Our work Projects Feminist Leadership The Invisible Health Workplace Initiative Too often women’s health needs are ignored or misunderstood in the workplace - to the detriment of them and their employers. The illnesses women face may not be recognised or are considered taboo and women can, and sometimes are expected to, suffer in silence. If women’s health needs were better understood and policies put in place to support them at work, not only would their quality of life would improve and so potentially would the quality of their work and productivity.but they would also feel much more empowered to reach their full potential at work. With so many of us working from home due to the Coronavirus pandemic, and the additional challenges and pressures that home working brings, this issue is just as, if not even more, relevant right now. As members of the Manchester cohort of the Women’s Resource Centre’s Feminist Leadership Course and as women members of the workforce we all have our own lived experience of health issues that specifically affect women. By focusing on some of the key conditions women can face, our aim of this project is to get better recognition and understanding of women’s health needs and experiences in the workplace and offer recommendations for employers of the ways they can be supported through these often invisible health conditions. Periods & Premenstrual syndrome (PMS) Premenstrual dysphoric disorder (PMDD) Perinatal mental health Endometriosis Infertility Polycystic Ovary Syndrome (PCOS) Hysterectomy Menopause Periods & Premenstrual syndrome (PMS) About periods and PMS (premenstrual syndrome) A period is normal vaginal bleeding that occurs as part of a woman's monthly cycle. On average bleeding lasts between 3 and 7 days and symptoms during this time include tender breasts, abdominal cramps, bloating, fluid retention, muscle and joint pain, headaches, acne, diarrhea and constipation. The symptoms experienced for up to 1-2 weeks before the period are called PMS and include: moodiness, bloating, anxiety, irritability, breast tenderness, changes in appetite and headaches. Sanitary products are an expensive but necessary monthly cost for women, many of whom cannot afford this and therefore experience period poverty. Period poverty is a widespread issue in the UK — with 49% of girls having missed a day of school due to periods and one in 10 women aged 14 to 21 not able to afford period products (The Independent, 2020). Period poverty encompasses the lack of; education, safe and hygienic spaces and includes shame and stigma around periods (Action Aid). This is a global issue. Impact of periods and PMS in the workplace 73% of women have lied when taking a sick day due to periods for fear of being judged by their bosses. There is still a huge stigma attached to periods and sick leave; and some employers might think that because women deal with them every month then they must be ‘used to it’. And it is not unusual for women to minimise their own experience of menstruation, no matter how ever the pain, in fact nearly 50% of women think painful periods are 'just part of being a woman' and wouldn't consider visiting their GP. What you can do as an employer Create a supportive work environment by educating staff and challenging unhelpful clichés such as "it's probably her time of the month" Have clear policies on menstrual leave and flexible working options. Provide flexibility for those in manual jobs so they can manage their workload in a way where they are completing less physically demanding tasks during menstruation. Raise awareness that trans-men, non binary and intersex people may also experience these health issues. Premenstrual dysphoric disorder (PMDD) About PMDD Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that affects roughly 1 in 20 people of menstruating age. Symptoms fall into physical and emotional categories. Physical symptoms include: Breast tenderness; Bloating; Food cravings. Emotional symptoms range from: Anxiety; Irritability; Suicidal ideation; The symptoms must occur only after ovulating and cease around the day of bleeding so typically 1-2 weeks of symptoms. The severity of symptoms can vary, but typically they must interfere with day to day life or people’s relationships. Workplace impact of PMDD PMDD can have a profound effect on a worker's ability to function during their luteal phase. Individuals may have trouble remembering deadlines, having the mental capacity to stay on task, or execute their work to their normal standard. Individuals may also need time off due to debilitating symptoms such as anxiety or migraines. All these factors can lead to many PMDD sufferers having trouble managing a full time job, if the workplace is not flexible or understanding of their needs. Many sufferers do not disclose their diagnosis for fear they will face discrimination or be passed up for promotions. What you can do as an employer Recognise the validity of PMDD as a chronic health condition, support workers if they require disability support and make reasonable adjustments under the disability and discrimination act (1995) Create a supportive work culture that recognises the needs of menstruating employees by allowing flexible working where appropriate, and allowing important tasks to be planned in advance to avoid overlapping with the person's luteal phase. Have open communication with your employee about what style of feedback works for them, and allow for important