For Elli Bliss, menopause cannot be separated from the wider systems women live and work within.

Her background spans nursing, higher education, social justice research and work focused on health inequalities. Her own experience of hormonal change has also shaped her growing focus on menopause and perimenopause.

Alexander Clementine founder Alex Perry spoke with Elli about misconceptions around menopause, mental health, support from men, workplace leadership, neurodivergence, health inequalities and why menopause care needs to recognise women as individuals rather than one homogenous group.

Key takeaways

Elli Bliss’s menopause perspective: perimenopause needs greater recognition; mental-health changes can be overlooked; support from partners should be based on partnership rather than trying to solve everything; workplaces should support women before they reach crisis point; menopause care needs to recognise differences in age, race, disability, neurodivergence and individual circumstances; evolving evidence should remain open to change rather than rely on one study; and inclusive workplace support should be holistic rather than a standard checklist.

What is the biggest misconception about menopause?

Elli’s answer begins with the narrow picture many people still have of menopause:

“That it’s hot flushes, it happens when you’re 50.”

For Elli, one of the problems is that perimenopause gets missed from the conversation.

“Perimenopause gets missed off the list.”

She says women she speaks to often know the word but do not necessarily understand what it means or when changes may begin.

Elli’s own experience has contributed to her interest in helping women recognise changes earlier rather than reaching what she describes as crisis point.

Her wider message is that this stage of life does not simply have to be endured.

“I think we can just enter into that phase of life, bossing it, rather than having just to try and survive it.”

What menopause symptom does Elli think is often overlooked?

Although Elli discusses symptoms including itchy ears, itchy eyes and dental problems, the area she believes people often fail to recognise is mental health.

“I think one of the biggest things that people don’t recognise is mental health.”

She talks about anxiety, depression, sadness and the feeling of becoming disconnected from yourself.

“Feeling sad, and not knowing why, or not feeling connected to ourselves.”

Elli says that when women are in the middle of the experience, they may not connect those changes with menopause.

For her, that lack of recognition is part of a wider education problem.

What would Elli say to men supporting someone through menopause?

Elli’s central message is partnership.

“Work with them, not against them.”

She specifically says:

“Saying things like, ‘you’re too hormonal’ is not helpful.”

Instead, she talks about acknowledging that somebody is struggling and asking what would help.

She also advises against immediately trying to solve the problem for them.

“Don’t find the solution for them.”

Her preference is to keep the conversation open and:

“Just be in partnership with them.”

Elli also talks about communication working both ways. She believes men can become more aware of women’s experiences, while women also need space to communicate what they are feeling.

Why does Elli see menopause as a leadership issue?

For Elli, treating menopause as a leadership issue means:

“Someone is taking accountability for it.”

She discusses this particularly in relation to female workforces.

Her example is nursing, a predominantly female profession where she says working patterns, uniforms and workplace conversations can be difficult for women experiencing hormonal changes.

Rather than waiting for somebody to reach crisis point, Elli argues for creating an environment where support is available earlier.

“You set up an environment that is actually beneficial to them, to be able to access the support as soon as they start noticing the changes.”

Elli draws on her own experience.

Despite being accustomed to difficult conversations with senior NHS leaders through her health-inequalities work, she describes reaching a point where she was:

“Crumbling after meetings, and just ... crying.”

She says she had been considering giving up the career she had created.

Her experience is one reason she believes better education could help women identify changes earlier.

Where does Elli think existing systems fail women?

When asked where she most clearly sees systems failing women seeking menopause support, Elli’s immediate answer is:

“Education.”

She connects education with research and with the healthcare professionals women may turn to for help.

Elli believes gaps in research feed into gaps in professional education, which then affect the support available to women.

Her wider criticism is that women’s health has a history of excluding different voices and experiences.

For her, the problem is not only what information exists, but whose experiences have shaped that information.

Are women treated as though there is one menopause experience?

Elli strongly rejects the idea of a single menopausal experience.

“It really has to be seen as individual.”

She points first to age.

A woman experiencing menopause at 40 can be in a completely different stage of life from somebody experiencing it at 50.

Elli uses her own situation as an example: she has young children now, whereas her circumstances will be very different a decade later.

“Needs are so different.”

She then broadens the conversation further.

