With approximately half of the population menstruating and most people working half their lives, menstruation and work simply cannot be separated. Yet, even though menstruation is a natural process and a part of so many people’s lives, there is still a stigma attached to it. Especially at the workplace, menstruation is not seen as an appropriate topic to discuss.
That’s a problem for employees whose menstruation-related symptoms (MRSs) have a profound physical, emotional or behavioural impact, and limit them in their day-to-day activities. Those living with a menstrual health condition, such as endometriosis, dysmenorrhea or premenstrual dysphoric disorder (PMDD) are likely to be affected even more. Not taking this into account at the workplace has a potentially devastating impact on well-being, health and social and economic performance. Ultimately, this can contribute to inequities and present obstacles for those who have trouble managing their symptoms alone.
To get a better understanding of the way menstrual symptoms interfere with well-being and productivity at work, I conducted an exploratory study with 150 menstruating people, predominantly from the Netherlands and Germany, between the ages 18 and 45. My main interest was to understand what it is like to experience different menstrual symptoms at work and how menstruation is communicated at workplaces.
What I learned was that while menstrual symptoms seem to have a significant impact on the workplace well-being of menstruating people in my sample, menstruation is still not perceived as an appropriate topic to talk about at work. As a result, people who menstruate put their energy into managing their symptoms and even try to hide the fact that they are menstruating. Naturally, no one is obliged to talk about their health at work; but dealing with menstrual health issues alone and going to work when feeling unwell can disrupt a workday and lead to productivity losses.
Symptoms related to menstruation
Every menstruating person experiences their period differently, and even within a person, no two menstrual cycles are the same. Menstrual symptoms fluctuate along with the more than 400 menstrual cycles, and the most accurate way to identify them is by tracking symptoms daily for more than two consecutive cycles.
I analysed how people in my sample experience their symptoms and whether they were diagnosed with a gynaecological condition. Of the suggested symptoms, some are less debilitating than others. The debilitating effect of symptoms also varies within a person and does not always limit their functioning in the same way.
The graph below displays the menstrual symptoms experienced in my sample. Menstrual pain and cramps are most common, with 4 out of 5 regularly suffering from them. Interestingly, only 4% do not experience any symptoms related to their menstrual cycle. On average, menstruating people experience around four symptoms regularly. The correlation between symptoms indicates that many of them co-occur. For example, 74% of those who report pain during menstruation also report mood-related symptoms. Additionally, those who experience dysmenorrhea often also suffer from other menstrual symptoms including back pain, headaches or nausea.
In what way do these symptoms impact work?
The symptoms that are most likely to affect the ability to work the most are menstrual pain and mood changes like irritability, anxiety and depression. In my sample, 47% state that menstruation sometimes interferes with their work and for 13% it always does. 1 in 3 rarely or never feel affected by their period at work. When asked in what way menstruation impacts their work, most of the answers fit one of the following five categories:
Menstrual symptoms can impact workplace well-being and productivity in several ways. Additionally, the side effects of treatments should be taken into account. Painkillers for example minimise the pain, but may lead to dizziness and fatigue. The following examples illustrate that the symptoms often lead to discomfort, and thereby impact the ability to concentrate and function:
“I feel sick and I‘m in pain. So sometimes it‘s hard to focus and do my work well.”
“Just before my menstruation starts and the first two days of my menstruation, I’m super tired, less focused, foggy in my head. I’m definitely not as sharp and productive as usual.”
“On day one of my cycle I feel worse than if I had [the flu]. I am in pain and very tired. Even if I take pain medication, I can‘t fully function because of this exhaustion.”
“Sometimes I don‘t feel concentrated because of the heavy pain; and in general during my period I feel weaker than normally.”
Unfortunately, little research has been done on the impact of MRSs on work and the impact of these symptoms likely varies between sectors - just think of people who only have a few fixed breaks per day or no easy access to restrooms! A recent study on the effect of MRSs on productivity losses found that only around 14% of women call in sick due to MRSs, with 3.4% calling sick every cycle. With 80.7% of women reporting decreased productivity, this resulted in an average of 1.3 days lost in absenteeism and an average of 23.2 days per year lost productivity in presenteeism. This finding challenges the common belief that menstruating people lose productivity by calling in sick and shows that working in spite of not feeling well is a bigger driver of productivity losses.
In my sample, 15% of respondents called in sick in the last 12 months because of their period, indicating that most of them go to work despite their symptoms. The responses’ subtextual meaning suggests that many of them believe that calling in sick due to menstrual symptoms is not legitimate, irrespective of how debilitating the symptoms are.
Talking about menstruation
In recent years, the way we talk about menstruation has changed. The UK introduced policies to tackle period poverty, various European countries discussed (and even abolished) the tampon tax, and conversations about menstrual health issues are now trending in the media. However, the communication taboo, i.e. the belief that menstruation should not be talked about, persists in many workplaces to date. Instead of talking about menstruation objectively, many menstruating people feel the need to keep their menstrual distress secret from their colleagues. Thereby, they unintentionally reinforce the view that menstruation is something shameful and a disadvantage for those who menstruate.
