She was never refusing to speak

It was one of those weekend trips where you promise not to talk about work and then talk about nothing else. Sunny street, coffee in hand, and my friend told me her company had just built a menopause policy. She was proud of it, and she should be! Most companies still have nothing at all.

It says two things. Everyone reads the guidance. And if you are going through menopause, you tell your manager, so she can be flexible with you. Someone there had already done it, quite matter of factly, which is wonderful. She knows what is happening to her, and she works somewhere safe enough to say it out loud. But that is one woman.

Three friends

One has been tired for years. She is in a leadership role, which is where a lot of women our age are, and everyone had the same answer: well, you work too much, of course you are tired. Then she was told it was probably burnout. And she agreed! I have two children, elderly parents, a demanding job, and I still want to write this book. I am the one who does not let myself rest. So it must be my fault.

She is still tired.

One went to a rheumatologist about her shoulder. She was taken seriously, for the shoulder. Then more than a year of circling, one specialist and the next, each looking carefully at their own piece of her, and nobody asking what the pieces had in common.

One read a book about menopause and recognised herself on almost every page. She brought it to her doctor, a woman roughly her own age. The doctor laughed and told her to put that book aside, it was not real medicine, just someone trying to be popular. Sent home for trying to understand her own body, with nothing offered in its place.

Now tell me how any of these three declares her menopause to her manager. They were not hiding anything. Every explanation they were given pointed back at the woman herself.

The other side of the desk

Suppose she says something anyway. Her manager is 35, male, first baby at home, and his world looks nothing like hers. He read the policy the way we all read the security policy. Right, be flexible if someone tells me something, understood, next.

So there are two people in a room and neither of them knows what they are dealing with. She is describing something she has no name for, he is accommodating something he has never seen, and both of them mean well.

In BSI's UK research, only about one in ten women who have been through it would feel confident even raising this with a male line manager.

Singling out

I have had hot flushes at the worst possible moments. A big client presentation, on video, and suddenly I am burning, my face red in front of everyone. I lose the thread of what I am saying, and then the second layer arrives, me watching myself lose it, certain that everyone on that call now thinks I am stupid. The more aware I am of it, the worse it gets.

And you want me to stop mid-sentence and explain that, when I am ashamed of something that is not even my fault? No. Most women carry on and act as though nothing is happening.

I will tell you something I am not proud of, too. About 10 years ago, in Stockholm, over lunch, a colleague quite a bit older than me told me she was working on menopause in the workplace. I can still see her across the table. And I was uncomfortable! I actually asked her, why talk about it at all? It happens, you handle it, why does the whole world need to know?

That was me. That is how deep it sits.

The standard

On 7 September ISO published ISO 45010, its guidance on menstruation and menopause in the workplace. The first International Standard on this subject, built on the British standard from 2023 that has been downloaded more than 13,000 times in 147 countries.

It is guidance, not requirements. Nobody gets certified. And ISO has made the full text free to read online, which ISO rarely does, so a 12-person company with no HR function can open it tonight. That is most companies.

The price is not why I like it. I like it because the work sits with the workplace and not with her. Culture, manager awareness, workplace design, practical adjustments. BSI, who publish the British edition, say this version adds new guidance on disclosure and privacy, which tells me the working group hit the same wall.

My test for any adjustment is one question. Can everyone use it without asking? If yes, nobody is singled out, and nobody has to announce anything.

Measure it

The frustration I hear from women is not that nothing is happening. It is that what happens is window dressing. A policy document, a lunchtime lecture where the management team answers email, tick, done, back to work. Women see that for exactly what it is. And in BSI's survey of 6,494 women across seven countries, six in ten have never heard their employer raise menopause support without being asked.

Same logic for measurement. If she cannot say it to her manager, she will not tick it on your engagement survey either. The ones struggling most stay quiet, so counting how many managers attended the training tells you nothing.

Measure what you already hold. Retention, sick days, promotions, salary growth, by age and gender cohort, never individuals. Compare women in their late forties and fifties with everyone else. If there is a gap, you have found it, and nobody had to confess anything. Does the gap close? That is the benchmark.

What is still missing

There is one piece the workplace cannot supply, and it is the piece all three of my friends were stuck on.

Most menopause tools begin by assuming menopause. They ask how you experience it, and they score it. But the real question is whether this is menopause, or something else, or both. This is exactly the age when chronic conditions start to arrive, and a cardiovascular risk missed because everything was labelled menopause is every bit as serious as a hot flush waved away.

That is the gap Scita Health is built for, and we are not live yet, we are finishing the first version. Scita sits between the tracker and the doctor. It helps her see the whole pattern instead of three symptoms half remembered in a 15-minute appointment, and gives her a structured summary to bring with her, so the doctor can do the part only a doctor can do. For an insurer or an employer, that year of circling specialists is the bill. The potential is to shorten it: the right questions asked earlier, and the right investigation sooner.

And it closes the loop back to that manager's office. A woman who understands what is happening to her can talk about it, in her own words, if and when she chooses. She was never refusing to speak. She simply had nothing solid to say.

The standard changes the conditions, and everyone who worked on it should be proud of that. The rest of us have to make sure she is not walking into the room empty-handed.