What is PMDD?
PMDD is a severe and serious form of premenstrual syndrome (PMS) which affects around 1 in 20 females and AFAB* individuals of reproductive age. It can cause significant emotional, professional, and personal harm to those who have it, due to the extreme physical and psychological symptoms which occur before their period(1).
PMDD is caused by a severe negative reaction to the natural rise and fall of oestrogen and progesterone during the menstrual cycle. It is thought to be a genetic disorder with symptoms often worsening over time and is also commonly triggered or hightened around reproductive events including pregnancy, birth, miscarriage and menopause(2).
Many people with PMDD report damaging and impulsive behaviours that may include suddenly leaving a job or a relationship. PMDD can take a serious toll an an individual’s mental health, with statistics showing that 30% of people with PMDD will attempt suicide(2).
*AFAB = assigned female at birth
Why is PMDD a workplace issue?
Although it is clear that PMDD has a great impact on an individual’s personal life, it has significant impacts in their professional life too. At work, the most common symptoms experienced include difficulty in concentrating, self-doubt, paranoia, fatigue, tearfulness, a heightened sensitivity to the environment and other people, outbursts, and finding social interaction particularly difficult during their premenstrual “episode” phase.
Although these symptoms are concentrated around the days leading up to their period, and disappear following its onset, many people report feelings of guilt, which can lead to over-compensatory behaviours such as working longer hours, taking on too much, setting unrealistic targets and taking work home.
Individuals with PMDD alternate between this ‘good’ and ‘bad’ state every month, which can have a long term impact on their overall health and wellbeing. As a result, they are leaving the workforce (voluntarily and involuntarily) and sometimes giving up on their career entirely. Therefore, employers need better awareness and support mechanisms in place for helping their employees with the condition.
What do I need to do as an employer?
Due to the chronic and repetitive nature of the condition, PMDD is classed as a disability under the Equality Act 2010. This means that reasonable adjustments should be made to help employees with PMDD. Failure to do so may result in an employment tribunal on the grounds of discrimination.
Talking about PMDD at work
PMDD is a difficult thing to talk about, especially at work. Stigma around periods and mental health often prevents people from being open with their manager about PMDD, even if they’re struggling as a result of symptoms.
Whether or not a person discloses PMDD at work is entirely their choice. However, without this information, reasonable adjustments can not be put in place, which may have a long term impact on the employee. To create an inclusive environment and help people to be open about PMDD and other menstrual conditions, you could:
- Provide staff (especially Managers and HR members) with PMDD awareness training
- Ensure staff have access to good support services, including occupational health
- Ensure staff are aware of the support available to them
- Encourage managers to hold regular 1:1s with their staff, with a focus on wellbeing
- Have clear procedures in place for when someone discloses PMDD and follow them
- Inform the person of what will happen following a disclosure and keep them updated
- Signpost staff to external care providers for additional support
- Make diversity commitments visible to staff and celebrate achievements of initiatives
- Acknowledge PMDD awareness month in April
Making reasonable adjustments
An employer has to make adjustments when they are aware (or could be expected to know) that an employee has PMDD. It is important to remember that each person with the condition will experience PMDD differently. Therefore, understanding the specific needs of the individual is critical.
You should hold a meeting with the member of staff to discuss what can be done to help them.
You may find it helpful by finding out:
- How PMDD affects them at work – PMDD affects everyone differently so a one-size-fits-all approach isn’t helpful. Finding out any specific tasks or responsibilities that are difficult during PMDD is a great first step in being able to provide the right support.
- Workplace triggers that make their PMDD symptoms worse. This could be specific tasks or responsibilities, commuting, meetings, the work environment, deadlines, colleagues etc.
- What would help? This will be informed by the specific challenges and triggers.
Occupational health involvement
Whilst a GP can certify that an employee suffers from PMDD, they have a limited ability to help with what adjustments might be useful at work. This is where occupational health can help.
However, not all occupational health consultants are familiar with PMDD and it is often necessary for various medical practitioners to work together (with your employee’s consent) to collect the appropriate data and make practical recommendations.
Supportive policies and practices for employees with PMDD
- Enable working from home, reduction in hours or relief from some responsibilities to prevent having to take time off sick for PMDD
- Allow staff time away from work to attend clinical appointments, without having to use their annual leave
- Consider PMDD absence as separate to sickness/illness, in order to prevent the person from being penalised by strict absence measures e.g. Stage 1, 2 and 3 trigger policies
- Allow staff to wear loose clothing (if there is a uniform policy)
- Provide a quiet place for staff to work or take time out
- Allow regular breaks
- Allow a gradual return to work after PMDD related mental health absence
Luna Hub PMDD Community – www.lunahub.net
See Her Thrive – www.seeherthrive.com
International Association for Premenstrual Disorders – www.iapmd.org
National Association of Premenstrual Syndrome – www.pms.org.uk
1. Mind. (2017, September). Premesntrual Disphoric Disorder: About PMDD. https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
2. IAPMD (2019) What is PMDD. https://iapmd.org/about-pmdd