Menopause and chronic pain: the symptom employers still aren't talking about
One of your team has been quieter than usual for months.
She's taking the odd day off here and there. A bad back. A migraine. Just not right today.
Nothing dramatic enough to flag. Nothing that quite adds up to a conversation. Each individual absence looks small enough to not be concerned about, and she’s always been a good worker.
Then her performance starts to slip.
She's slower to respond to emails. She seems distracted in meetings. A client mentions she wasn't quite herself on a call. Little things, but they're starting to add up, and you're the one who has to decide what to do about it.
You start wondering if she's lost interest in the role, or whether there's a wider performance conversation coming.
What you might not be considering: she could be in perimenopause, and those ‘just not right days’ could be chronic pain.
It's a scenario that plays out in workplaces every week, and it rarely gets labelled correctly until much later, if at all.
Menopause is finally being talked about. Pain still isn't.
October is Menopause Awareness Month, and World Menopause Day falls on 18 October.
Each year, the International Menopause Society sets a global theme for the day, meant to focus attention on one specific part of the menopause experience that isn't getting enough airtime. For 2026, that theme is chronic pain at midlife. The society is explicit about why: pain affects a significant proportion of women during and after the menopause transition, yet it remains underestimated in both research and clinical care.
That's a deliberate shift, and a telling one.
Most menopause conversations, including a fair amount of what's already been written on this subject, focus on hot flushes, brain fog and mood. Those symptoms are real and worth taking seriously, but pain tends to appear as one line in a longer symptom list, somewhere between joint aches and fatigue, and then gets no further attention from anyone.
For a lot of women, pain isn't a footnote. It's the symptom that actually stops them functioning properly at work, and it's one of the symptoms most likely to be missed, dismissed, or put down to something else entirely: ageing, an old injury, busy life, or just one of those things you learn to live with.
What menopause-related pain actually looks like
Chronic pain at midlife doesn't always look like an obvious injury or arrive with a clean diagnosis attached. In practice, it can show up as:
● Joint and muscle pain that wasn't there before, often worse first thing in the morning and easing slightly through the day.
● Migraines that become more frequent, more severe, or start for the first time in someone's forties or fifties.
● Existing conditions such as fibromyalgia, arthritis or endometriosis flaring up or becoming markedly harder to manage during perimenopause
● Pain that fluctuates significantly, so someone can seem completely fine one week and be really struggling the next, with no obvious trigger in between
That fluctuation is part of what makes this so easy to misread. An employee who copes well on Monday and is clearly struggling by Thursday doesn't look consistent on paper, and inconsistency is exactly what tends to raise flags in a performance conversation. It's rarely framed as a health issue at that point. It's framed as reliability.
The uncomfortable truth is that it's often easier to have a conversation about someone's timekeeping than it is to ask whether they might be in pain.
Why medicine is only just catching up too
Part of the reason this gets missed at work is that it's still being underestimated in clinical care as well. The International Menopause Society has been explicit that chronic pain during the menopause transition remains under-researched and under-treated, which is precisely why it's the focus of this year's global campaign rather than something already well understood.
The scale of it is easy to underestimate. A pooled analysis of multiple studies estimated that around seven in ten perimenopausal women experience musculoskeletal pain, a marked increase compared with the years beforehand. UK research published in late 2025, following women in a British birth cohort study from their forties into their fifties, found that those who already had chronic pain at 44 were nearly three times more likely to go on to experience a high overall symptom burden during the menopause transition. Pain, in other words, isn't only something that turns up alongside the menopause. For a lot of women, it's one of the things shaping how difficult the transition becomes.
That matters for employers because it means an employee raising pain as a menopause-related issue may not yet have a tidy diagnosis, a specialist referral, or a GP who has fully joined the dots. Waiting for gold-standard medical paperwork before taking someone seriously isn't realistic, and it isn't what the law expects either. A reasonable belief, formed from what the employee tells you and whatever evidence is available, is enough to trigger a duty to consider adjustments.
Why it hits small businesses harder, not less
There's a temptation to think this is mainly a large-employer problem, the kind of thing that shows up in council HR departments or national hotel chains with occupational health contracts already in place.
It's actually the opposite in a lot of ways.
In a team of six, one person having an unpredictable bad week is immediately visible, and immediately felt by everyone else covering for her. There's no large pool of colleagues to quietly absorb the gap. And most small and medium-sized businesses don't have an in-house occupational health function, a dedicated HR team, or a ready-made policy for fluctuating conditions. It usually falls to you, or to a line manager with no formal HR training, to notice, ask the right question, and decide what to do next, often while also doing their own job.
