While hormone replacement therapy (HRT) used to be seen by many as the panacea, its safety profile has plummeted since research in 2002 linked it with a higher risk of breast cancer, stroke and blood clots (even though for most women the risk of these is still small – see box).

A million women quit HRT virtually overnight and by 2006, only 15 per cent of those aged 50-plus were taking it, compared to 40 per cent in 2000. Only this month, figures from Cancer Research UK pointed to HRT as the cause of the small rise in breast cancer over the past decade.

Since then, not much has emerged as an effective treatment for menopause symptoms. the latest research suggests that acupuncture may help ease hot flushes, with women who had needles inserted at various points on the body reporting fewer of these symptoms than those who had sham treatment. the theory is that this traditional Chinese treatment may help stabilise the body’s temperature controls. But, with only 53 women participating, the findings are far from proven.

For women in demanding jobs like Layward’s senior management role, this time of life can be particularly tough. At work she did her best to hide her symptoms, despite feeling lousy much of the time. “there was no way on earth I would have gone to HR and told them about how I was feeling,” she says. “it would have felt like professional suicide.”

And with hot flushes visibly obvious, she didn’t wish to become a figure of fun to some of her more ribald colleagues. “In the past, I’d seen women at work teased when they were having hot flushes” she says.

High-profile celebrities such as Oprah and Kim Cattrall (whose character, Samantha, experiences hot flushes in Sex and the City) may be “coming out” about the menopause; but new research reveals that, as in Layward’s case, “the change” is still something working women prefer to keep to themselves, out of embarrassment and fear of being seen as less competent.

The study, just published by the University of Nottingham, has shown that nearly half of women going through the menopause have difficulty coping with symptoms at work; yet two thirds say they would not dream of disclosing their menopausal status to their bosses, male or female. this was particularly true of those in demanding jobs – which might involve giving presentations at lengthy meetings, for example. half of these said they would also avoid mentioning hot flushes and other symptoms to colleagues, especially if these were men or younger women,

It is understandable that people want to keep intimate health details to themselves, says lead researcher Amanda Griffiths, Professor of Occupational Health Psychology at Nottingham. But with 3.5 million women over the age of 50 working full-time, the challenge of the menopause is fast becoming an occupational health issue and should be treated as such, with more support from employers, she says.

“If women don’t feel they can speak openly, then they won’t get the support they need,” she argues. Prof Griffiths’s study is the basis of new guidance published by the TUC on how support for menopausal women can be increased, through more awareness, more flexible working hours and, crucially, improvements in workplace temperature control and ventilation.

“If you need to take a break and have a lie down, you are entitled to ask for it. it should be understood that you may need a fan, to sit by an open window or have time out,” she adds.

Jenny Hislop, senior researcher in primary care at Oxford University, who has recently conducted extensive interviews with nearly 50 menopausal women for the charity website, Healthtalkonline, agrees that women are reluctant to talk about some of the difficulties.

“We found that menopausal symptoms are at odds with the self-confident, professional image women want to convey at work,” she says.

Her interviews include one senior police officer who contemplated early retirement when she felt her hard-won authority was being undermined by menopausal symptoms. “I was suffering frequent panic attacks and very frightening problems with concentration and memory loss. it felt as though somebody had taken the chip out of my brain,” she says. Another woman, working on a Tesco checkout, felt it was better to join in male colleagues’ laughter at her hot flushes than show her feelings. “Deep down, you’re upset, but it’s happening in a public place so what can you do? You get your blonde jokes, you get your menopause jokes,” she says.

It doesn’t help that the menopause is largely neglected in medical education and GP training, says Oxford GP Sally Hope, a specialist in women’s reproductive health. “the consensus among GPs today is that menopausal symptoms are trivial – and most doctors don’t have time to offer the support needed or talk through the complex issues surrounding HRT.”

Layward, who is now working as an independent scientific consultant, eventually decided to take HRT after carefully weighing up its risks and benefits, and says she has never regretted it. “My symptoms disappeared as quickly as they had arrived and six years later, I still feel great. anyone who tries to take it off me will have a fight on their hands.”

Just in case any younger women are now dreading the menopause, there is a liberating upside to this time of life, she adds reassuringly. it is not just that her children are grown up and flown the nest. “not having to worry about getting pregnant or the menstrual cycle is lovely, and I feel I have a lot more confidence and experience.”

healthtalkonline.org

Menopause: what works?

Eight out of 10 women suffer from menopausal symptoms, linked to fluctuations in hormone levels as fertility comes to an end. These include hot flushes, memory loss, mood swings and vaginal dryness.

HRT is effective but has risks for every 1,000 women using HRT in their 50s, there will be six extra cases of breast cancer, blood clots or stroke. Regulatory bodies advise taking the “lowest possible dose for the shortest possible time”.

Tibolone, a synthetic hormone, can help but, like HRT, it increases the risk of stroke and breast cancer. Clonidine is sometimes used to treat hot flushes but has side effects. Testosterone, combined with oestrogen, may occasionally be given as implants for low sex drive.

Some women take plant oestrogens, available as supplements, but one study from 2007 found no good evidence for these. some experts worry that these could increase the risk of hormone-related cancers. Researchers are not sure if herbal remedies, such as agnus castus and black cohosh, are effective.