PMS, PMDD and the workplace

It’s no wonder, then, that these experiences often affect a person’s professional life. According to one study, 73% of menstruators struggle to do their work the way they’d like to because of period-related symptoms including low energy, concentration difficulties, pain and anxiety. 

‍Another showed that those with moderate to severe PMS symptoms often report poorer work-life balance, higher perceived work demands and less control over their work. Other studies have demonstrated a correlation between PMS and lower performance and productivity, as well as higher absence from work.

Calls for workplace policies such as menstruation leave have grown louder in the UK and across Europe. Recently, the Spanish parliament approved a bill giving people with incapacitating periods a right to paid sick leave, provided they can get a doctor’s note.

As things stand in the UK, while there have been notable cases of businesses leading the way with their own takes on PMS policies, employers are not obliged to offer their employees any such leave or a PMS contract. Instead, those whose symptoms are severe enough to require time off work are left with no choice but to use their Statutory Sick Pay (SSP). If you’re off for less than seven days, you no longer need a sick note from your doctor. Instead, you can self-certify that you’ve been unwell when you return to work.

There are issues with this approach, though – one being that the first three days of sick leave are unpaid, and another being that an accumulation of unexplained sick days is unlikely to make a favourable impression on employers. In other words, it’s potentially both a financial barrier and a career progression obstacle. Not to mention the negative connotations of labelling a natural and normal part of our cycle as a ‘sickness’.

With a bill about the right to paid time off work for fertility treatment currently going through the House of Commons, and a growing number of organisations now taking steps to be more accommodating of such needs, there is certainly hope that change is on the horizon for those experiencing PMS and PMDD too. Judging by the numbers, menstrual leave policies could certainly boost employer branding efforts, with 69% of participants in a recent survey being in favour of menstrual leave and similar initiatives.

Until such time that menstrual leave becomes a thing in the UK, what can you do?

Defining your rights is slightly trickier in relation to PMS than it is if you have PMDD, because PMS is a term for a collection of common symptoms and not classified as an illness as such.

That said, we know that reduced stress levels can have a positive impact on PMS symptoms, and studies of PMS at work tend to emphasise the need to address menstrual health in the workplace context, among other things through management training and by enabling flexible working.

This is noteworthy, as employees in the UK have a right to request flexible working. If the new Employment Relations (Flexible Working) Bill is voted through, those rights will be strengthened further.

While flexible working might sound less appealing than time off during your most taxing PMS days, the range of options that could be made available to you is not insignificant. Between remote work and compressed, annualised or staggered hours, there’s huge potential for making the most of the days when we feel energised and motivated, and getting space and rest when we need it most.

PMDD is technically defined as an endocrine disorder, meaning that it relates to hormones, and is listed as an official diagnosis in the DSM-5 – the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, a reference book containing the most up-to-date criteria for diagnosing mental health disorders. Put simply, it’s recognised as a mental health problem, and as a result, it’s classed as a disability under the Equality Act 2010.

The Equality Act protects you from discrimination, at work and elsewhere. This means that your employer is obliged to make what’s referred to as reasonable adjustments, including, for instance, changing working practices or policies and providing additional support. Failure to make such adjustments to help you could result in an employment tribunal on the grounds of discrimination. 

What’s deemed as ‘reasonable’ depends on the size of the organisation, how practicable the changes are and what costs they might incur. Crucially, though, the first step is to make sure that your employer is aware of your disability.

Studies have shown that those experiencing PMS and PMDD symptoms are often unlikely to disclose this in their place of work. Evelyn’s studies support this, showing that 71% of people taking time off work for PMS/PMDD did not disclose the reason for their absence to their employer. 

There are understandable reasons for this. Many are aware of the widespread perceptions of ‘appropriate’ reasons for work absence, where menstrual cycle-related issues rarely feature. In addition, old notions that biologically female bodies are taboo subjects make those who are impacted by PMS or PMDD unwilling to draw attention to it. In fact, even in countries where PMS policies are in place, uptake can be low among employees because of the stigma surrounding periods.

However, there are many reasons why disclosing your situation is important. Research has shown that those who choose not to disclose often end up struggling more over time. It’s not uncommon that they try to compensate for menstrual cycle-related absences by working longer hours, resulting in poorer work-life balance, and some even lose their jobs as a result of unaccounted-for absences and ongoing issues.

Another reason – and this is crucial – is that your rights hinge on your openness. If your employer isn’t aware of your health status, they can’t be expected to make reasonable adjustments for you.

