Nearly a quarter of women often miss work because of menstrual symptoms, according to a survey examining hormonal health among women in full-time work in Ireland.

The survey looked at the impact of menstruation, fertility and motherhood, and perimenopause and menopause.

Research from The Menopause Hub found more than one in three women who had not disclosed a menstrual health issue at work said the lack of a clear workplace policy was the reason.

More than a quarter said they did not think their concerns would be taken seriously, while 22 per cent cited embarrassment and 18 per cent feared being judged.

Nearly half of respondents said better workplace support would have made them feel less stressed, while 40 per cent said it would have made them feel more valued. Some 36 per cent said they would have felt more comfortable speaking up.

Some 76 per cent of women surveyed said they experienced menstrual health issues, with 23 per cent of those often missing work because of symptoms.

Nearly half of respondents, 49 per cent, said they felt uncomfortable talking about menstruation at work.

One respondent said: “As a woman, we try to get through the day, sometimes in pain that can’t be seen. We feel emotionally and physically drained.”

The research also found that 62 per cent of those who experienced baby loss reported a moderate or significant impact on work attendance.

More than half of respondents who experienced depression during pregnancy also reported a moderate or significant impact on attendance.

Some 63 per cent of mothers said it was “difficult” to return to work after pregnancy, while nearly half said their maternity pay arrangement had negatively affected their financial wellbeing.

One respondent said: “I almost walked away. The only reason I stayed was because I had to provide for my family.”

The survey also found that nearly half of respondents said menopause had some impact on their attendance, while more than six in 10 reported an impact on their work performance.

Some 44 per cent of women said they were “uncomfortable” discussing perimenopause and menopause at work.

One person said they were “already terrified of losing my job at my age:

“I need to just struggle through this without support or acknowledgement. That’s basically workplace discrimination.”

The Menopause Hub chief executive Loretta Dignam said women’s hormonal health has been treated as a “private or personal issue” for too long, “when the reality is that it has a very real impact on women’s working lives”.

“The fundamental point is that women are not ‘mini men.’

“Our biology is different, and workplaces that were largely designed around a male model of health and working life need to evolve to recognise that.

“What is striking is how many women continue to show up, perform, push through and progress at work while managing significant physical and emotional symptoms, often without the policies, understanding or practical support they need,” Dignam said.

She added that because expectations are changing, Gen Z and Gen Alpha employees will be “far less willing than previous generations to accept workplaces that ignore their health and wellbeing”.

Women using PIEDs reported difficulty accessing reliable information, testing and clinical expertise, according to a qualitative study.

Researchers interviewed nine women who used performance- and image-enhancing drugs, primarily to enhance body composition, physical appearance or sporting performance.

Participants reported problems accessing comprehensive blood and hormone testing and finding clinicians familiar with health concerns linked to women’s use of these drugs.

This has been a male-dominated area of research for a long time, so there are significant gaps in understanding women’s health care needs.

The research, led by University of Queensland School of Psychology PhD candidate Hannah Schuurs, explored how the women managed their health while using PIEDs, which include substances such as steroids and peptides.

Schuurs said: “We interviewed nine women who use PIEDs about how they managed their health throughout their PIED use.

“They reported difficulty accessing reliable information and a lack of clinical expertise and formal health care support.

“The study participants were all active in self-monitoring, tracking changes in their bodies, and actively sought formal health care support.

“But they found it hard to access comprehensive blood and hormone testing, or clinicians who were familiar with the unique health concerns associated with women’s PIED use.”

The study found participants spent considerable time educating themselves about the drugs and their potential risks.

“They often found themselves educating healthcare professionals rather than receiving guidance tailored to their circumstances.

Schuurs said: “The participants had spent considerable time educating themselves about PIEDs and their risks and found they were often educating their health care providers, rather than receiving guidance tailored to their circumstances.”

“Structural and systemic barriers shifted a disproportionate level of responsibility for harm reduction and care coordination onto the women themselves.”

Participants were also aware of sex-specific risks, including hormonal disruption and virilisation. Virilisation is when masculine physical traits develop due to high levels of androgens.

However, the women did not necessarily expect healthcare professionals to have all the answers.

Schuurs said: “Participants were often understanding of gaps in clinical knowledge, provided they were met with openness and a willingness to work collaboratively.

“They emphasised that respectful, nonjudgmental health care relationships were just as important as technical expertise.”

The findings also challenged stereotypes that people using PIEDs are uneducated or indifferent to their health.

Participants reported actively managing their health while navigating stigma, uncertainty and gaps in healthcare.

Schuurs said: “The participants actively managed their health and navigated stigma, uncertainty and gaps within health care.”

“We need health care responses that are collaborative rather than judgmental, as those narratives can oversimplify people’s experiences and make it harder for them to seek support.”

She said the research showed PIED use could form part of wider goals relating to health, wellbeing, performance and self-management.

Schuurs said: “Better understanding women’s experiences is critical if we want health care systems to respond effectively and ensure women can access the support they need.”

“There is a real opportunity to improve education, clinical guidance and support for health care professionals in this space that values and draws from the lived experience of women themselves.”

Women later diagnosed with endometriosis used more antidepressant and anxiety medication than other women, with the pattern emerging years before diagnosis, recent study found.

The difference was evident up to 10 years before diagnosis and continued for a decade afterwards, according to a large Danish registry-based study involving 136,842 women.

Women with the condition also had substantially more contact with psychiatric hospital departments than those without it.

Researchers at Aarhus University found that women with endometriosis redeemed 29 per cent more prescriptions for antidepressants and 16 per cent more for anxiety medication in the years before diagnosis.

After diagnosis, the differences rose to 40 per cent for antidepressants and 46 per cent for anxiety medication.

Marie Josiasen, PhD student at the department of public health and one of the researchers behind the study, said: “What surprised us was how clear and persistent the pattern was, and that the difference did not diminish over time.

“On the contrary.

“Women with endometriosis consistently redeemed more prescriptions for antidepressant medication than women without the disease throughout the entire period, from ten years before to ten years after diagnosis.”

The study does not provide an answer as to what causes the mental strain.

Josiasen said prolonged pain, uncertainty about the cause of symptoms and fertility problems could be among the factors contributing to psychological strain.

She said: “It’s possible that prolonged pain, uncertainty about the cause of the symptoms, and frustration over not being able to live the life one wants may be among the reasons. For some women, fertility problems can also be a major psychological burden.”

Researchers also found that the gap compared with women without endometriosis did not narrow after diagnosis. Instead, it became more pronounced in the years that followed.

Josiasen said: “A diagnosis can be a relief, but it also involves coming to terms with having a chronic illness.”

The study does not indicate whether diagnosing endometriosis earlier could reduce psychological strain.

As part of her PhD project, Josiasen will investigate the role hormonal contraception may play in the mental health of women with endometriosis.

She said: “We can see that many receive medication and are in contact with psychiatric services. But we still lack an understanding of what actually helps these women.

“That’s what I want to help find out.”