That's not a reason to do less. It's the reason a bit of structure helps more here, not less, because there isn't a bigger system behind you to catch what gets missed.
The good news is that structure doesn't have to mean a formal policy suite from day one. It can be as simple as a short, agreed process: notice a change, ask a direct question, write down what's agreed, and put a date in the diary to check how it's going. That's roughly what larger organisations pay occupational health providers and HR teams to do. There's no reason a smaller business can't do the first two steps just as well, often better, because you actually know the person involved.
Why it's easy to miss, and expensive to ignore
Hot flushes are visible. Pain, especially pain that fluctuates, often isn't.
Nobody clocks a colleague wincing when they sit down the same way they'd notice someone fanning themselves in a meeting. Because pain doesn't come with an obvious, universally recognised marker, it's much easier for a manager to read the symptoms as something else entirely: low motivation, poor time management, or a bad attitude on a difficult day.
If you manage people, it's worth asking yourself honestly: when was the last time you asked a team member whether they were in pain, rather than asking why a piece of work was late?
Instead of noting a pattern of lateness or missed detail in a file and waiting for the next formal review, try something more direct.
"I've noticed a few deadlines have been missed recently, and I want to check in properly rather than assume. Is everything alright health-wise?"
That single question does more to prevent a formal process than any policy document will, because it gives someone the opening to explain what's actually going on before it's written down as a performance concern.
This isn't only a wellbeing issue, it's a legal one
Under the Equality Act 2010, menopause itself still isn't a protected characteristic. But where symptoms, including pain, have a substantial and long-term effect on someone's ability to carry out normal day-to-day activities, they can meet the legal definition of disability. Once that threshold is met, you're required to make reasonable adjustments, and failing to do so carries real legal risk, not just a reputational one.
This isn't hypothetical. In Simon v Manorview Hotels (2024), an employment tribunal in Glasgow found that the claimant was disabled under the Equality Act because of fibromyalgia and perimenopause together. The tribunal heard that during a flare-up she had difficulty sleeping, walking, standing, sitting, concentrating and making decisions, all of which counted as normal day-to-day activities. The judge also noted that perimenopause was independently causing similar symptoms, plus low mood and anxiety, and that the two conditions were compounding each other.
The lesson here isn't really about fibromyalgia specifically. It's that pain-related symptoms, whether menopause is the sole cause or one of several overlapping factors, can meet the disability threshold even without a single tidy diagnosis to point to. If you're waiting for a label before taking someone's symptoms seriously, you may already be behind where the law expects you to be.
More recent tribunal decisions, including cases heard as recently as 2025, show the same pattern continuing. Tribunals are giving medical evidence close, careful scrutiny rather than taking claims at face value in either direction. The direction of travel is consistent. Pain-related and fluctuating conditions are being taken seriously as potential disabilities, and employers who disregard them too quickly, or accept them without any real inquiry at all, are both exposed if the assessment later turns out to be wrong.
If you want the fuller legal picture on menopause and the Equality Act, including how earlier cases such as Rooney and Merchant shaped this area, we've covered that in more detail in a previous blog about how to support women experiencing menopause in the workplace:
When the medical evidence gets ignored
Employment tribunal claims referencing menopause have more than trebled in two years, from 64 cases in 2022 to over 200 by 2024, and disability discrimination now accounts for around one in four of the menopause-related claims referred to ACAS. This isn't a niche or occasional risk any more. It's a well-established and growing category of claim.
Shearer v South Lanarkshire Council (2024) shows exactly what that looks like in practice. A teacher was told to transfer to a different school, despite occupational health advice warning the move would worsen her menopause symptoms and mental health. The council went ahead regardless. She was later dismissed on capability grounds. The tribunal found both disability discrimination and unfair dismissal, and awarded her just over £61,000, partly because the council had other, less damaging options available and hadn't properly explored them before dismissing her.
The pattern in both cases is the same. Someone raised a genuine health concern, backed by medical evidence, and the employer either didn't investigate it properly or pressed ahead regardless of what they'd been told. That's the point where a manageable situation turns into a tribunal claim, and where the compensation stops being theoretical and starts being a real cost to the business.
What you can actually do differently
Most menopause guidance still defaults to fans, flexible hours and a word about the office thermostat. All useful for hot flushes, but not much help to someone managing joint pain or a fibromyalgia flare.
For pain specifically, it's worth considering a slightly different toolkit:
● An occupational health referral where pain is affecting someone's ability to do their job, rather than waiting to see if it settles down on its own. Even a one-off assessment gives you something concrete to act on.
