Improving the workplace support for neurodivergent women managing their menstrual health: Neurodiversity and menstrual health at work

1.Executive Summary

The current study explores the experiences of neurodivergent women who manage menstrual health (e.g., periods and peri/menopause) at work, a topic which is currently overlooked in the literature and research on work and employment. In order to address this gap, this report outlines the extant peer reviewed literature and presents the findings from in-depth interviews with 16 neurodivergent women working in the research and innovation sector who manage their menstrual health in various work environments. Finally, this report offers some practical recommendations for managers to improve workplace support for neurodivergent women.

1.1Main findings

This report presents the analysis of a review of the limited extant literature and findings from interviews with 16 neurodivergent women working in the research and innovation sector:

•Neurodivergent and autistic women face greater challenges in managing the mental health side of the menstrual cycle and the perimenopause, reporting heightened cognitive and psychological symptoms in the premenstrual stage (PMS and PMDD) and during the menopause transition (perimenopause).

•The hormonal fluctuations throughout the menstrual cycle and the unpredictability of the perimenopause disrupt the sense of control which many neurodivergent and autistic people rely on to function. The lack of control over psychological and physical symptoms of the menstrual cycle and the perimenopause considerably increases anxiety in neurodivergent women.

•Neurodivergent women explained that they developed an ability to ‘mask’ their neurodivergent traits in the workplace environment as a strategy to conform to neurotypical standards. In some cases, this ability helped them ‘mask’ also the symptoms of the perimenopause, while other women reported that changes in hormones negatively affected their ability to ‘mask’ their condition.

•Some autistic women shared that they do not relate with normative experiences of womanhood, pointing out that they do not feel appropriately represented in work-wide initiatives and women’s networks (e.g., menopause cafes).

•Women described different experiences in accessing specific treatments for perimenopause (e.g., HRT), which greatly depended on clinicians’ competence and knowledge of menstrual health conditions. Neurodivergent and autistic women reported issues with misdiagnosis and inappropriate prescriptions, highlighting clinicians’ lack of awareness about the interaction between menstrual health and neurodivergence.

1.2Recommendations

In light of the findings from our study, we suggest that employers should:

•Include diversity of voices when planning workplace policies.

•Avoid assumptions on experiences of womanhood and menstrual health for example, heavy bleeding is not the only challenge.

•Use inclusive language, for example recognising that not all those who go through perimenopause older women, and some may be trans and non-binary, including trans men.

•Create workplaces where employees can be their true selves without the need to ‘mask’ who they are to abide by neurotypical and inaccessible structures.

•Be aware that there may be interactions between neurodiversity and menstrual health e.g., the effects of hormones such as oestrogen on neurodivergent traits.

•We encourage employers to design any policies and practices in relation to menstrual health, with those most affected. Embedding the lived experience of a diverse range of people who menstruate and go through the menopause will ensure that your policies and practices address a range of needs faced by women, trans and non-binary people.

We also note that further research focusing on this area is urgently needed to accurately reflect the wide range of experiences with relation to the management of menstrual health at work, which will ultimately inform meaningful and successful workplace policies and practices supporting thriving and flourishing careers for all.