How employers can support neurodivergent women's menstrual health
Neurodivergent women face a number of barriers in the workplace, from discrimination to a lack of accessibility. But new research highlights that women with individual differences such as autism, attention deficit hyperactivity disorder (ADHD) and Tourette’s Syndrome are also often managing — and hiding — severe psychological distress linked to their menstrual health.
Around one in five people are thought to be neurodivergent, an umbrella term which refers to natural differences in human brain function and behavioural traits. Yet despite this figure, awareness of the needs of neurodiverse workers, and knowledge of the support they may need in terms of their menstrual health, is lacking in many workplaces.
Although some employers have introduced "period leave" for workers, many find themselves having to "grin and bear" menstrual problems like intense pain, heavy bleeding, anxiety and overwhelm. And crucially, conditions like autism and ADHD can intensify symptoms during the menstrual cycle, according to researchers at Heriot-Watt University.
“We noticed that menstrual policies and research don’t often mention neurodivergent women,” says Professor Kate Sang, who led the study. “Our data showed that neurodivergent women may experience many of the same barriers as neurotypical women, but with additional challenges.”
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For the report, Sang and her team reviewed research on the topic and interviewed 16 neurodivergent women working in different sectors including higher education, finance, law and marine biology.
They found that neurodivergent and autistic women faced 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 and during the transition to menopause.
Although menstruation and menopause don’t cause neurodivergent conditions, they can potentially intensify symptoms or alter how they manifest. Although research on the topic is scarce — and often reliant on individual testimonies — studies suggest that hormonal fluctuations during menopause can influence neural pathways that are already distinct in individuals with conditions like ADHD, which can increase the severity of symptoms associated with these conditions.
One of the key problems reported by Sang’s women was feeling a lack of control over the psychological and physical symptoms of menstruation. “This unpredictability can considerably increase their anxiety and may affect how they carry out their work activities and relationships,” says Sang.
“Neurodivergent women interviewed for our research reported that the hormonal fluctuations throughout the menstrual cycle disrupted the sense of control which they often rely on to function, especially in the workplace environment."
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Sang added that some of the autistic women and those with ADHD reported heightened psychological, cognitive and emotional symptoms of conditions like premenstrual dysphoria disorder or PMDD.
While most people who menstruate will recognise the symptoms of premenstrual syndrome — like mood swings, lethargy, and cramps — PMDD is a lesser-known condition. It’s a severe form of PMS that can cause a range of emotional and physical symptoms during or before a period, like chronic anxiety, depression or physical pain.
Sang and her team also found that the women they spoke to found it much more difficult to "mask" at work. Masking is when someone neurodiverse acts in a way they think is socially acceptable, in order to fit in with those around them or avoid being stigmatised.
What this involves varies between individuals, but it often means people hide symptoms of a condition like ADHD by controlling impulses, suppressing emotional reactions or copying the behaviours of neurotypical people. Although masking can be stressful and exhausting, it’s often a technique neurodiverse people use to navigate workplaces.
“For many of the neurodivergent women we spoke to, they were no longer able to draw on the strategy of masking their neurodivergent traits,” says Sang.
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Additionally, for some neurodiverse workers, the medications that help them manage or regulate their symptoms are less effective due to hormonal changes. Her findings are supported by a recent study by Swedish researchers at Dalarna University, who found ovarian hormone levels may potentially reduce the effectiveness of ADHD medications. These hormonal changes may also increase the severity of ADHD symptoms like executive dysfunction, emotional disregulation and attention disregulation.
It’s not just periods, or conditions like PMDD, that cause challenges for neurodiverse workers. In Sang’s study, many women in perimenopause — the time during which your hormone levels gradually begin to change before your periods stop — said the hormonal fluctuations disrupted the sense of control they relied on to function day-to-day.
Perimenopause is known to cause stress, anxiety and depression, and the side effects for neurodivergent and autistic people can be exacerbated. And, Sang found, treatments like hormone replacement therapy (HRT) may not work for neurodivergent women in the same way as for neurotypical women.
Nobody works to the best of their ability if their basic needs aren’t met. Yet for many neurodivergent women, this is their day-to-day reality.
What can employers do to support their employees?
“Clinicians, employers and researchers urgently need to listen to the needs and experiences of neurodivergent women living with problematic periods at work, to understand how they cope and to make sure they are better supported at work,” says Sang.
It’s also important for employers to be aware that there may be interactions between neurodiversity and menstrual health.
However, Sang adds, it’s really important employers realise that menstruation doesn’t stop neurodivergent or neurotypical women from working well.
“The key is to ensure that policies at work are intersectional — so they take into account neurodiversity as well as gender or sex.
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“We would suggest that organisations use inclusive language — perhaps even using examples of neurodivergent women’s experiences during training.”
“Also it’s key to recognise that trans men and non-binary people may also face these challenges, requiring the use of gender inclusive language.”
One of the most important things employers can do is ensure neurodivergent employees have a sense of psychological safety at work.
“They should also create workplaces where employees can be their true selves without the need to ‘mask’ who they are to abide by neurotypical and inaccessible structures,” says Sang.
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