● Practical, physical adjustments: a different chair, a sit-stand desk, permission to move around more during the day, or reduced screen time during a flare. None of these require a large budget.
● Flexibility around timing rather than just total hours, so someone can start later after a bad night's sleep or take a proper break rather than pushing through and making things worse.
● Reviewing how your sickness absence policy treats fluctuating conditions specifically, so someone isn't penalised through a standard trigger-point system for a pattern that's genuinely medical rather than a discipline issue.
● Training managers to ask what's actually going on, rather than assuming that inconsistency automatically means a lack of effort or commitment.
None of this needs to be complicated or expensive. It mostly needs someone to ask the question, take the answer seriously, and keep a short written note of what was discussed and agreed, in case things need to be reviewed later.
How to actually start the conversation
The biggest barrier here usually isn't policy, it's the conversation itself. Managers often worry about getting it wrong, saying the wrong thing, or prying into something private, so they say nothing at all.
You don't need to diagnose anything or ask for details you're not entitled to. You just need to open the door.
Rather than: "Your performance has dropped, is there a reason?", which can land as an accusation, try: "I want to check in properly. I've noticed some changes and I'd rather understand what's going on than guess. Is there anything affecting you at the moment, health or otherwise, that I should know about?"
If the answer involves menopause, pain, or both, the next step is simple. Ask what would actually help, rather than assuming you already know. Someone managing joint pain might need a different adjustment to someone managing brain fog or hot flushes, and the only reliable way to find out which is to ask directly.
It's worth having a second version ready too, for when someone has already disclosed a condition and you're checking in on an ongoing basis. Rather than: "How's the pain thing going?", which can feel dismissive even when it isn't meant that way, try: "Last time we spoke you mentioned the fibromyalgia was flaring up. How has that been this week, and is there anything that would help right now?" Naming the condition specifically, rather than a vague reference back to "the pain thing," tells someone you were actually listening the first time.
But we're nowhere near 250 employees…
In March 2026, the government published guidance under the Employment Rights Act 2025 on Equality Action Plans. From April 2026, employers with 250 or more staff can voluntarily publish a plan covering how they're supporting employees through menopause. From spring 2027, this becomes a legal requirement, and affected employers will need to select at least one recommended action from the menopause category as part of that plan.
If you're running a business with one to 100 staff, that specific duty doesn't apply to you, and it isn't about to.
But it's worth paying attention to anyway. Once larger, well-resourced employers start publishing structured menopause support publicly, it stops being a nice-to-have and starts becoming a comparison point, both for candidates deciding where to apply and for your own people deciding whether to stay.
Getting ahead of that now, even informally and without any of the reporting overhead a 250-plus employer will carry, is a recruitment and retention decision as much as a legal one. It's also considerably cheaper to build good practice gradually than to bolt it on under pressure later.
Three questions to ask before you assume it's a performance issue
If someone on your team seems inconsistent, distracted, or is taking more short-term sick leave than usual, ask yourself:
1. Have I actually asked what's going on, rather than guessed?
2. Have I considered whether pain, menopause, or both could be a factor?
3. Have I looked at what adjustments might genuinely help, rather than defaulting straight to a formal process?
If the answer to any of those is no, that's where to start, before a capability conversation, not instead of one.
It's not just the right thing to do
Supporting someone through chronic pain at midlife isn't only about avoiding a tribunal claim, although as Shearer and Simon both show, that risk is real and growing.
It's about not losing good, experienced people over something that, with a bit of curiosity and a few practical adjustments, was often manageable all along. It's also about the message it sends to everyone else watching how that situation gets handled, long after the individual case is resolved.
Go back to the scenario at the start of this piece. The version where nobody asks the question ends with a difficult capability conversation, possibly a resignation, and quite possibly a tribunal claim eighteen months later. The version where someone simply asks what's going on, early and directly, usually ends with a short conversation, a small adjustment, and someone who stays. The difference between those two outcomes is rarely the policy on file. It's whether anyone actually asked.
We've written blogs before about building a supportive culture around menopause more broadly, including menopause champions and how to open up the conversation across a whole team, and this all sits alongside a well written menopause policy. If it's been a while since you looked at your menopause policy, or you don't have one at all, October is as good a prompt as any to revisit it.
World Menopause Day exists to shift what gets talked about, and this year, that includes pain. It's worth making sure your own workplace conversations catch up with it, rather than waiting for a tribunal to make the point for you.
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Disclaimer: this content is provided for general guidance and does not constitute legal advice. Always seek professional HR or legal advice for your specific circumstances
