Abstract / Summary
Background: Menopause is a universal life-course transition that coincides with midlife employment for a growing proportion of the global female workforce. Despite increasing recognition, robust cross-country evidence linking menopausal symptoms to burnout and workforce wellbeing remains limited, particularly outside high-income settings.
Methods: This mixed-methods analysis draws on MARIE WP2a, a multi-country cross-sectional cohort of 5,133 participants aged 40–65 years across 13 countries (Brazil, Ghana, India, Sri Lanka, Malaysia, Nigeria, Nepal, Oman, Pakistan, Rwanda, Singapore, Tanzania, and the UK). Quantitative data assessed burnout using the Burnout Assessment Tool (BAT-12) and its subscales (exhaustion, mental distance, cognitive impairment, emotional impairment). Linear mixed-effects models examined associations with employment characteristics, health factors, and menopausal treatments. Qualitative interviews were synthesised with a topics guide using cross-country thematic analysis to contextualise workforce impacts.
Results: Overall burnout burden was moderate (mean BAT-12 2.41, SD 0.84), with exhaustion and cognitive impairment most pronounced. Participants early in their current specialty (1–5 years) consistently demonstrated higher burnout and subscale scores than those with ≥21 years’ experience. Disability and long-term conditions were associated with significantly higher burnout across domains. Marked cross-country heterogeneity was observed, reflecting differences in labour structures and social protection. Qualitative findings revealed convergent mechanisms across countries: symptom-driven capacity loss, amplification by inflexible work structures, stigma and non-disclosure, reliance on informal support, policy absence, and financial precarity.
Conclusions: Menopause substantially shapes workforce wellbeing across diverse economic and cultural contexts. Symptoms interact with job demands, stigma, and inequitable access to care to drive presenteeism, reduced productivity, and constrained occupational choice. Menopause-informed workplace policies, manager training, low-cost job adjustments, and equitable access to evidence-based care are urgently required to protect women’s health, workforce participation, and productivity in ageing economies.