Neurodivergent women 'urgently' need workplace support around menstrual health

Neurodivergent women at work are often managing—and hiding—severe psychological distress related to their menstrual health, new research from Heriot-Watt University suggests.

In a new report, business management researchers at the University say there is an "urgent need" to explore support for neurodivergent women in the workplace, particularly those who are managing problematic menstruation and perimenopause—the transition phase leading up to menopause.

Neurodiversity, which includes differences such as autism, attention deficit hyperactivity condition (ADHD) and Tourette's Syndrome—and sometimes medications used to regulate some of the symptoms—can affect how women experience and manage the symptoms of hormonal fluctuations, the report finds.

Lack of control over the psychological and physical symptoms of the menstrual cycle and the perimenopause was a particular challenge highlighted by a large number of the neurodivergent women interviewed for the research.

"This unpredictability can considerably increase their anxiety and may affect how they carry out their work activities and relationships," the researchers say.

"Neurodivergent women interviewed for our research reported that the hormonal fluctuations throughout the menstrual cycle and the variability of the perimenopause and its associated symptoms disrupt the sense of control which they often rely on to function, especially in the workplace environment."

Neurodivergent women are often experts at "masking" their neurodivergent traits to fit into workplaces, including using this ability to mask symptoms of the perimenopause, the researchers note. But the impact of hormonal changes related to menstrual health can make this increasingly difficult.

Workplace initiatives like menstrual health policies and menopause cafés—pop-up events to raise awareness of the menopause—can also be inaccessible to neurodivergent women who may feel they don't "fit in" with traditional women-only spaces.

The report, "Improving the Workplace Support for Neurodivergent Women Managing Their Menstrual Health," is based on a review of published research in this area and interviews with 16 neurodivergent women working in roles in sectors including higher education, finance, justice and marine biology.

The research is part of the Equality, Diversity and Inclusion Caucus (EDICa), a research group led by Kate Sang, a Professor of Gender and Employment Studies at Heriot-Watt University's Edinburgh Business School, to improve equality, diversity and inclusion in the research and innovation sector.

One of the interviewees for the research, an autistic woman who, as part of her role, carries out research in prisons, shared that she struggles to manage her premenstrual syndrome (PMS) in "a very emotional context."

"I've got depression and panic attacks, and I am also autistic," she said. "Which means that I spend a lot of my time trying to control what is happening around me...[It's] really frustrating that there's this thing [PMS] that whatever I do, it's just this time when I can't control it and it just gets really overwhelming and sad.'"

The psychological distress that neurodivergent women can experience around their period or during perimenopause can manifest as depression, cognitive fog—symptoms that affect thinking, memory and concentration—and premenstrual dysphoric disorder (PMDD), the researchers say.

PMDD is a serious form of premenstrual syndrome that can lead to extreme depression and in some cases even to suicidal ideations. The report finds that neurodivergent women are currently "overlooked" in research around work and employment and that in areas like dyslexia, studies on the relationship between neurodivergence and menstrual health are "almost non-existent."

Professor Sang and Chiara Cocco, a Research Associate in Heriot-Watt University's School of Social Sciences, led the research, which included neurodivergent people in the research team. They said, "We were surprised to see how little existing research on menstrual health includes the experiences of neurodivergent women.

"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."

The findings also revealed that neurodivergent women find it difficult to access appropriate health care, because medications such as Hormone Replacement Therapy—a treatment that helps relieve menopause and perimenopause symptoms—may not work for neurodivergent women in the same way as it can work for neurotypical women.

Research reviewed for the report also suggests that hormonal fluctuations during the menstrual cycle can impact the effectiveness of some medications, for example those for ADHD, potentially worsening symptoms like mood swings and risky behaviors.

Recommendations in the report include involving more neurodivergent people in workplace policy planning and avoiding the assumption that heavy bleeding is the only challenge related to menstrual health. Workplaces should be places where employees can be their true selves without the need to "mask" who they are to fit in.

Be aware that there may be interactions between neurodiversity and menstrual health, for example, the effects of hormones such as estrogen on neurodivergent traits. Use inclusive language that recognizes it's not only older women who go through perimenopause—"some may be trans and nonbinary, including trans men," the researchers say.

The report specifically focuses on women working as researchers, but has implications for all genders, workplaces and career stages, the researchers say. The study builds on another EDICa report from earlier this year, "Recommendations for improving support for researchers managing menstruation," which reviewed published research and interviewed more than 50 women working in diverse settings.