Place-Based Experiences in the Work Environment During the Menopausal Transition: A Case Study of Canadian Physiotherapists

Background: The global workforce is aging, with increasing numbers of employees experiencing the transition to menopause. This transition to menopause, known as perimenopause, involves hormonal changes with secondary symptoms impacting individuals at various degrees, times, and intensities. Menopause marks the end of the menstrual cycle, although the transition can last from 7 to 14 years. In the work environment, menopause is often a taboo topic. However, the 2021 Global Consensus Statement on Menopause in the Workplace from the European Menopause and Andropause Society recognized the individual experience(s) of menopause and the relationship of this experience within the work environment. In addition, new research suggests that the work environment affects the experience of menopause, and the embedded physical, psychosocial, and cultural factors are critical to understand and explore when creating inclusive work environments. Continued investigation is critical to ensure institutions are knowledgeable and aware of structures necessary for the increasing number of menopausal employees.
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\nObjectives: While the literature on menopause enhances our understanding of health issues (e.g., osteoporosis, cancer, cardiovascular disease), these findings remain descriptive, biomedical, lacking theoretical frameworks, and void of the lived experience. This research focused on increasing our understanding of the gendered dimensions of health and wellbeing concerning the transition to menopause within the work environment, using a case study of Canadian physiotherapists. Specifically, the research explored the following question: How do place-based experiences in the work environment impact physiotherapists undergoing the transition to menopause? In addition, the research addressed the following objectives: 1) To examine the relationships between aging, gender, health, and wellbeing in the workplace, 2) To explore the experiences of perimenopause for physiotherapists in the Canadian work environment, and 3) To document the perceptions of existing structural support(s) in the workplace shaping physiotherapist’s experiences with the menopausal transition.
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\nMethodology: Stake’s approach to qualitative case study research guided this work. Feminist geography provided the theoretical perspective to shed light on how relations of power and inequality over the life course shape health and wellbeing as part of aging. Examining life course experiences further exposes how gendered relations of power and inequalities experienced over time shaped experiences of wellbeing as part of aging and the menopausal transition. In-depth interviews with 29 participants were audio-recorded and transcribed verbatim for subsequent analysis in NVivo. Data analysis used Braun and Clarke’s reflexive thematic analysis approach.
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\nFindings: Three main themes emerged; 1) Exploring Being Well at Work, 2) The Embodied Experience, and 3) Navigating Supports. In keeping with feminist geography, these themes and sub-themes were developed by understanding power and exploring the intersections of identity, knowledge, and agency as they relate to health and wellbeing.
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\nDiscussion and Implications: Through the engagement with physical bodies, physiotherapists provide health care to improve the mobility and wellbeing of patients. In this context, the menopausal body is problematic as the physiotherapist must conform to being strong and manage the complex clinical environment. Negotiating the experiences of perimenopause in the work environment requires attention to both individual characteristics and institutional context. While menopause continues to be unrecognized and unaddressed within work environments, an embodied approach that attends to the biomedical perspective and the lived experience may normalize the menopausal experience at work.
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\nThis research makes three contributions. First, to understand workplace experiences of perimenopause and how aspects of work can intensify these experiences through health geography. Second, recognizing ‘age’ as another structure of power that organizes society and informs group identities within feminist geography. Third, by demonstrating the need for supportive and inclusive organizational culture(s) in the workplace. 
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\nConclusion: The findings of this research have implications for physiotherapists and other health care providers. Health care teams knowledgeable about menopause create confidence to offer support to themselves, their team, and their patients. The participants recommended education, practice and policy interventions in the workplace that include demystifying menopause through education, supporting flexibility, and focusing on wellbeing, not only health.

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