Hayley Merrick: Promoting workplace awareness for endometriosis and menstrual health support

In recent years there’s been a very welcome turning of the tide when it comes to discussions around menstrual and menopause wellbeing in general, as well as in the workplace.

There is however much more to do to ensure that employers are supporting their employees and meeting, or exceeding their duty of care.

It is estimated that around 80% of the workforce who menstruate will experience period pain at some stage, with PMS symptoms (impacting moods and emotions) affecting around 75% (CIPD 2023)

This research highlights the importance of having robust systems, policies and training in place to support women and people who menstruate in the workplace.

Lack of awareness

It is imperative to have a menstrual and menopause policy and to provide training to managers and employees around the topics of menstrual and hormonal wellbeing.

For decades there has been a lack of awareness and such topics, until very recently were seen as taboo and unmentionable, meaning that many women feel embarrassed to discuss these health issues (CIPD 2023)

Unfortunately, this also means the message has been missed that excessive pain or heavy bleeding, which affects a person’s ability to undertake daily activities, is not normal and requires investigation.

This had led to menstrual conditions such as endometriosis, fibroids or pelvic inflammatory disease being missed, or the diagnosis being delayed. The Endometriosis Foundation (2022) states that despite being as common as asthma, endometriosis diagnosis can take between 7 to 9 years.

This is a staggering amount of time that employees experiencing symptoms are likely to be struggling with pain, excessive bleeding and fatigue, which can impact on their wellbeing, contribution and progression in the workplace.

It is important to remember therefore, that anyone experiencing such symptoms may, or may not have a formal diagnosis in place, yet.

What is endometriosis?

Endometriosis is a condition where cells similar to the ones that line the uterus are found in other areas of the body, including the ovaries, fallopian tubes, thorax, bladder or bowel (NHS 2022)

This tissue acts the same way as uterine tissue, breaking down to bleed each month. However, unlike a menstrual period which is released, blood and cells in other areas of the body have nowhere to go, which causes extreme pain (Endometriosis UK)

Symptoms of endometriosis

• Severe pain, which affects daily activities, usually in the approach to menstruation, however, it can occur throughout the month.
• Back and lower pelvic pain which is often worse during menstruation.
• Pain during, or after having intercourse.
• Heavy periods that can cause leaking through clothes and require frequent pad changes.
• Pain when visiting the toilet, painful and severe bloating.
• Excessive fatigue and brain fog which can present as poor concentration, feeling confused, or thinking more slowly than usual (NHS 2003)
• Feeling sick, constipation, experiencing diarrhoea or bleeding when going to the toilet.
• Fertility issues and emotional upset relating to diagnosis or trying to start a family.
• Endometriosis can significantly impact on quality of life and lead to anxiety or depression.

The nature of chronic illness

The nature of chronic illness is that symptoms can affect each person differently. There can also be times of flare up and remission, which can mean that employees can feel well for weeks, months or even years, before experiencing another flare up of symptoms.

In my previous role as an occupational health nurse, this aspect was often the most difficult for managers to understand and manage, due to fluctuation of the condition. A flexible step on/off approach to support is often required.

Endometriosis may be considered a disability if it has a sustained and significant impact on daily activities, even if it doesn’t impact everyday (Endometriosis UK.) Therefore consideration should be given and guidance sought from occupational health, as to whether reasonable adjustments are necessary under the Equality Act 2010.

The importance of support and empathy

It is imperative that employees are believed and receive empathetic support from managers.

By the time employees disclose their symptoms at work, they may have struggled to be diagnosed or taken seriously due to endometriosis having similar symptoms to other conditions (Endometriosis UK) or being considered as “just” period pain.