conversations about performance to be scheduled in a good week. Raise awareness that trans-men, non-binary and intersex people may also experience these health issues. Go to https://iapmd.org/pmdd-and-the-workplace/ and https://www.seeherthrive.com/ for more information. Perinatal mental health Perinatal Mental Health Up to 1 in 5 women are affected by perinatal mental health issues, with 50 per cent going unidentified and unsupported. Find out more about your maternity rights here. What is a perinatal mental health issue? A mental health issue experienced any time from a woman becoming pregnant, up to a year after giving birth. Examples of common perinatal mental health issues: Perinatal depression, Perinatal anxiety, Perinatal OCD, Postpartum psychosis, Postpartum PTSD. Personal story I’ve had four children and have experienced perinatal mental health issues with all of them. With my first, I had an extremely traumatic birth and, as a result, I experienced PTSD, with nightmares and flashbacks that were distressing and difficult to manage. Motherhood was not what I thought it was going to be and with this came a sense of shame around how I was feeling. I struggled so much that I never did go back to work. My job was quite demanding and my employer inflexible, so I felt like there was no other option. After my second child, I developed Obsessive Compulsive Disorder (OCD) and spent many hours exhausting myself (as if I wasn’t tired enough!) with complicated ‘rituals’ around bottle preparation and cleanliness. Once again, I felt I was ‘failing’ as a Mum and the stigma stopped me from reaching out for support. During my third pregnancy, I developed a mixture of depression and anxiety. I didn’t feel like I could tell my employer the truth because I was worried they would judge me to be incapable or a problem to the organisation. And to be honest, it isn’t like they really asked how they could support me at work in any meaningful sense. I tried to block out the fact I was pregnant and just put all my energy into work and doing a good job. I was in denial about being pregnant and became consumed with work, much to the detriment of my wellbeing. When I think back, I’m sure it was obvious to my colleagues and managers that something ‘wasn’t right’ with me, but no one asked. Everyone assumed I was happy and excited to be having another baby. Then, after I had the baby, my anxiety became progressively worse to the point that I was in a constant state of distress day and night, a permanent state of panic. It was terrifying. I couldn’t sleep at all (even though the baby could) and after going five nights on zero sleep I started to hallucinate, developed psychosis and was ultimately hospitalised. What followed was a long road of recovery. However, when I returned to work my manager questioned me about my ‘capability’. They had heard (through a breach of confidentiality) what had happened to me and implied I could pose a risk, trying to force me into an unsuitable role. Not once was I asked how they could support me in the workplace. I felt ashamed and that made my recovery even more challenging. With my fourth child, I decided to be proactive, open and honest with my employer (a new one!) from the outset. I explained about my history of perinatal mental health issues and what happened with my previous employer. This time, my manager was fantastic. She was empathic and listened to understand, she reassured me that the organisation would stand by me, and she worked collaboratively with me to come up with a support plan, which included flexible work options and a review of my workload, in addition to extra paid time off to attend various mental health support sessions. After I had the baby, while on maternity leave, my manager showed genuine care in relation to my wellbeing. When I returned to work great care was taken to support that transition. I did experience some postnatal anxiety, but this time had such fantastic support all around me that I was able to manage it in such a way that I did not become severely distressed. I genuinely believe that my employer’s positive treatment of me made a huge difference to how I was able to cope. My plea to employers would be to become educated on perinatal mental health, to demonstrate to female employees that they do understand the issue and to address mental health as part of any discussions about pregnancy/post-natal support in the workplace. Removing shame and stigma is a massive step, in addition to offering practical support. Endometriosis About endometriosis Endometriosis is a condition that affects many women, however not many people are aware of this or what it is. This can often lead to misdiagnosis and lack of understanding around this painful disorder; in fact it takes on average 7.5 years to receive a correct diagnosis. Endometriosis is a long-term condition where ‘small pieces of the womb lining (the endometrium) are found outside the womb’ (NHS). Symptoms of endometriosis can vary and can include: Pain in your lower tummy or back (pelvic pain) – usually worse during your period; Period pain that stops you doing your normal activities; Pain during or after sex; Pain when going to the toilet during your period; Feeling sick, being constipated, having diarrhoea, or having blood in your urine during your period; Difficulty getting pregnant. Unfortunately, there is not a cure for endometriosis, but there are many treatments and ways to manage the pain. For mild cases, symptoms