Perimenopause and Menstrual Health in the Workplace

This summer, I worked as the Sid Lerner Women’s and Adolescent Health Fellow for the Gender, Adolescent Transitions and Environment (GATE) Program, supporting efforts to explore the experience of perimenopause in the workplace. I conducted literature reviews around perimenopause symptoms and experiences, managing perimenopause in the workplace, and health equity issues related to this reproductive health stage. Since the aims of the study were to understand the experiences of employees, I also investigated validated instruments to measure work outcomes, work stress, and work conditions. As I learned more about how employees experience perimenopause, I reflected on the themes between my own experience with severe menstrual pain.

I struggle with severe menstrual pain, something that is often normalized (and dismissed) by society. The first period I can remember was marked by me passing out on the kitchen floor. My senior year of college, I was diagnosed with endometriosis. Endometriosis, a menstrual disorder that includes endometrial-like tissue growing outside the uterus, is oftentimes associated with intense menstrual pain and other issues related to inflammation and immune responses. It is a disease that impacts the entire body. Living with endometriosis, with nearly nonexistent medical support, had been drastically impacting my ability to do work in the way that I wanted to. The gendered stigmas around pain compounded the stigmas around menstrual health. It was confusing to know how to manage my symptoms, and even more confusing to try and figure out how I could excel as a student at the same time. Perimenopause, the multi-year-long transition into menopause, similarly often results in unanticipated or unexplained symptoms that impact experiences in the workplace and in daily life.

These menstrual conditions and stages also impact the worker. For example, similar to the stigma I have experienced in association with menstrual pain, many perimenopausal workers experience stigma around managing their menstrual health needs due to their physical and social environments. This stigma is pervasive and impacts decisions such as deciding whether to disclose their perimenopausal status with colleagues and/or seeking support from often male supervisors. When met with a lack of supervisor knowledge, acknowledgment, and support, symptoms can deeply impact an employee’s well-being.

Structural factors also impact the work outcomes of employees experiencing perimenopause or endometriosis: 31 percent of women are denied promotions in their jobs and 20 percent are fired due to endometriosis. Many women do not seek promotions due to perimenopause and/or miss work or leave work entirely. Perimenopausal women and women with endometriosis perceive a decrease in work ability that could likely be avoided with better structural and environmental conditions. Other conditions, like work stress may also aggravate symptoms. The lack of structural support has a large economic cost, amounting to $1.8 billion annually in the U.S. for perimenopause alone.

It is critical that employers remove structural factors like rigid work-from-home policies and address menstrual stigmas that harm their employees’ menstrual health, regardless of whether they have a “normal” period, severe pain, or if they are transitioning into the menopausal stage. As a fellow with the GATE program, I helped create the protocol for a study that would identify the potential role of employers in alleviating stress around managing perimenopause at work. When thinking about the management of severe pain or the wide range of symptoms during perimenopause, it is easy to see why the ability to support one’s menstrual health as an employee should be guaranteed if employers are to ensure the health and safety of their employees. As menstrual health and hygiene continue growing in the public discourse and policy debate, it is important for employers, policymakers, and advocates to address systemic and environmental conditions to best support menstrual health needs across the life course, from menarche to menopause. There can be no gender parity if workplace structures leverage menstrual health conditions and stages with the effect of absenteeism, decreased work ability, and aggravated menstrual symptoms.

Regan Moss is a second year MPH student in the Department of Population and Family Health with a certificate in Public Health Research Methods.