“It’s not intersectional.”

Elli says menopause conversations frequently fail to adequately consider race and physical disability.

She raises practical questions about how experiences such as unpredictable bleeding might affect somebody who uses a wheelchair and says she has struggled to find people publicly discussing those experiences.

For Elli:

“No one’s talking about it.”

What does Elli say about race, culture and menopause?

Elli is deliberately cautious when asked how race, culture or background affects women’s ability to talk about menopause or seek help.

“It’s one that I don’t feel fully qualified to answer at the moment.”

She says:

“There’s literally such a lack of research in it.”

It is an area she wants to understand better, particularly how different communities experience menopause and what stops conversations from happening.

One issue she identifies is shame, although she says the way that shame appears and is expressed will differ between communities.

Elli also points to barriers within healthcare communication and access.

Her own summary is:

“Our services are not set up for different communities.”

What does Elli think we need to understand about neurodivergence and menopause?

Neurodivergence is a recurring theme throughout Elli’s interview and her own experience.

She believes neurodivergent women can notice hormonal fluctuations earlier.

“If you are neurodiverse… you feel those hormonal fluctuations a lot earlier.”

This is one reason she questions rigid assumptions about the age at which perimenopause should be considered.

She is also clear that this remains an evolving research area.

Elli connects the issue with changing expectations of women’s working and family lives. She contrasts previous generations, where more women may have left work during midlife, with women today who may be balancing employment, children, caring responsibilities and other demands.

Her own experience has convinced her that those responsibilities alone did not explain the difficulties she was experiencing.

For Elli, understanding how neurodivergence, hormonal changes and individual circumstances interact requires a much less standardised approach.

How should we communicate evolving menopause research?

This produces one of Elli’s clearest answers in the interview:

“We just have to be open to it changing and being fluid.”

She argues against building conclusions around a single piece of research.

“We can’t rely on one study.”

Her reason returns to the central theme of the interview:

“Women are not one homogenous group.”

Elli believes something may work for one woman but not another.

“Some things are gonna work for some women, and some things are not gonna work for other women, and that’s okay.”

For her:

“To have choice in healthcare is okay.”

What does inclusive menopause support look like in the workplace?

Elli does not believe there is one standard workplace solution.

“That is an individual conversation to have with each workplace.”

She is concerned that menopause workplace support could become reduced to a small number of standard adjustments.

She gives examples such as flexible working, fans or changes to uniform and says those measures can be useful.

But:

“They’re not going to fix the issue at hand.”

Instead:

“It’s about a whole holistic approach.”

Elli talks about knowing employees as individuals and supporting them before they reach crisis point.

She describes this as:

“Being a menopause-positive place to be.”

In her own workplace, Elli says conversations about hormones form part of how the team understands workload and individual needs.

Her broader point is that employers can think more carefully about the individual people within their workforce rather than treating menopause support as a universal checklist.

Why does Elli think menopause support can benefit more than menopausal women?

During the conversation, Elli discusses proposals for more menopause-friendly nursing uniforms.

Her response is that a better-designed uniform should not necessarily be restricted to menopausal staff.

If something is more breathable, flexible and comfortable:

“Everyone should have access to it.”

For Elli, this illustrates a wider principle.

Changes designed around people with particular needs can sometimes create a better environment for everybody.

She compares it with a classroom designed to work well for children with ADHD, where the teaching approach may ultimately help other children too.

What is Elli’s advice to someone beginning their menopause journey?

Elli’s first answer is simple:

“Listen to your body and believe it.”

She also wants women to know that this stage of life does not mean everything is finished.

“It doesn’t mean that you’re done.”

Her final message is deliberately optimistic:

“You have so much life ... your 40s and your 50s and your 60s and beyond can be amazing.”

About Elli Bliss

Elli Bliss has a background in nursing, including cardiac intensive care, before moving into higher education and research.

Her work has included social justice, workforce retention, patient and service-user experience and health inequalities. She later co-founded a business working nationally with NHS trusts and higher education around health inequalities, with much of that work focused on race through an intersectional lens.

Her own experience of the healthcare system and hormonal change has increasingly led her to focus on menopause and perimenopause.

This conversation forms part of Alexander Clementine’s Expert Conversations, sharing perspectives from people working across menopause and women’s health.