The exacerbating reality of working with chronic PMS

Written by Raifa Rafiq

Women with premenstrual dysphoric disorder (PMDD) have found working from home life-changing. It’s helped many cope with their chronic symptoms but it shouldn’t have taken a global pandemic for offices to implement shifts to their employees’ work life.

There is a growing number of women who, despite finding the pandemic anxiety-inducing, have also found working from home to become somewhat of a relief; particularly women with premenstrual dysphoric disorder (PMDD). 

PMDD is “a particularly severe form of premenstrual syndrome,” explains Kate Sang, professor of Gender and Employment studies at Heriot-Watt University. Estimates of how prevalent health condition is varies considerably, but she tells Stylist that “Research evidence suggests that those with PMDD may be misdiagnosed with another condition such as depression,”  

According to the NHS, most women will experience some PMS symptoms during their lifetime but for the most part, it is manageable. Nothing that some painkillers and a hot water bottle can’t fix. However, for 2-10% of women of reproductive age, their experience of PMS is far more intense.

This is something I know too well. After being diagnosed with PMDD over the past 12 months, although I was grappling with it for four years. When it comes to the symptoms, what I’ve found hardest is the depression and low mood. I’m very sensitive during this time. I get in my bed earlier than usual so I can have time to be sad before work as getting up can be very difficult.

Before the pandemic, a typical working day when my symptoms were in full drive was dreadful. My anxieties are often intensified and I’d find myself thinking about how I would survive in the office – even the thought of commuting was exhausting. I have often been worried about calling in sick and using my “women’s problem” as an excuse. Regularly, I would use the famous, “I am very under the weather” line in emails to lighten how I am truly feeling. But almost every month, I’d gather up the strength to go to work and put on a show of enthusiasm despite how much pain I was really in.

Professor Sang’s research shows that employees living with PMDD can endure severe psychological distress, including suicidal ideation, in the days commencing their period and this can make working unmanageable. Iman, a 26-year-old engagement coordinator in the arts sector shares my concerns about being too afraid to talk to my employer about my gynaecological health. “I try not to call in sick because of anxiety around taking too many sick days. I started a new job while in lockdown, and I had a very bad PMDD last month, which meant I had no choice but to take time off.” 

“To say the decision was nerve-wracking was an understatement. I was worried about what my new colleagues would think of me, if they would see me as a liability and if this absence would affect my probation,” she adds.

There’s an extra layer of complication here, too. Pain experienced by Black women like myself and Iman, is often not recognised or given sympathy, and it’s a big problem in society as well as the healthcare industry. 

For example, Black women are five times more likely to die in childbirth, according to UK Confidential Enquiry into Maternal Deaths, and there are reports medical trainees upholding the myth that Black skin is “thicker” than white skin. It’s no wonder that, carrying all of this information, I feel like I have to put on a pantomime at work to showcase my pain and discomfort, just so they believe me when I need to take a few days off.

And why would we feel comfortable sharing such personal information when it could be met with scoffs, belittlement and sometimes ill-mannered remarks. This rings true for 27-year-old teacher Fifi Olusanya who also has suffered from PMDD. “My workplace made comments about how ‘I’m not the only one to have a period and I’m not the only one to feel down about it’. I was told to suck it up or I won’t get far.” She recently left that job for a number of reasons, with their unwillingness to not acknowledge her health issues being one of them.

Professor Sang points to significant research by Claire Hardy and Jenna Hardie, which suggested that women may engage in presenteeism, i.e. turning up to work but not able to fully function because of PMDD, and often reported feelings of guilt after their PMDD symptoms subsided. This is something 25-year-old lawyer Sabiah is certainly familiar with. “I have to constantly remind myself that my period is affecting the way I’m thinking as I find my negative thoughts get out of hand, sometimes affecting my work output and relationships. My work-life is tumultuous thanks to PMDD.”

In addition, she has been diagnosed with anaemia, a condition which means her body is low on iron and so means Sabiah experiences exhaustion, too. “I’m very conscious about how much I’m bleeding pretty much all of the time. I mostly feel really uncomfortable and when my estrogen levels dip, I find I’m low in energy and really anxious.” But would Sabiah call in sick or perhaps ask to work from home? “Never,” she replies, adding that she often feels regret after she makes her way into the office with her agonising pain. 

Paving the way for the future is Coexist, a women-led company in Bristol whose “period policy” is intended to empower women to take time off without being shamed. But such initiatives feel like they will never exist in male-dominated fields, such as law. “I haven’t ever asked for time off due to my period because my seniors have mostly been male, so I’ve not thought about how I would word my explanation. I’ve also internalised that PMDD isn’t a serious enough excuse and that it may come across as ‘lazy’. I haven’t worked with another woman who has used it as a justification to work from home either,” says Sabiah.

Due to the unprecedented lockdown in the UK, many women with PMDD have been able to work from home for the very first time. For Iman, this new experience of working freely with a hot water bottle by her side and wearing loose clothes has made her menstrual cycle less terrifying. “The commute was my least favourite part so I’m happy that I don’t have to do that anymore. I’m also in a comfortable space where I can express my emotions openly without judgment and I feel loved and cared for, which is nice when you’re dealing with such chronic symptoms,” she says. 

Fifi is able to juggle her pain and the high demands of work at home with ease, leaving her feeling empowered, “For my pain, I can arrange ‘down’ times and it doesn’t get in the way of my productivity because I run on my own schedule.”

While normalising flexible working is likely to be one of the positive outcomes of this lockdown, women should be able to bring their whole selves to work, including justifications of their gynaecological health without any shame. Professor Sang says there’s data to support where medical leave was taken, PMDD was not cited as the reason due to shame and stigma but Iman hopes “that one day our working environments become more accepting of people taking time off just because, without having to lie about having a cold or the flu.”

Joe Levenson, director of communication and campaigns at the Young Women’s Trust told Stylist how offices can support women with health issues: “Coronavirus allows us all an opportunity to radically rethink our working environments, and to make working life fairer for those who have caring responsibilities or health issues.”

“Homeworking and more flexible hours can be indispensable for women experiencing a variety of mental and physical health conditions or who are juggling caring responsibilities. This relies on employers, however, to be willing to move away from outdated practices and value the contribution that women can make when their needs and experiences are factored into the design of workplaces.”

Levenson adds: “We really hope that a more flexible approach from employers becomes the norm so that we truly have equal workplaces that allow young women to flourish, and so that no young woman gets left behind.”

Images: Courtesy of Fifi Olusanya and Sabiah

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