can be managed with painkillers, hormone treatments or contraceptives, and heat patches/hot water bottles. For severe cases, symptoms may require surgery to remove patches or endometriosis or in some cases a hysterectomy is required. Workplace impact of endometriosis Lack of endometriosis awareness can make people experiencing it feel alone and not willing to disclose to employers. This leads to many suffering in silence. Endometriosis can cause feelings of tiredness and exhaustion and symptoms can last for 1-2 weeks each month; this can often often lead to difficulty in completing everyday tasks and has a massive impact on someone’s physical and mental health. What you can do as an employer Allow staff to use heat treatments to ease their pain at work, such as hot water bottles. Educate staff to ensure those suffering with endometriosis are not discriminated against. Provide flexible working options and discuss pain management plans to make staff feel supported. Read up on symptoms and have a basic understanding of the condition. Including HR staff. Be kind and supportive. Raise awareness that trans-men, non binary and intersex people may also experience these health issues. Go to www.nhs.uk/conditions/endometriosis and www.endometriosis-uk.org for more information. Infertility About infertility Infertility is described by the WHO as 'a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse'. Infertility affects around 1 in 7 couples and can cause great psychological and financial stress, not to mention the examination and treatment process, which in some cases may take up to several years. Depression levels in patients with infertility have been compared with patients who have been diagnosed with cancer. According to the NHS and the National Institute for Healthcare Excellent (NICE), the cause of infertility cannot be identified in 1 every 4 couples (25% of cases). When identified, infertility can be caused by: Ovulatory disorders (25%); Tubal damage (20%); Uterine or peritoneal disorders (10%); Factors in the male causing infertility (30%). Impact of infertility in the workplace Despite infertility being a medical condition, there is little awareness among employers of how physically, psychologically, and financially demanding infertility can be for couples going through treatment. A study by Fertility Network UK showed that couples who were working full time and going through treatment were: Finding it difficult to focus at work; Worrying about their career progression; Experiencing high levels of stress; Having to take holiday days to undergo treatment; Unlikely to disclose their condition to their employers. Employers should grant time off for fertility treatment and could face an Employment Tribunal claim for indirect sex discrimination if they refuse. What you can do as an employer Provide paid leave for fertility treatment appointments Create a supportive work culture by allowing flexible working. Raise awareness that trans-men, non binary and intersex people may also experience these health issues. Go to http://fertilitynetworkuk.org/ for more information. Polycystic Ovary Syndrome (PCOS) About PCOS (polycystic ovary syndrome) PCOS affects around 1 in 10 women and is one of the most common, but treatable, causes of infertility. It is a hugely undiagnosed condition; one study showed that up to 70% of women hadn't yet been diagnosed with PCOS. Symptoms of PCOS include: Weight gain; Hirsutism (increased hair growth on the face, chest, stomach, back and toes); Androgenic alopecia (thinning hair and hair loss from the head); Oily skin or acne; Pelvic pain up to 14 days before menstruation cycle and intense period pain; Infertility; Depression; Anxiety; Bipolar disorder; Eating disorders. According to the NHS, women and girls with PCOS are at greater risk of developing long-term health problems such as insulin resistance and diabetes, high blood pressure, cancer, depression and mood swings, fatigue or sleepiness during the day. According to one study by De Montfort University, South Asian women have higher rates of PCOS in comparison to white women. Impact of PCOS in the workplace PCOS can cause feelings of tiredness and exhaustion resulting in a lack of focus at work. Due to a PCOS going widely undiagnosed, many women will be suffering with symptoms in silence. What you can do as an employer Acknowledge that some staff might be suffering with PCOS but not know they have it; always be supportive. Raise awareness of the symptoms of PCOS to improve its visibility and make staff feel supported. Provide flexible working options to help staff deal with their physical and emotional symptoms. Raise awareness that trans-men, non binary and intersex people may also experience these health issues. Go to https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/ for more information. Hysterectomy About hysterectomies A hysterectomy is a surgical procedure that involves removing the womb. It is most common for women in their 40s and 50s however any adult can have one depending on the health condition it is intended to treat including: heavy periods, PMDD, long-term pelvic pain, endometriosis, uterus prolapse, fibroids, and cancers of the ovaries, uterus, cervix and fallopian tubes. A hysterectomy is major surgery and is only considered after less invasive treatments have been tried. You can be in hospital for up to 5 days after surgery and it takes around 6-8 weeks to fully recover, during which time you