Understanding the non-disclosure by women in their mid- to late-life at work

A better understanding and awareness of factors that influence a woman’s willingness to speak up about taboo, stigmatised or “hidden” health issues can improve her support at work. Report by Dr Belinda Steffan, Professor Wendy Loretto.

Up until now, the relationship between women’s health at work and their employment has been underreported. Government, policymakers, and employers now realize that barriers to improving women’s overall health must be addressed to improve workplace outcomes.

Women’s health is often a term that only refers to hormonal, reproductive and transitional health. In addition, women are more prone to experiencing non-gendered issues like chronic pain (Vincent & Tracey, 2010,) and anxiety.

These are often referred to as hidden health problems, because they can’t be seen or might be taboo.

This article discusses menopause, which is one of the hidden health issues that affects women during their mid- to late-life phases.

Menopause is the collective term for peri- and postsmenopause. This is because menopause (the cessation or menstruation after at least 12 month) can be a highly personal experience with a wide range of physical and psychological symptoms.

Many workers are reluctant to disclose their health status due to stigmatised hidden health problems. This is mainly because of fear of negative outcomes, which is relevant to those in the middle-to-late life stages (Gignac, et. al., 2024).

The article focuses on the reasons for not disclosing hidden health issues at work. Due to gendered health issues and age-specific barriers, we are focusing on menopause.

This article summarizes key findings about non-disclosure regarding women’s health, based on the results of in-depth life-course interviews conducted with 80 women over 50 in the UK, from four different organisations, as part of the “Supporting Healthy Ageing at Work” (SHAW) Project.

The SHAW Project was a multi-disciplinary, three-year study that examined how organizations can support ‘hidden’ health issues, such as menopause and sleep disorders, cognitive decline and anxiety, among others.

To improve the health of all employees, occupational health practitioners (OH) must be more aware of the complex decision making processes that determine whether or not employees reveal hidden health issues at work. They should also become familiar with other formal routes for workplace health support, such as human resources (HR) or line managers (LM).

Individual factors that affect non-disclosure.

Disclosure of health information at work is an individualised, contextualised decision that is heavily influenced by social and organisational factors.

Disclosure at work is a process that begins with a decision-making process. This involves weighing up goals (positive outcomes), support sources, outcomes affecting the individual (for instance, health), as well as interpersonal relationships (for instance, trust).

In reality, however, health disclosure may have both positive and adverse outcomes. It highlights the difficult environment in which people who experience taboo, less-discussed or stigmatized aspects of their health must navigate.

Disclosure can result in appropriate supports which reduce stress (Munir, et. al., 2007), a clear positive outcome. Disclosure can lead to stigma and discrimination.

Setting disclosure boundaries

Employee preferences regarding the disclosure of private and personal information at work will determine whether sensitive health issues are disclosed at work. It is particularly true when sensitive and relevant disclosure topics are not discussed openly in the workplace, which leads to individuals creating their ‘privacy boundary’ around workplace health disclosures. (Petronio and Child 2020, page 76).

The SHAW project results suggest that in relation to menopause the actual disclosure decision-making process is far more complex than theoretical frameworks suggest.

Participants reported that they set their own boundaries for disclosure based on a variety of factors, including the gender and age of the disclosee as well as whether or not it would worsen perceived performance judgments.

To protect women from the negative impact of menopause on their performance at work and attitude towards work, privacy boundaries were created. The fear of being evaluated based on an official record of menopause and its effects was the main reason for avoiding disclosures to traditional support, such as OHs, HRs and LMs.

Participants preferred to disclose their health in informal ways, such as informal talk sessions and social support networks, because they believed that this would result in positive support.

Ageism and gendered ageism

Gendered ageism is a result of the intersectional effect between gender and age. It plays a major role in workplace decisions regarding health disclosure. Menopause as a manifestation gendered age can lead to bias and discrimination in the workplace.

To avoid gender- and age-based assumptions, employees in their mid- to late-life may hide health-related issues to appear productive or a good fit within their team.

It has been shown that women who hide their menopause symptoms in the workplace experience a cognitive dissonance, as they are unable to present themselves as productive workers while feeling a stigmatized and precarious body (Steffan 2021; Steffan & Loretto 2024).

The SHAW data extends the findings to the mental health of women during menopause by making them more visible.

Many participants in menopause age experienced memory deficits, lack concentration and slower processing speed. It was the fear of being labelled as ‘an old woman’ with all its connotations (Rochon et. al., 2021), that led to participants not disclosing their health concerns to OHs, HRs and LMs.

This shows that medical disclosures must take into account psychological and social factors as well (in otherwords, a biopsychosocial workplace disclosure model).

In the middle-to-late life phase, the decision to disclose age-related health aspects is largely driven out of fear of a negative performance-based evaluation by others at work (managers, colleagues, or clients).

The employee feels threatened when they perceive that the appraisals are based on ageist stereotypes which perpetuate a narrative of age as decline.

The findings of the SHAW project show that women with disruptive menopause often struggled to accept this narrative. This prevented some from disclosing, but it also reduced fear in the decision-making process for others.

Personal and professional identity

The importance of professional and personal identity in the non-disclosure mental health problems at work is highlighted (McGrath, et. al., 2023).

Women may also choose to conceal their gendered health in the workplace to protect their professional image, because of the stigma attached to certain health conditions. For example, menopause symptoms, both psychological and physical, can be difficult to discuss (Grandey, et. al., 2020).

