E57: The Environmental Domain of Midlife

Kirtly: If I were going to create an environment that was midlife-woman-friendly at my home, it would have a big bathtub, a nearby walking trail that wasn't too steep, and it would not have any milk chocolate or potato chips or mayonnaise. Those are too dangerous for my waistline, so those shouldn't be in my environment.

I'm Dr. Kirtly Parker Jones and this is the "7 Domains of Midlife." And today, we're driving down into the environmental domain. With me is my co-host, a woman of a certain age, Katie Ward. Katie is an anthropologist, a doctor of nursing practice, a certified midlife women's specialist, and a world explorer. Hi, Katie.

Katie: Hi, Kirtly. Great to be here with you.

Kirtly: So what were your adaptations to your home space to make it midlife- or menopause-friendly? Did you make any changes when . . .

Katie: Yes, and I'm continuing to make them. So we've talked about this before. Well, I installed a ceiling fan in my bedroom. I think that was probably my first big change, was having a ceiling fan that's over my bed where I can set it up so the light is always off at night, but I can adjust the fan speed.

So that was probably the first sign I was going through menopause, was I had to have a bedroom fan.

Kirtly: A fan? Yeah. Actually, my sister did too. That's exactly what she did.

Katie: And I know the seasons are changing when it's time to turn the fan back on. That's happened just recently. I have a red brick house and it soaks up a lot of heat, and it lets it all out at night. And so the fan at night has been the best thing.

Kirtly: Menopause and perimenopause are marked by a lot of irregular periods, so to make my environment menopause-friendly, I had menstrual products available in a number of places in my purse. I had to make sure I always had them around because my periods weren't predictable then. So I always knew where I could find a menstrual product.

And I got some really cool cooling sheets, which are made out of Tencel, Lyocell, which really are remarkably cooling. In fact, they often feel kind of wet when they're not. They're just cool. I bought some expensive cool sheets, and I made sure I had products for unpredictable periods around. It was pretty easy for my house.

What do you think? Other things? Other adaptations?

Katie: I have a friend who worked in a very male-dominated field and she bought herself . . . she said she had a pen with a fan on the end of it.

Kirtly: Oh, yes, I've seen those.

Katie: And she just told everybody, "If the fan's going, don't come in."

Kirtly: Well, that was the other thing I thought. I think you also need a crying room, but I think you need a crying room all the time. When you need a time out, whether you're 20 or 40 or 55, from your family or whatever is happening, the bathroom is always a good option, except we only have one bathroom in our house.

And so if I hide out in the bathroom in the bathtub, it has to be an arrangement that you can come in, but you can't talk to me. So there's a little curtain. You can come in and pee because we only have one potty, but don't talk to me.

So having some space where you just say, "This is really more than I want to deal with in a socially acceptable way and I'm just going to time myself out a little bit."

Katie: Grown-up time out.

Kirtly: Grown-up time out. Well, how about a workspace? There's been a lot of talk both in the "New York Times" and certainly in the British press about a menopause-friendly workspace.

Katie: It's been a trend I've seen in a lot of ways. The place where I work has created lactation rooms, and that was something that didn't exist when I was feeding my babies. I'd either just have to pump at my desk and whoever walked by walked by, or worse, go sit in the bathroom. So I think that there is a move afoot to make workspaces sensitive to a variety of needs that people have.

And I think it's only fair that . . . Menopausal women are still really quite productive. In fact, it might be some of the most productive years of my life. In my career, I feel like I'm really at the top of my game and doing some of the best work I've ever done, and lots of it.

And so, yeah, if I have a few little adaptations in my space that make me comfortable, that I can change the temperature in my office to heat it up a little extra or cool it down a little extra, or those menopause products are in the bathroom, I think that's a really nice thing that my employer can do that makes my work just a little easier and gives me a little bit of security.

Even though I know I'm doing well in my job, you start to worry if you're going to be replaced by a younger version of yourself. So it's a nice way of saying, "We appreciate you."

Kirtly: Katie, the reality is it takes two millennials to replace a boomer. So you don't want to replace us.

Now, I know you're a young boomer and I'm kind of an older boomer, but it turns out there's a good business model to taking care of midlife women, because these are women at the top of their game. About 8 in 10 menopausal women are actually at work. They're often the most productive and the most reliable of the workers that you've got. So you should take good care of them.

The problem is having a conversation. My boss might say, "Yeah, I really want to take care of you because you're really important and your patients love you or you've been a great teacher." But I don't want to say, "Well, if you want to take care of me, these are what I need to get through my menopausal transition," because I would never say that word.

But increasing the awareness in the workspace that a few small things . . . it doesn't take a lot. It takes, first, the conversation. It takes the conversation that there are people, mostly women, but there could be guys . . . When I think about it's easier to get warmer, it's easier to put more clothes on than it is to take clothes off in the workplace. So there might be guys who want a desk fan.