So you’re nervous, perhaps, but you’ve decided it’s time. What do you need to think about ahead of that PMS workplace chat?

Firstly, consider which people need to be involved. If there’s a proper HR department at your place of work, that might be a good place to start. If not, is it your direct line manager you want to speak to, or do you have a good relationship with a higher-up boss?

A doctor’s note is not a must, but many people find that it’s helpful. Even if your employer doesn’t ask for it, it can be comforting to have something to fall back on if you’re nervous, and it might feel good to show that you’re taking the situation seriously.

HOPE, the initiative Healthy Optimal Periods for Everyone at the Centre for Reproductive Health of the University of Edinburgh, advises to keep these five things in mind:

• Be prepared – be specific and direct, have relevant facts to hand and use tangible examples where possible.
• Find the right time and place – you want to be comfortable, perhaps with a witness but most likely not in a public place.
• Be positive and as rational as you can be – it can be tricky with such an emotionally charged topic, but at the end of the day you want your manager to leave with the impression that you love your job and want to be a responsible, dependable professional. Don’t think of the conversation as ‘Boss v PMS’; this is a time for you and your boss to come up with a constructive, responsible approach to managing both your health and work.
• Be constructive and solutions-focused – you’re here because of a problem but you want it solved, so consider if it’s remote work, flexible hours or something else that would make the greatest difference to you, and try to demonstrate how and why.
• Remember to listen – your boss might have questions, and the very best outcome of a conversation like this is an open dialogue that allows you both to come up with sustainable solutions.

It can be a good idea to consider ahead of the meeting what questions your boss is likely to ask and how you would answer them. They’ll probably want to know how your symptoms affect your work and what makes your symptoms better or worse. They’ll certainly be interested in any changes that could make a positive difference with regard to your presence and output in work, as well as whether there are specific tasks or areas of responsibility that you would prefer to delegate or reallocate. 

Finally, do consider how you’d feel about different adjustments such as reduced hours, remote work and increased flexibility. The more prepared you are, the more likely that you’ll come out of the meeting feeling like your boss has heard you and positive change is coming.

Whatever way you go about raising the impact of your PMS or PMDD at work, there are things you can do if it doesn’t go the way you’d hoped.

Like with any issue you raise with an employer, you can raise a grievance if you’re not happy with their response. Worst case, you can take your employer to an employment tribunal, in which case you need to go through a process of reconciliation first. This takes time and a lot of energy though, so for most people, this is seen as a last resort.

In a lot of cases, an honest and open dialogue is very effective in finding sustainable solutions. So, if it isn’t, it’s worth considering what the root of your concerns is and whether there are external solutions that can be sought as well. If you have debilitating premenstrual symptoms, it’s always a good idea to see your GP.

Most people who experience PMS at work find that lifestyle changes can make a big difference, even if cyclical symptoms and mood swings will often remain to some extent.

Consider these alternative treatment tips to give yourself the best chance of managing any PMS symptoms:

• Regular exercise has been proven to minimise symptoms drastically.
• Both smoking and eating food high in fat, sugar and salt appear to increase the risk of physical PMS symptoms. 
• Since reducing stress is known to have a positive impact on PMS, yoga or meditation can help – and if work is very stressful, perhaps that’s another conversation you need to have with your manager.
• PMS and the luteal phase of the menstrual cycle are known to affect sleep and contribute to sleep deprivation, so paying attention to your sleep schedule and making sure to get your hours in is advisable.

These habits should be helpful regardless of the severity of your symptoms, but if you think that you might have PMDD, don’t put off seeing your doctor. They might suggest that you try treatments such as talking therapy, antidepressants or going on the combined oral contraceptive pill, all of which could help ease your symptoms. For instance, 60-75% of those with PMDD are helped by selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication. In rare cases, a complex and expensive, but usually effective, form of hormone treatment known as gonadotropin-releasing hormone agonists (GnRH) can be used, and some vitamin and mineral supplements may be beneficial, too.

In addition to the above, a growing number of researchers and health professionals are talking about ways to use your cyclical moods and energy levels to your benefit, also in a professional context. This school of thought suggests that the traditional world of work is failing to capitalise on the brain superpowers that peak at different times throughout the menstrual cycle. 

As such, the idea is that, by tracking your cycle, you can find ways to be even more effective and creative in your job, all while allowing yourself to rest and reflect when your cycle demands it (another vote for those flexible working agreements!). If you’re just beginning to think about how to deal with PMS at work, certainly not every job and workplace will be suited to this kind of approach, but isn’t it at least an exciting, empowering prospect?