In this guide, ‘menstruation’ refers to the monthly period in which bleeding occurs, while ‘menstrual health’ has a broader meaning including physical or mental health and wellbeing, with underlying medical conditions, related to the menstrual cycle. 

The latter acknowledges that while menstruation is a natural bodily function, some people experience physical and/or mental health symptoms and challenges linked to menstruation, which range from things like painful, heavy and/or irregular periods and premenstrual syndrome (PMS) through to formally diagnosed chronic health conditions such as endometriosis, adenomyosis, polycystic ovary syndrome (PCOS) and premenstrual dysphoric disorder (PMDD). Some of these conditions can have significant impacts on daily life and can also affect fertility. Issues such as heavy, painful or irregular periods can be experienced by anyone who menstruates and can take people by surprise.

We have separated menstruation and menstrual health to recognise that menstruation is a normal biological process that occurs for many people, but that certain people will experience specific menstrual health conditions that can be very challenging and require special consideration and support. We use the term ‘symptoms’ to recognise that, even though menstruation itself, and painful or heavy periods are not medical conditions, some find they have a significant impact on their quality of life.

The CIPD’s aim in producing this guidance is to be as inclusive as possible in our definition of menstruation and menstrual health. While we predominantly talk about women in relation to menstruation and menstrual health, we recognise that it can impact some transgender and non-binary people who will require support and flexibility relevant to their needs.

One study reported that a third (32%) of men think it’s unprofessional to talk about periods at work, and CIPD research found that 43% felt embarrassed to tell their manager the reason they were unable to come into work. Against this cultural backdrop, work should urgently be done to normalise menstruation in the workplace. 

Employees working in supportive environments are more likely to discuss menstrual health conditions, be honest when time off is attributable to menstrual health or ask for adjustments which might enable them to continue working. To achieve this, attention should be focused on building a culture of psychological safety, where good working conditions, respect and open conversations are prioritised. 

Discussions around menstruation and menstrual health should be encouraged and taken seriously, and any issues raised must not be mocked or trivialised. 

Discussions should also be inclusive when it comes to gender identity (including transgender and non-binary employees) and sensitive to cultural differences, neurodivergence and other forms of intersectionality. For example, staff networks could arrange discussions to identify issues and challenges that are bespoke to certain groups, and this could feed into policy and broader communications, via blog posts, etc. Training sessions should make use of diverse examples. 

Try to avoid making assumptions around menstruation, including who menstruates, at what age, what symptoms they might experience, and what support (if any) they require. Make sure that employees and managers understand that with menstruation and menstrual health conditions, symptoms and challenges can relate to mental health as often as physical health, and that both should be given equal standing.

Clearly define how the senior leadership team is accountable and responsible for implementing the organisation’s approach to supporting employees and, where possible, where those leaders with lived experience can champion the support available. 

You should also seek buy-in and support from senior leaders by building a business case highlighting the impact of doing nothing. This could include data on absence and retention, or the number of employees affected by menstrual health symptoms. 

A study by Manchester Metropolitan University in partnership with the Northern Care Alliance NHS Foundation Trust found that perceptions of adequate information and support around menstrual health and endometriosis were lower than other women’s health issues such as menopause and pregnancy loss. This study also found that over 50% of those with lived experience of endometriosis felt unable to take the time off they needed. This was often linked to perceptions about the condition and its severity. There were also perceptions that the mental health tolls of endometriosis and other menstrual health issues were less acknowledged than the physical tolls, and that it was difficult to ask for support before you had a formal diagnosis, which can take a long time. 

Clearly, more needs to be done to raise awareness. There are various ways for employers to do this, including:

• acknowledging menstruation as a normal life experience in wellness discussions/blogs
• having a dedicated section for information and resources on the company intranet
• engaging with awareness days/weeks for specific menstrual health issues
• having posters on display
• including reference to menstruation and menstrual health conditions in policies and discussions around performance and team dynamics. 

Signposting should include specialist organisations and charities external to the organisation and also internal provisions, such as occupational health (OH), employee assistance programmes (EAPs) or private medical insurance. Links to some sources of further information can be found below. 