And ensuring access to fresh, cool water, that's something everybody could use. Regular breaks and flexibility with working hours, that's pretty good too. And free sanitary products. Now, guys mostly aren't going to use those.

And also dress codes. If you told me after 40 that I was going to have to wear pantyhose ever again, I might've gone in total revolution. Thank you. I'm sorry for the pantyhose makers. They just don't really exist anymore, except on Taylor Swift's outfits. She always wears something like a pantyhose.

Katie: She's got some kind of support hose there going.

Kirtly: Yeah, super tight. Setting up a quiet space and practicing dress codes and uniforms that are layered, I'd say those are things that make a workspace menopause-friendly. But I would say those are things that make a workspace friendly not just for women.

I think having the conversation about how small things can make a big difference with people who are having hot flushes or unpredictable periods or they just need a little adult timeout for two minutes to gather themselves. And that's not just women that need that. Men sometimes need that too.

Katie: I agree. It is not just women, but I think recognizing women stay in the workforce for a long time, we live longer than men. I'm certainly planning to work past what I thought was going to be the traditional retirement age. So I'm a good investment.

I think it's worth thinking about what are the needs people have at various stages in their life, whether it's menopause or other stages, breastfeeding or pregnancy. These are good investments to make in your workforce to keep people happy.

So I do think Europe is a little bit ahead of us often in thinking about these issues, paternity leave and vacation. Policies in Europe tend to be a little bit more worker-centric than the United States is. So I say hats off to the menopause workspace.

Kirtly: Having given this something I never did, and I was lucky to have minimum menopausal symptoms, but how do you think you would approach your employer about the needs in your workspace? Would you say, "I'm having a lot of hot flushes, or I have some brain fog and I'd like some help for me and my fellow women in the workspace"? How do you begin to have that conversation?

Katie: Well, I think that it blends in nicely with some of our inclusion kind of work. I think actually we've been talking about it in my building, and it's not exactly menopause-specific, but maybe more age-friendly. We're thinking about it broader than just menopause.

Kirtly: Midlife.

Katie: Yeah. But what are the things that . . . thinking about employees across their lifespan, there may be some unique things for people on the second half of their career that make workspaces a little bit more appealing.

So you see a lot of initiatives that make work fun for young employees, make people want to come to work, that there's a coffee pot or a . . . Where my daughter worked in New York, they had a whole cocktail hour once a week on Fridays that were sponsored.

Kirtly: Inside the workplace?

Katie: Inside the workplace.

Kirtly: Sponsored by the work? Oh my gosh.

Katie: Yeah.

Kirtly: I've been here too long. I've been here so, so long.

Katie: But it is something that we've been talking about where I work, and it's not just menopause, but I think we've been talking about the value of older employees and how do you make the workspace friendly for people as they're aging. So there are a lot of things.

And I think this gets a little bit back to what we were talking about, about how you make your home comfortable too. It's making sure that the workspace is easy to navigate and it's safe and the sidewalks are clear and people aren't going to fall down. But making sure that people are seen and that they have opportunities for interaction and collaboration and respect.

And so I don't know that you have to talk about it just as menopause, but as a . . .

Kirtly: No, and that's something that clearly goes both ways. It really helps to have collaborative groups, to have the older folks actually see the younger folks and the younger folks see the older folks. That, to me, would be an acceptance of the lifespan of the people at work.

Some people are maybe younger, maybe they've got young kids at home. That creates a whole spectrum of needs to be working from home or needs to take a half day off to take your kid to the doctor. There are so many things that are unique to the younger group and to the older group.

But it's much better if instead of talking about older folks and younger folks, if we talk about ourselves as folks. There are clearly some skills that both sides have. I wouldn't be the one to be the fastest with a new electronic health record, but I know a lot more about medicine and how to think about broadly.

But how do we honor the special parts of people's lives in the workspace?

Katie: Boy, I wish I had all the answers to that, but they're good conversations to start to have.

Kirtly: Well, I think when I see workspaces where there are several generations or there are several spectrums, often the young people go off in one corner and they talk about young people things, and the old people go off and talk about their health, their IRS, or whatever they want to talk about.

Katie: Retirement accounts.

Kirtly: Their retirement account. Here I am having a senior moment.

But more things where people can do them together so that we can enjoy each other the way we would in a family. I think that families often, when they gather the youngers and the olders, can tell stories and everything together, where in the workspace that's a little more difficult.

Katie: And they are sometimes difficult conversations. I'm thinking about my team that I work with, and there are a lot of conversations in my team about how to make sure that time off is equitable. At the same time, I think, "Well, these young people are taking maternity leaves and I'm not going to need that again, but where's my equivalent?" And so it takes a little bit of a difficult conversation about how you do this inclusively. Everybody's sensitive to . . .