Often, menstruating people go great lengths to conceal any sign of menstruation at work, smile through their symptoms and hide their menstrual products on the way to the restrooms. This is accompanied by the so-called “leak anxiety”, the fear of leaving a bloodstain on their clothes, which would expose them to being on their period. This way of self-surveillance can be distracting and even harmful because it leads to increased self-objectification. All this is done subconsciously to fulfil the social expectation of how women are supposed to behave.
To learn how periods are talked about both inside and outside the workplace, I first asked whether people in my sample find it embarrassing to talk about periods. 39% of them state that they never find it embarrassing. Only about 3% are always embarrassed to talk about menstruation.
Despite their rather positive attitudes towards menstruation, there is a discrepancy in how people in my sample talk about their periods. 73% always or often talk about their period with their friends, but only 11% always or often talk about their periods with colleagues or superiors. A staggering 39% state that they would never talk about their periods with their colleagues or superior. The graph below illustrates the disparity when it comes to talking about periods.
Interestingly, of those who said that they never find it embarrassing to talk about their period, only 1 in 5 often or always talks about it at work, although 86% of them talk to their friends about it. Whether or not people in my sample talk about their periods at work is not influenced by their symptoms.
This finding indicates that menstruation is perceived as an inappropriate topic to discuss at the workplace, even if it causes discomfort or stress. As a result, workplaces are not menstruation-aware and do not take into account the needs of menstruating people. This can also be seen in the number of workplaces that offer free period products (in my sample that is only 21%). If you’re working in a place that does provide them, that’s great! Unfortunately, most workplaces still don’t provide any period products, and while there is not a lot of research about this topic yet, the rise of organisations that aim to tackle period poverty show the need for it.
Is menstrual leave the answer?
Menstrual leave, i.e. the possibility to take paid or unpaid leave during menstruation, is without doubt the most prominent period policy. At first glance, it seems to be an easy solution and applicable to everyone that menstruates. Digging a bit deeper in the needs of menstruating people at work however, shows that period policies should always take into account the individual’s situation. This requires more than a one-size-fits-all solution.
Although meant well, implementing menstrual leave without proper training can have adverse effects and even reinforce gender inequality and the objectification of women. This is because menstrual leave frames menstruation negatively, giving the impression that every menstruating person is sick or unable to work. As such, it perpetuates the belief that menstruation and other reproductive health matters, like menopause, make people weaker or less reliable and might even keep up the harmful belief that menstrual health problems are untreatable.
If menstrual leave is not accompanied by the possibility to openly communicate menstruation, it implies that this topic is best kept private and dealt with alone. Aside from making it difficult for those with less severe symptoms to speak up and find a solution that fits their needs, menstrual leave may also enforce the perception that strong menstrual symptoms are not severe enough to qualify them for sickness-absence.
Nevertheless, period policies have the potential to lead to an open handling with menstruation and offer menstruating people the chance to talk about their struggles. More awareness about menstrual health would also educate people on how to take care of themselves, when it is necessary to recover and when to seek medical help. An open debate about menstruation within companies has the potential to finally destigmatise and normalise it.
There is no one solution
Approximately half of the respondents who called in sick because of their period wished they had more flexibility in their work setiing. Examples were to work fewer hours, take an unplanned work from home day, or the possibility to shift some tasks that involve a lot of communication and presentations to other days. 1 out of 2 would like to have some support at work that helps them deal with their symptoms, ranging from heating pads and painkillers to relaxation rooms or the possibility to do some yoga. What all of these suggestions have in common is that they all require communication about their needs.
The variety of symptoms and medical conditions make it almost impossible to find a solution that fits everyone. Flexible working policies, which are often only available for parents and carers, are a good possibility to look after people’s individual needs and equip them to find solutions that work for them. With enough guidelines, this policy enables everyone to get their job done in a way that is suitable for them. If anything, the ongoing pandemic serves as proof that most people can work from anywhere, anytime.
The lack of research about the communication of menstrual health at the workplace makes it hard to find an answer to the question whether we would be better off implementing period policies. In order to combat the menstrual stigma we have to start taking action and raise awareness for menstrual health!
Inclusivity at work can only be achieved by allowing and encouraging people to communicate their needs. That is what menstrual equity is all about: Besides ensuring equal access to period products for everyone, “[it’s] about making sure that people have the needs, support, and choices to decide how they want to take care of their menstrual health.”
*Please note that this does not serve as an indicator of how many menstruating people experience symptoms, or how many of them are impacted by them. The mere goal of this questionnaire was to listen more closely to the needs of menstruating people at work and to identify patterns. To put these insights into perspective, it was necessary for me to gather demographic and health-related information.