As the first point of contact for most employee health and wellbeing issues, it is important that we train and support managers to be confident, comfortable and inclusive when discussing menstruation and menstrual health. Training should include information about the diversity of menstruation experiences, and the importance of sensitivity and discretion. While the organisation wants a culture where this topic is not considered taboo, it is important to recognise that it will still be seen as a personal and private thing by some employees, and that this should be fully respected. 

Ensure managers know where to go for information, be that HR, health and safety, occupational health or external providers.

Check that managers know to watch out for, and can properly address, any shaming, bullying, joking/banter, dismissing or disbelieving related to menstruation in the workplace.

In many cases, menstruation in the workplace will be managed independently and privately by the employee without the need for workplace support. However, in addition to signposting to information, there are some provisions and adjustments that can create a more comfortable working experience, and make a workplace more menstruation-friendly. 

These include:

• Offering free or subsidised period products or an ‘emergency supplies’ store. This can help with the financial and logistical challenges that can accompany menstruation.
• Providing the opportunity for employees to store sanitary products and fresh clothes.
• Offering free painkillers.
• Authorising the use of a TENS machine, heat pads, hot water bottles or another pain-relieving device, or access to appropriate alternative therapies.
• Ensuring all staff have access to toilets and discrete places to change clothes.
• Ensuring suitable (and possibly additional) rest breaks during shifts.
• Consulting staff on uniform design, including consideration of colours that better hide menstrual leaking, looser fitting and/or materials that stretch to better accommodate bloating.
• Having spare supplies of uniform, of various sizes.
• Offering flexible working arrangements, including location and tasks.
• Offering access to digital health apps/symptom trackers.
• Implementing a menstruation and menstrual health at work policy, ideally with input from managers and employees.
• Reviewing risk assessments, where appropriate, to verify they include a reproductive health and wellbeing component as well as a physical and mental health assessment.
• Introducing menstruation advocates/champions, with suitable training and resources.
• Offering comprehensive health insurance policies.

All of the above can signal to employees and management that menstruation is a topic that can be discussed freely and without embarrassment in the workplace, as well as offering specific support.

Employees will be more likely to be able to manage their menstrual health condition and thrive in the workplace where an organisation has good people management practices throughout the employee lifecycle. This means that recruitment and selection processes should be inclusive; managers should be trained in how to support all employees; performance management and promotion processes should be fair and not penalise employees for menstrual health-related absence; and information and support should be available through multiple channels. 

Managers who build trust-based relationships with their team help to create an environment that is open, respectful and kind, in which people feel ‘psychologically safe’. This means individuals feel able to speak up about menstruation, menstrual health conditions, and specific physical or mental symptoms without fear of criticism, minimisation, ridicule or discrimination. They feel safe in the knowledge they will be listened to and receive support and understanding. This doesn’t mean that a manager should act in the role of health professional or therapist, but rather they should help the employee navigate the work aspects of the situation and make helpful adjustments where needed.

Many employees find telling others about their menstrual health conditions challenging. An employee might be unsure of what to say, worried that the condition will be trivialised, or afraid that others will see them differently. However, talking about it is a necessary step to access support and work adjustments. It can also improve working relationships, enable access to solidarity and peer support, and help people feel more authentic at work. 

To encourage employees to share information, policies and practices can make explicit reference to menstruation and menstrual health and make it clear that any sharing of information will be treated fairly, discretely and with compassion. It should be clear that this extends beyond core/permanent staff, to include those on atypical contracts. 

The CIPD people managers’ guide to mental health has useful tips and a conversation checklist that can be followed when opening a conversation about someone’s health and its impact on their work.

It is important to ensure that employees with menstrual health conditions can easily access information that could help them stay in work and work productively. This includes their rights under any relevant legislation (like the UK’s Equality Act) and company policies and provisions around absence, flexible working and wellbeing. You might consider access to condition-specific wellbeing supports as part of the benefits package (such as digital health apps).

As there can be significant psychological and mental health issues associated with menstrual health conditions, but employees may feel these are less legitimate to raise, managers should be prepared to talk about psychological wellbeing if an employee raises a menstrual health issue and offer signposting to appropriate resources. 