Kirtly: Yeah. I don't want it to be, "It's only women because they have period products and they have a lactation room and they have a cooling fan." I think it's thinking about what's inclusive for everyone as best that's reasonable within that field.

And now I have to take my own little rant in terms of the environment and menopause and aging. It turns out that women who age in a city where the air quality is poorer have more rapid cognitive decline. And this is when you even control for education and for socioeconomic status.

It's actually been an extension of the Nurses' Health Study. These are all nurses, so they are well educated and they have whatever incomes. But if you live in bad air, it's like losing a couple years of cognitive health.

So when I think about an environment that is midlife-friendly, it would be for everyone, not just the people who are going to be grandmas someday. I think it's for everyone. We want a space that's healthy for everyone to breathe clean air and drink clean water.

Certainly, more things happen to older people in terms of bad air. There are more pneumonias and there are more cardiovascular events and more heart attacks and more strokes and more cognitive decline in the olders, but the youngers are just setting themselves to get those things later.

As I said, for me, when I think about the environment that's healthy for midlife women and menopausal women, I think we need to do what we can to make indoor air . . . So if you're working in a restaurant and you're working next to the grill or you're working in a place that has wood-fired pizzas, you can bet your indoor air quality is awful.

So I want my indoor air quality, my air quality at my home to be pristine. I want it to be that for all women and find ways that the air that they breathe is good. So that's my little rant on air quality and aging and cognitive function.

Katie: It's so important. We see the air in our valley, just the entire valley, is a problem, and we know that. So the political will to think about this issue and engage in this issue for the health of everybody who lives in the Salt Lake Valley, but especially on the west side of the valley.

Kirtly: Absolutely.

Katie: And there's some really interesting data that's available that really looks at the differences in air quality just in different zip codes within our valley. There is good hard data that people that live on the west side of the Salt Lake Valley where it's just a little bit lower at the bottom of that lake bed where that dirty air sinks, it is costing people years off their lives and quality off of the years that they have.

I think we all have a responsibility to get engaged in that issue. So I'm absolutely with you, Kirtly.

Kirtly: And when we talk to midlife women and menopausal women about things that they can do to feel a little bit better and get their bodies ready for the next 30 or 40 years, we talk about exercise, but if the air quality is bad, then you need to have exercise facilities that are people-friendly.

And I have to put a shoutout to our local sports facility, the Salt Lake Sports Facility. I'm sure that many towns have these. I called up the person who is in control of the Salt Lake Sports Complex and asked what the air quality was. What were the air quality measurements during some bad-air days? Because people are encouraged to go and exercise indoors.

They said they didn't know, so I tromped right down to Salt Lake Sports Complex with my portable PM 2.5 meter and I walked into the track, and I walked into the exercise rooms, and I walked even into the pool where it's not fair because humidity makes these data off a little bit. But it was outstanding. They didn't even know how good it was.

And the great thing about our own local, open-to-everyone-for-a-very-small-fee sports facility, but for women of a certain age, the track goes around the skating rink and it's always cool, if not chilly. So if you want a chilly moment, all you have to do is just go to your local . . . Well, not your local because you may not have this, but to our sports complex and you can walk around and watch people skating, and it's very cool up there.

Katie: That is a fantastic recommendation. And hats off to the Zoo, Arts & Parks program that is funding those sports complexes.

Kirtly: You betcha. And it turns out a bunch of the exercise machines look over into the ice rink. So if just the thought of being cold would be lovely, you can get on the elliptical or you can get on the treadmill and look down at the ice rink. It's always funny to watch 6-year-old hockey players run into each other.

Katie: And so talking about walking, I want to just put in a plug for the importance of walking. I think I hear this really often from my patients, that they're gaining weight and nothing at all has changed. But in fact, it's easy to move just a little bit less.

And so I think that that's always one of my recommendations, is to make sure you have good walking shoes. This is the time in life when it's time to stop wearing cute shoes and make sure you're wearing shoes with good traction and ones that you can walk in and that you take a few extra steps, assuming good air.

This is really the time when it's important to park a little further away and get a few extra steps, and take the stairs instead of the escalator, and maybe carry something on your back for a little extra weight. Get that movement in because this is when it really pays off. Think about going for a walk with your friends rather than going out to lunch or out to drinks. Keep those steps going.

Kirtly: Absolutely. Well, in thinking about what you need in your environment, whether it's your home environment or if it's your work environment or if it's in your overall community's environment, thinking about air, a smart psychiatrist told me once 40 years ago that if I needed something, it was my responsibility to speak up like a grown-up. I thought that was very remarkable she just said that to me. If I needed it, I need to speak up.

But at home and in the workplace, it's hard to speak up and speak out about menopause and midlife issues that would be better with the changes in home and workplace.

So if there's something that you can do to make it a better space, then speak up. Women can lead the way in making spaces more comfortable for everyone. And guys, wouldn't you like a fan sometime?

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