CIPD research found that 49% of employees never tell their manager that the reason for their absence is menstrual-related. Just over 1 in 10 (12%) of employees report that their organisation provides support for menstruation and menstrual health, for example in the form of a policy, guidance or training (CIPD 2023)

Possible factors to consider when offering support to employees with Endometriosis:

• Ask your employee if there is a way that you can support them. Endometriosis symptoms and severity vary from person to person, so it’s important to provide individualised support.
• Consider ways to support your employee if they experience fluctuating energy, or brain fog. Working from home if experiencing heavy bleeding, pain or fatigue may be helpful. Or undertaking the most mentally and physically taxing tasks in the morning, while their energy is higher.
• Considering a change of role temporarily if necessary, or facilitating changes of position e.g. sitting and standing during the day may help, depending on individual needs.
• A basic, but often highly appreciated addition is having a lockable cupboard, somewhere private to store menstrual pads, pain medication and a change of clothes in case of leaking.
• A private or an individual toilet, somewhere to wash or shower and a changing facility in case of heavy bleeding through clothes is beneficial. Taking consideration that toilet visits may be more frequent and take longer, due to digestive symptoms, or frequent pad and tampon changes.
• Flexibility for appointments and an appreciation that frequent medical appointments may be required due to the length of time to diagnose and having to rule out other conditions. Considering a phased return, or adjusted duties after periods of flare ups or after recovering from surgical interventions and referral to occupational health may be appropriate.
• Having breaks split over the day, or an increase in short breaks to support energy levels and to allow for medication to be taken.
• Desk assessments, avoiding “hot desking” and personalised ergonomic chair fitted can be beneficial if backache is problematic and to support during flare ups of pain.
• Having a manager that is approachable and understanding. Providing training to managers and considering each manager’s skill set, level of experience and communication skills is important.
• Employees may prefer to discuss with a female manager who has lived experience of menstruation. Discussing menstrual problems has been considered taboo for so long, that embarrassment can be a factor on both sides and impact on communication.
• Consider providing counselling, holistic therapies or wellbeing events for all employees to assist in management of stress and to prioritise mental and physical wellbeing which can help to support balanced hormones and pain management.

Ultimately, having a positive period culture, menstrual policy, as well as policies for chronic illness and employee wellbeing, can lead to a positive workplace culture where employees feel valued and understood. This can lead to increased productivity and retention of staff, which saves a company money in the long run (CIPD 2023)

It is a costly mistake to ignore the impact of menstruation and menopause in the workplace. 3% say they have left a job due to a lack of workplace support in relation to their menstrual symptoms and a further 5% are considering leaving (CIPD 2023) which increases a business’s training and administrative costs.

Choosing to prioritise and see menstruation and inclusive wellbeing practices as an avenue to create an exceptional culture of support, can lead to your business being set apart as an industry example and positive place to work (CIPD 2022)

References

https://www.cipd.org/uk/knowledge/factsheets/well-being-factsheet/#:~:text=The%20value%20of%20employee%20wellbeing&text=A%20healthier%20and%20more%20inclusive,Better%20employee%20morale%20and%20engagement.

https://www.cipd.org/uk/knowledge/guides/menstruation-support/

https://www.cipd.org/uk/knowledge/factsheets/diversity-factsheet/

https://commonslibrary.parliament.uk/research-briefings/cdp-2019-0228/

https://www.endometriosis-uk.org/getting-diagnosed-0

https://www.endometriosis-uk.org/what-endometriosis

https://www.endometriosis-uk.org/sites/default/files/files/Endometriosis_employee%20guide%20to%20rights%20at%20work_final%20April%202021_0.pdf

https://www.gov.uk/guidance/equality-act-2010-guidance#:~:text=The%20Equality%20Act%202010%20includes,an%20exception%20from%20the%20ban

https://www.mfgsolicitors.com/site/blog/mfg-blog/how-should-employers-be-supporting-workers-with-endometriosis

https://www.nhs.uk/conditions/endometriosis/

https://www.theendometriosisfoundation.org/support

https://www.endometriosis-uk.org/menstrual-health-work

https://www.unfpa.org/menstruationfaq