Absence and return to work are often managed as a one-off event, but many employees with menstrual health conditions will need to take one or more days off each menstrual cycle. 

Furthermore, absence requirements may fluctuate considerably from month to month, as many menstrual health conditions are unpredictable. Absence management approaches that include trigger mechanisms to monitor attendance and disciplinary or capability procedures for elevated levels of absence are likely to be experienced as an additional stressor by employees with menstrual health conditions. Avoiding the use of trigger systems and taking a flexible and individualised approach to absence management can help prevent unhealthy presenteeism and avoid unfairly penalising employees. 

You might also want to consider offering ‘period leave’, which is a legislative provision in some countries, and has been introduced in some UK companies. 

Social enterprise Coexist first introduced their policy in 2016, co-designed by management and staff, based on values of respect, dignity and wellbeing at work. The policy hinges on flexible working arrangements and contingency planning to allow individualised support. Other companies that have introduced period leave include investment services company Hargreaves Lansdown, and gaming platform GOG. 

Period leave policies have attracted some controversy, and ‘menstrual leave’ might be problematic for certain groups or individuals. Policies should be inclusive and flexible, and recognise that there are many different health and wellbeing issues where individuals could need to take time off and should not be penalised for doing so. Where an employee has long-term absence related to a menstrual health condition, you should manage this supportively and treat the return to work as you would with any other long-term health condition. 

For both short and long-term absence linked to menstrual health, you should be guided by the employee in terms of any communications around the reason for time off in the wider team.

Some employees may require adjustments to their job role, work environment or work schedule to manage their menstrual health condition alongside their work. 

Where an employee has a menstrual health condition diagnosis, and providing that the employee’s agreement has been given, it may be helpful to contact their GP or medical specialist for advice about the condition and the most appropriate work adjustments. It is important to recognise, however, that many people struggle with a menstrual health condition for some time before diagnosis, and this should not pose a barrier to the provision of appropriate support. 

Remember that employees might need to make a series of adjustments to treatment regimens or lifestyle to manage their symptoms and keep well. These self-management strategies play a vital role in enhancing work and health outcomes. Self-management support in the workplace can help employees to develop skills to manage the impact of the symptoms and treatment. Examples may include trialling different contraceptives or medications, adhering to diet or lifestyle advice, trialling alternative therapies or forms of pain relief, and so on.

The nature of any adjustment will differ depending on many factors, including the nature of the job, the organisation and the employee’s unique needs. It is important to consider how best to accommodate menstruation and menstrual health in jobs and environments that have little in-built flexibility. Consultation with staff may be beneficial in identifying possible solutions. 

It is recommended that a menstruation and menstrual health policy is developed, ideally in consultation with employees/representatives. To facilitate a fair and consistent approach, this policy should be cross-referenced with other relevant policies, such as those relating to health and wellbeing, sickness absence, long-term health conditions and/or disability, flexible working, performance management, fertility investigations and treatments, maternity, or menopause. 

It is also important to review organisational procedures and processes to ensure they are aligned (for example, ensuring that menstruation-related absence can be logged as such in the absence management system), and to communicate policies and procedures to managers and staff.

Company leaders, especially in male-dominated environments, need to signal that policies are there to be used, and there will be no negative career consequences.

To understand how the organisation’s policies and practices are working, it is necessary to implement a system of reporting and review. 

You could also consider conducting a gender and age profile of your workforce and asking how employees with menstrual health conditions are experiencing work, to ensure that workforce needs are being met. To ensure the voices of different employee groups are heard, you might want to partner with different staff networks. 

You might find it helpful to include information on or signpost to some of the following sources of information and advice:

• NHS information on periods
• NHS endometriosis information
• NHS adenomyosis information
• NHS polycystic ovary syndrome (PCOS) information
• Menstrual Matters, for information and trackers
• BUPA: Painful periods information
• Endometriosis UK
• Verity: Support for PCOS
• PCOS Awareness Association
• Mind premenstrual dysphoric disorder (PMDD) information

This guide was written by Dr Krystal Wilkinson, Associate Professor of Human Resource Management, Manchester Metropolitan University, MCIPD. 

The legal section was written by Helen Burgess, employment partner at Gateley Legal.