It is also called reputation management, where’maintaining your reputation’ is an important factor in mid-life to later life health disclosure decisions (Gignac et. al., 2024; p. 178).

The SHAW data shows that women of all job types and backgrounds use these principles when making decisions about disclosure.

The job type or seniority of the employee did not seem to have a significant impact on their reputation or perceived performance.

Women who avoid disclosing their symptoms use personal adaptations and coping strategies to deal with menopause-related symptoms at work. Gottardello & Steffan (2024), for example, found that women with neurodivergent symptoms of menopause hid their symptoms and felt unable to seek support from formal support systems like OH, HR, and LMs.

The expected and anticipated reactions are important in the decision-making process around disclosing health issues at work. The reasons for a preference to personal coping rather than seeking workplace supports are unclear. However, participants in the SHAW study reported that, while they were unsure of the reasons, they had little expectations of receiving support at work with regards to menopause symptoms, or other health issues they believed to be connected with menopause such as fatigue, anxiety and stress.

This low expectation for organisational support led to non-disclosure. It is a way to mask symptoms. They chose to focus their resources on self-care, demonstrating and performing personal responsibility in health.

The implications for researchers and organisations

Women base their decision on complex factors that are highly personalised. They include:

• Set disclosure boundaries based on a variety of needs and interpersonal relationships.
• Fear is a common emotional reaction to lack of trust. This leads to gendered ageism.
• Women from all types of jobs found that managing their professional identity and reputation was important.
• Low expectations from organisations can lead to low self-care and responsibility during menopause.

2) Organisational factors that influence individual health disclosure decisions

It is generally believed that a workplace culture which encourages the discussion of hidden health issues, like menopause, can influence disclosure decisions.

A culture of openness can be achieved by training, health promotion programs and formal/informal networks (Mackenzie, et. al., 2019), but this requires explicit organisational commitment to workplace well-being support (Manner, et. al., 2024).

The findings of the SHAW project found that when making disclosure decisions, it is important to consider how an inclusive culture (or lack thereof) is communicated throughout the organisational culture as well as more locally in team culture.

The decision-making process was influenced by a variety of levels of culture. This area needs further research.

Disclosure influenced by formal and informal sources

Health disclosure is encouraged by organisations with supportive practices and clear policies (Munir, et. al., 2016). This also promotes an inclusive and open culture which can reduce the fear of discrimination.

Managers can benefit from training in aspects of taboo or hidden health, even though the dynamics can be gendered.

The SHAW project found that while research identified a need for menopause-specific management support (Beck et. al., 2020), the findings of the SHAW project suggest that managers are already overworked. Expecting them to be experts on all aspects health can negatively impact their mental wellbeing.

The majority of participants preferred to share their menopause related health with same-age and same-sex support groups at work. This suggests that general management training about menopause may not be as effective as mechanisms to ensure that there are enough same-age and same-sex supporters in place.

When should you disclose information?

There is a disconnect between employees and employers regarding the timing of disclosure. OH and HR prefer a more timely disclosure, while individuals with experience do not.

This is because individuals need to have time to decide who they can trust with their personal health information (McGrath, et. al., 2023).

The SHAW data confirms this conclusion. Participants reported high levels of reluctance when it came to disclosing their health problems, and they only disclosed them when the issues affected or were likely impact performance.

Employees’ decisions can have a lasting impact on how and when they disclose in the future. Employees are more likely than not to disclose sensitive information in the future if they have a positive experience with disclosing it.

This study highlights the importance of team and organisational culture to create a supportive and inclusive environment that encourages employees to disclose sensitive health issues.

The implications for researchers and organisations

• When inclusivity is promoted through an organisation’s culture, it is more likely that disclosure will occur. This could be a local team and not a global organization.
• The role of a manager should be to communicate an inclusive culture and to provide resources.
• The employees are more likely to want a reactive disclosure whereas OH/HR prefer a proactive disclosure. This suggests a disconnect in the preferred time of disclosure.
• Positive organisational responses to disclosure encourage future disclosures.

The conclusion of the article is:

It is important to understand the factors that affect employee decisions about whether they will disclose less-discussed issues, taboos, taboos or “hidden health” issues at work. This knowledge is vital for the effectiveness of workplace health support.

This article discusses menopause, a hidden but common aspect of workplace health. The findings of the Supporting Healthy Ageing at Work project (SHAW), suggest that occupational healthcare, human resources, and line managers all need to be aware that formal health support alone will not encourage disclosure.

A bio-medicalised method can also exclude psycho-social influences on health disclosure. Interconnectedness between individual factors (trust and fear), societal (ageism based on gender) and organizational factors (open culture and inclusivity) all can influence the hidden disclosure of health at work (for instance menopause).

The formal organisational health support pathway should be able to navigate the individual disclosure boundaries, and work to provide appropriate workplace health supports.

• 
  The Shaw Project
  

The Supporting Healthy Ageing at Work (SHAW) project can be found at https://www.shaw.business-school.ed.ac.uk/. The authors, Professor Wendy Loretto and Dr Belinda Steffan, were members of the SHAW Project, which was funded by UKRI Healthy Ageing Challenge Social, Behavioural and Design Research Program, Grant Number ES/V016148/1. Other project members are acknowledged on the SHAW website.

Steffan, B. and Loretto, W. (2024) provide more details on the SHAW methodology. Menopause, mid-life and work: Challenging stereotypes of the ideal worker. Gender, Work & Organization. Available online at: https://onlinelibrary.wiley.com/doi/full/10.1111/gwao.13136

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