments

The working environment may exacerbate symptoms for some people. Employers have a duty of care to provide safe and healthy working conditions. Consideration of hazardous substances, shift work and unsafe working environments can present risks, and employers should put measures in place to reduce harm to general and reproductive health. 

Employers should also carry out risk assessments in your work environment that consider the needs of all their employees. This will include risks from chemicals, screen work, and workplace temperatures. They are also required to ensure access to rest facilities, toilets, washrooms, drinking water and lockers for nursing staff working in clinical roles within health and social care buildings. 

You should also be involved in discussions about appropriate adjustments for your individual circumstances, and an individual risk assessment should be carried out. In advance of any discussion, consider what would help you manage your symptoms in the workplace. For example, you may find it helpful to be able to go outside for fresh air, have regular comfort breaks and easy access to changing facilities. Other options may include flexible working arrangements such as changes to shift patterns, a uniform change or access to cold water.

Occupational health may also be involved, who can assess and discuss any adjustments and make recommendations to your employer. It is best if you can agree a plan with your manager. This may involve using a health ability passport (see below) but it is best to have any agreements made in writing.

Health ability passport

A health ability passport is used by some employers and details the reasonable adjustments that employees with health or disability issues require at work. Many organisations have adopted the passport; ideally it should be used in accordance with a supporting policy and after an open dialogue with your manager. 

The RCN's peer support service has guidance on using health ability passports. The service has lots of advice and support if you have a long-term health condition.

If you are experiencing difficulties at work and are unable to get the adjustments and support you require, please contact us.

Performance and capability

It is important that women are listened to and supported at work. Symptoms relating to ill-health may affect performance at work and should be considered when deciding if this is impacting on performance; this includes symptoms of the menopause or conditions such as endometriosis. Your employer is required to establish any medical facts and discuss support that can be offered. For more information about capability and ill health including menopause, see our guidance on capability and performance reviews.

You should also check your local policy for how performance and capability issues are managed.

The RCN recommends that menopause-related absence is taken out of sickness triggers to avoid individuals being subject to a formal capability process. You can discuss this with your manager and record any agreement made. This would, however, depend on individual circumstances and your local workplace policy. For more information on this see our position statement, Menopause and you at work. 

Career changes or retirement due to ill health

Our careers service can advise you on options to consider if you are considering a change of career due to your health.

Ill-health retirement may be raised during management meetings or may be something you are considering for those who have an NHS pension scheme.

If you are worried about redeployment or losing your job, please contact us. 

Encouraging open workplace discussions can normalise women's health issues, whilst fostering best practices in managing and supporting individuals wherever they work. Communication, supportive policies and reasonable adjustments can help encourage open dialogues. 

Managers should consider whether absences or any performance problems may be related to underlying health conditions, including reproductive health concerns. Sensitive and sympathetic communication is needed; any concerns raised may require support and possible referrals to occupational health. Remember to maintain confidentiality when dealing with any health-related matters, including that of the menopause. 

Managers can also collaborate with occupational health and local trade union representatives or any wellbeing teams who can advise on any adjustments.

Flexible working arrangements can be helpful in supporting women’s health at work. Whilst it is important to balance this against the needs of the service, there are a range of options relating to work patterns, plus other ideas, such as adjusting meeting times, or allowing virtual attendance at meetings.

Our position statements on Women’s reproductive health at work and Menopause at work provide information about how employers can bring about change to ensure the support of women’s reproductive health needs in the workplace.

The NHS also has a range of resources available on menopause and the workplace. 

You may find it helpful to join a local group or network - some workplaces may have a women’s forum or similar group. You can also contact your employee assistance programme, if there is one.

If there is a lack of support at work, or local policies do not allow flexibility, for example, uniform policies, you can contact your local RCN health and safety rep for support. You can find out more about how a health and safety rep started an initiative for nursing staff experiencing menopause symptoms.

You can find links to groups who can provide information and support about specific conditions in our further information section below.

If you are worried about work and feel you are being treated unfairly, our problems at work guidance can help you identify the areas of concern and what the next steps might be. 

If after reading our guidance above you remain concerned about how you are being treated and want help, or feel at risk of losing your job, please contact us.

The RCN offers a peer support service including a peer support network for people with long term conditions.  

We also have a counselling service and range of resources on mental health and wellbeing. 

 RCN Women’s Health Forum for a range of resources, information and events

RCN Position statement: Women’s reproductive health at work

Daisy Network for premature ovarian insufficiency information and support 

Endometriosis UK

Tommy's: Fertility treatment and the workplace

Fertilitynetworkuk - fertility and the workplace

British Menopause Society

RCN Position statement: Menopause and you at work 

Menopause matters

Gov.uk:  Reasonable adjustments for disabled workers

NIDirect.gov.uk:  Disability discrimination law: employment rights

NHS Employers: Menopause and the workplace

NHS England: Supporting our NHS people through menopause: guidance for line managers and colleagues

Scottish Government Health Workforce Directorate: Interim national menopause and health policy for NHS Scotland

NHS Wales: Menopause policy