Workplaces often have policies for sick leave, parental leave, and even coffee breaks, but rarely do they have menstruation and menopause policies, even though approximately 50% of the workforce will experience both. For millions of workers, problematic period symptoms like heavy bleeding and pain, or perimenopausal symptoms including hot flashes and “brain fog,” affect their work and personal lives. Yet, in most organizational and workplace policy frameworks, there is no mention of menstruation and menopause, often leaving women with little choice but to “suck it up and push through.”
That silence is breaking. Portugal and Spain recently introduced menstrual leave at the national level, the UK Parliament and Australian Senate have commissioned inquiries into the effects of menopause and perimenopause in the workplace, and companies globally have experimented with menstrual and menopause workplace policies. These developments reflect a growing recognition that reproductive health is a workplace equity issue.
Our recent global scoping review of workplace policies on menstruation, menstrual disorders, and menopause shows that many of these initiatives are fragmented, inconsistently applied, and are rarely evaluated.
If policymakers and employers are serious about advancing gender equity, reproductive health can no longer be treated as an afterthought.
Why Menstruation and Menopause Policy at Work Matters
We know that conditions such as period pain (dysmenorrhea) and heavy menstrual bleeding affect over 75% of women at some stage in their reproductive life, while 1 in 7 to 1 in 10 women have endometriosis with often debilitating pelvic pain and fatigue, and over 75% of women will experience peri- and post-menopausal symptoms that can persist for years, causing real fatigue. These experiences shape how people participate in paid work, influencing absenteeism, presenteeism, career progression, and long-term financial security.
Studies consistently show that workplace productivity is negatively affected in workplaces that offer limited support. Endometriosis, for example, is estimated to cost tens of thousands per person annually in lost productivity, while problematic menopausal symptoms contribute to burnout and early retirement. Providing entitlements such as reproductive health leave or work flexibility would cost far less; in our recent paper, we discuss the potential benefits, including improvements in retention, productivity, wellbeing, and equity outcomes.
The human cost is equally pressing. In unsupportive environments, workers often feel compelled to conceal symptoms or “suffer through” pain, which reinforces stigma and exclusion. Over time, this silence compounds gendered inequities across the life course, from diminished earnings, stymied career progression to reduced retirement savings.
Recognizing reproductive health at work is not about special treatment. It is about recognizing unmet needs and building inclusive, sustainable workplaces.
What We Found: Global Patterns in Reproductive Health Policy
Our review identified a wide range of policies, guidelines, and practices, as well as significant gaps.
- Menopause policies take center stage. Guidelines on menopause, often developed by UK and EU trade unions or federations, were the most common. These typically emphasized flexible work, adjustments to the work environment, and manager training. This raises important questions: is menopause perceived as more acceptable or visible than menstruation, thus making it less taboo to address?
- Fragmented policy responses. The limited existing menstrual policies globally were largely limited to additional leave entitlements, rather than broader strategies such as flexible working arrangements, reasonable adjustments, or worker education.
- Limited focus on menstrual disorders. Despite the prevalence and impact of conditions like dysmenorrhea, chronic pelvic pain and endometriosis, very few policies explicitly recognized these conditions or sought to ameliorate their effects on workers’ lives. This gap highlights the disproportionate attention given the evidence of their widespread burden.
- Persistent inequalities. Most policies are designed for stable, salaried employees. Often young workers or those in precarious, low-wage, or informal jobs (often those with the least labor protections or access to paid leave) are excluded.
- Lack of evaluation. Few initiatives have been systematically evaluated, leaving little evidence of their effectiveness or potential unintended consequences.
Spain’s menstrual leave policy, introduced in 2022, is an instructive case study exemplifying the promises and limits mentioned above. While hailed as a progressive step toward more inclusive workplaces, early evidence shows limited uptake, with many workers reluctant to use the entitlement due to fears of stigma or discrimination and worries over transgressing against the existing workplace culture that promotes an unfaltering commitment to work.
This highlights a broader challenge: leave entitlements alone may acknowledge menstrual health but do little to shift entrenched gendered cultural norms and workplace structures that perpetuate inequities. Without robust evaluation, advocates and policymakers cannot know which approaches are most effective or how best to design policies that genuinely contribute to workplace equity.
Intersectional Dimensions
Reproductive health is not experienced in isolation. Workplace responses must consider how gender intersects with other social and economic inequities:
- Class and income: Low-wage and precarious workers often have the least access to paid leave or flexible work arrangements.
- Race and migration: Racialized and migrant workers are overrepresented in jobs with minimal protections, compounding and potentially amplifying inequities.
- Gender diversity: Framing policies only as “women’s health” risks excluding non-binary and trans workers.
- Disability: Despite robust debates concerning the utility of this approach (including concerns about whether menstrual leave policies reinforce the pathologization or medicalization of menstruation) in several legal settings, framing reproductive health through disability and occupational health legislation has enabled new avenues for change. In the UK, menopausal symptoms are protected from discrimination under the Equality Act (2010). Conditions such as endometriosis are reasonable grounds for adjustment and protection from employer discrimination in both the UK and Australia under the Equality Act (2010) and Disability Discrimination Act (1992), respectively. This approach shifts responsibility from workers to employers, requiring reasonable adjustments to support workplace participation. Positioning reproductive health concerns in this way highlights how gendered experiences of disability intersect with labor rights and occupational health. Disability and occupational health legislation may offer a crucial lever for designing inclusive workplace policies and practices.
- Parenting and care responsibilities: Reproductive health challenges are compounded by broader inequalities tied to caregiving responsibilities. For many workers, limited sick leave entitlements to care for children, aging parents, or other family members result in little or no leave available for them to manage their own health. The strain is often acutely experienced by single parents, those with multiple children, or carers of dependents with additional or higher needs.
Without attention to these intersections, workplace reproductive health policies, if not carefully formulated, risk reproducing the very inequities they seek to challenge.
Next Steps for Reproductive Health Policy
For policymakers, the next step is to embed reproductive health considerations more explicitly into labor laws. This includes supporting pilot programs and funding robust evaluations to build a stronger evidence base. Importantly, policies must move beyond a narrow focus on leave to also consider flexibility, reasonable accommodations, and workplace education.
For employers, action is equally urgent. Organizations can foster open discussion to reduce stigma and normalize support, while training managers and HR staff to recognize and respond appropriately to reproductive health needs. Inclusive benefits, such as flexible work and reasonable adjustments, should extend beyond salaried employees to those in precarious or low-wage roles. A key question is whether reproductive health supports are best integrated into broader health, wellbeing, and diversity and inclusion strategies, or if they should be developed as standalone policies. It’s critical that a genuinely intersectional approach is taken to formulate any policy intervention.
Crucially, both policymakers and employers must ensure that new initiatives are evaluated and reported on. Without systematic assessment, it is difficult to know which approaches are effective, for whom, and under what conditions. Transparent reporting not only strengthens accountability but also provides the evidence needed to refine policies and develop best practices over time.
Reproductive health, from menstruation through to menopause, has long been treated as an individual matter rather than a structural workplace concern. Emerging policies signal progress, but without careful design, evaluation, and an intersectional lens, they risk reinforcing inequality instead of dismantling it. The challenge is not only to acknowledge reproductive health but to recognize it as a fundamental issue of labor rights and workplace equity. By investing in inclusive, evidence-driven approaches, policymakers and employers can move beyond piecemeal responses and create workplaces that reflect the realities of workers’ lives.
