RIGHT now, hundreds of thousands of women in Scotland are struggling in silence. They are on your telly, running industry, fighting fires and tending to the sick. They may be at the supermarket till, a neighbour, your partner, a friend, sister or mother.

You wouldn’t necessarily know it, but each is undergoing a profound physical, psychological and emotional transformation that, although as ancient as time itself, appears to be taboo.

Like death and taxes, menopause is inevitable. It happens when a woman’s menstrual cycle stops, typically around the age of 51, and is preceded by a phase known as perimenopause which can take a decade to unfold.

As well as fertility ending with monthly periods, hormone level fluctuations trigger a range of responses from night sweats and hot flushes to crippling anxiety, joint pain and outbreaks of rage.

Judging by last week’s Edinburgh policy summit on Menopause in the Workplace, anger is justified. Despite the fact that 69% of women in their late 50s are in paid employment, few are aware of their rights: a recent STUC survey of 3649 women revealed that 99% do not know even if their workplace has a menopause policy.

That matters because women in work may need support to enable them to manage their menopause symptoms.

For some, that involves ensuring the windows in meeting rooms can be easily opened, or that there is a desk fan available. For others, it is about cooler uniforms, or taking extra breaks. But it’s also about changing a workplace culture that treats menopause as a joke – and 63% of the STUC survey respondents reported that.

Many women do not disclose menopausal symptoms at work, fearing judgement and discrimination. There is evidence that many women take time off work, reduce their working hours, or even retire completely as a result of menopause, which may be affecting them at a time when they have dependent children and ageing parents to care for too.

Given that it will directly affect half the population, there is a great deal that is unknown about how menopause affects women at work. The studies have been done focus on middle-management and much more investigation is needed into the experience of women working on the shopfloor and in the growing gig economy.

Nothing is known about how women with disabilities, women of colour, migrant women or LGBT women manage menopause at work. And there is only one study of the impact of so-called cliff-edge menopause when periods suddenly stop, perhaps because of surgery or cancer treatment.

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THE economic case for menopause-positive work-places is compelling, as is the emerging legal one. A handful of cases have been brought (and won) by women under existing legislation such as the 2010 Equality Act, which offers protections for sex, age and disability. The threat of legal action might spur the 90% of employers who do not yet have a menopause policy to act.

There are good examples. The Scottish Parliament recently launched a period and menopause policy that aims to inform staff and managers about the issues, give some tips and open conversations about how to continue to make improvements.

For Scotland’s menopausal firefighters, that might mean reviewing mixed-sex accommodation where men and women have no choice but to share sleeping areas and toilet facilities on shift. Being unable to sleep, flooding with blood, and sharing a room with nine men while awaiting an emergency call-out must be a daunting prospect.

The Scottish Government lent emphasis to the cause in its Programme for Government. The outline for the year ahead includes developing a Women’s Health Plan, which will lead on actions to target women’s heath inequalities.

When it comes to menopause that will be a challenge. The average duration of symptoms is 7.4 years, and more than 20% of women report them as severe. Accessing help is not easy.

Few GPs have specialist knowledge of menopause symptoms and how to best treat them. In an ideal world, women experiencing problems that cannot be addressed locally are referred on to dedicated services – but only half of Scotland’s health boards offer those, and there are long waiting lists.

Listening to the experiences of the women – and one man – who attended the Holyrood Events summit was a stark reminder that although it’s nearly 2020, equality for all women (particularly older ones) still has a way to go.

Ultimately, the biggest block is ignorance. Time-worn stigma, and the insidious, prevailing perception that the menopause marks the end of a woman’s useful purpose, has to be consigned to the history books. In England and Wales, schoolchildren now learn about menopause as part of the human life cycle. That is not happening here yet.

As rites of passage go, menopause is significant. It’s about time it was dragged out of the shadows and celebrated for the liberator it should be.