have to rest as much as possible and not do anything strenuous. If someone has a hysterectomy before they have been through the menopause, they will experience a surgical menopause. This can happen immediately or up to 5 years after their surgery and will have the same symptoms as natural menopause including hot flushes, depression, vaginal dryness, sleep problems/insomnia, fatigue and night sweats. Workplace impact of hysterectomies “I had my hysterectomy at the age of 55 after suffering from heavy periods for many years...I was pressured to come back to work before I had fully recovered. Proper health and safety assessment was not carried out including phased return which would have been more comfortable and manageable.” Returning to work depends on how the individual feels and what sort of work they do. If their job doesn’t involve manual work or heavy lifting, it may be possible to return to work after 4 to 8 weeks. However, it is important to remember that no one recovery is the same and will vary from person to person. Consider whether your employees need a car to get to work because during hysterectomy recovery they will be unable to drive until they are comfortable wearing a seatbelt and performing an emergency stop. What you can do as an employer Provide phased return options and health & safety assessments for those who have had a hysterectomy. Provide regular check-ins and encourage flexible working and additional time off if needed. Organise training and events to educate staff. Survey your staff to find out their needs and what you can do better. Raise awareness that trans-men, non binary and intersex people may also experience these health issues. For more information please visit: https://www.nhs.uk/conditions/hysterectomy/ Menopause Menopause is often defined by three stages, as reflected below: “Menopause is defined as a biological stage in a woman's life that occurs when she stops menstruating and reaches the end of her natural reproductive life. Usually, it is defined as having occurred when a woman has not had a period for twelve consecutive months (for women reaching menopause naturally). The average age for a woman to reach menopause is 51, however, it can be earlier or later than this due to surgery, illness or other reasons. Perimenopause is the time leading up to menopause when a woman may experience changes, such as irregular periods or other menopausal symptoms. This can be years before menopause. Post menopause is the time after menopause has occurred, starting when a woman has not had a period for twelve consecutive months.” (University of Leicester, 2017) Between the ages of 35 and 45 women become perimenopausal, the stage between having their last regular period and their periods stopping altogether. As oestrogen levels fall, symptoms include irregular periods, night sweats, weight gain, hot flushes and loss of libido. After periods stop, there is an increased risk of vaginal discomfort and some women can experience depression. In postmenopause, with oestrogen levels flatlining, women are at increased risk of osteoporosis, urinary infections and the drop in the hormones has also been linked to heart disease. Recognising the impact for women is crucial for everyone, and it should not be dismissed purely as “a woman’s problem”. Both the Government Equalities Office and the Work Foundation reported on the gendered ageism women experienced as a result of the menopause, and how women were routinely left to feel dismissed and without lack of sufficient organisational support (Unison 2019). Research has shown that where employers have a policy in place regarding menopause, not only does this normalise the discussion, it legitimises a culture of supporting women across the organisation. Test cases such as Merchant VS BT PLC (2012) and Davies Vs Scottish Courts and Tribunal Service demonstrate the lack of compassionate consideration within workplaces through negation of adopting supportive policies and practices which can support women to navigate this transition in their lives. Forth’s research (2019), from a survey with 1,000 women to determine the ways in which they were significantly affected in the workplace, found that 63 per cent of menopausal women say their working life had been negatively affected by their symptoms. Henpicked offer a wealth of example policies for employers to adopt, including a checklist to determine how menopause friendly your organisation is, and webinars to review. There is a dedicated “Menopause Hub” to learn more. As menopause is a well-documented period in women’s lives it is essential to consider how to improve the experience for women both in and outside of the workplace, so discussion can become normalised and given due consideration without the stigma women often face. Research has shown that where employers have a policy in place regarding menopause, not only does this normalise the discussion, it legitimises a culture of supporting women across the organisation. Through frameworks that include considered and compassionate policies and procedures to manage issues such as absence, workload, resilience (both for the organisation and the individual) and peer support, women can feel supported through their menopause, which has the added bonus of ensuring women are not leaving organisations and their skill, knowledge and experience are retained – win win! This project is created by the Manchester Cohort of the Feminist Leadership programme 2019-2020.