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”.

A perimenopause app that maps existing smartwatch data to the menopausal transition has launched across 39 markets in the UK and Europe.

anna app uses information already recorded by wearables, including sleep, heart rate and body temperature, and returns one suggested lifestyle action each morning alongside the research behind it.

The company says each rule in its library links a defined pattern in a woman’s own data to a specific action. The recommendations were developed with an advising clinician and draw on more than 300 published studies.

The company says recommendations are not generated automatically and each can be traced to research reviewed by a doctor.

The app was built by two women in Riga, has been funded without outside investment and was tested with women in the UK over three months before launch.

Perimenopause is the period of hormonal change before periods stop and usually begins after 40.

The company says one of the challenges is the unpredictability of the transition, with sleep, energy, mood and concentration potentially changing from week to week.

Because the experience varies between women, the developers say it can be difficult to find care tailored to individual needs. After 45, there is also no reliable blood test to confirm perimenopause.

The transition can coincide with a busy period in women’s working lives.

CIPD research published in 2023 found that 27 per cent of working women aged 40 to 60 with menopause symptoms said they had affected their career progression, equivalent to around 1.2m women in the UK.

Some 79 per cent said they felt less able to concentrate.

The long-running Study of Women’s Health Across the Nation, which has followed thousands of women through the menopausal transition, found that cognitive difficulties reported during perimenopause appear to be time-limited, with improvement returning in early postmenopause.

The developers say anna differs from standard wearable data by interpreting measurements specifically in the context of perimenopause.

A smartwatch may show changes in sleep, heart rate or temperature, but anna is designed to look at combinations of those signals and link them to lifestyle guidance for that day.

The app is also designed to work without daily symptom logging.

Users can complete an optional daily check-in if they want to add more context, but the app can operate without a symptom diary or daily manual entries.

It uses information from a compatible device the user already owns, such as a watch, ring or band.

Elina Pika-Lepere, co-founder and chief executive of anna app, said: “Perimenopause arrives exactly when a woman has the least spare capacity. She is often at the peak of her career, raising children, caring for ageing parents. What she has lost is not information, it is predictability.

“We built anna to offer a helping hand and evidence-based guidance through a stage that is difficult but temporary.”

The company gave the example of a morning when a user’s watch shows she has slept well below her own 28-day average.

Rather than simply telling her she is tired, anna may suggest choosing one priority and working on it in 25-minute blocks with a short break between them.

The app also displays the sleep and concentration research used for the recommendation.

anna was founded by Pika-Lepere, who spent 15 years building products in advertising, retail and e-commerce, and product lead Zanda Freimane, whose background is in product management in fintech and e-commerce.

The wider team includes a mathematician and university researcher advising on data architecture, a senior developer and a user experience adviser from a Baltic unicorn company.

anna app is not a medical device and does not provide medical advice.

Its guidance is limited to lifestyle support, and the company describes the app as a tool to complement a doctor rather than replace professional medical care.

anna app is available on iOS across 39 markets in the UK and Europe and is listed on the App Store as anna: Perimenopause & Sleep.

The app is in English and works with Apple Watch, Garmin, Fitbit, Oura and Whoop through Apple Health.

The company says user data is hosted in the EU and is never sold.

The service costs £13.99 a month or £99.99 a year in the UK and €14.99 a month or €99.99 a year in the euro area after a seven-day free trial.

Women using menopausal hormone therapy had a lower dementia risk, with oestrogen-only users showing fewer Alzheimer’s-related brain changes in a recent study.

Researchers stressed that the findings do not show that hormone therapy prevents dementia, but found women using oestrogen-only treatment had fewer biological signs linked to Alzheimer’s disease.

The observational study also found that women using this form of hormone therapy were less likely to receive a clinical dementia diagnosis.

The study combined clinical data with biomarkers and evidence from brain tissue collected after death to build a more detailed picture of the relationship between hormone therapy and Alzheimer’s-related changes.

The findings contrast with several previous studies reporting that menopausal hormone therapy increases dementia risk.

Dr Hadi Hosseini, associate professor of psychiatry and behavioural sciences at Stanford University in the US and senior author, said: “Our study is unique in that we looked at all the standards of Alzheimer’s diagnosis, including the gold-standard outcome: Alzheimer’s-associated hallmarks in autopsied brains.”

Hosseini said many conditions can affect memory and that clinical diagnoses are not always accurate. Examining brain tissue allows researchers to look directly for the defining biological features associated with Alzheimer’s disease.

Researchers examined medical records from 21,462 women taking part in two large US studies.

They looked only at women who used oestrogen-only therapy because previous studies indicated that treatment combining oestrogen and progestin may increase dementia risk.

This group was compared with women who reported no use of menopausal hormone therapy.

The records included data from 258 brain autopsies of women who had reported using oestrogen-only menopausal hormone therapy and 2,701 autopsies from women who had not used hormone therapy.

After adjusting for factors including age, women who took hormone therapy had a 35 per cent lower chance of showing biological signs of Alzheimer’s disease than those who did not use hormone therapy.

Hormone therapy use was also associated with a 39 per cent lower risk of receiving a clinical dementia diagnosis and a reduced risk of memory problems or declining functional abilities.

Dr Tom Blackmore, research programmes manager at Alzheimer’s Research UK, said: “Dementia has been the leading cause of death for women in the UK for over a decade, yet we still don’t fully understand why women are more likely to be affected by the condition than men.

“Understanding how hormones, menopause and ageing influence brain health is an important area of dementia research.

“While these findings are interesting, this study can only show an association and cannot tell us whether hormone therapy itself reduced dementia risk.

“Many factors influence a person’s likelihood of developing dementia, and women who received hormone therapy may differ from those who did not in ways that also affect their long-term brain health.”

In current standard practice, oestrogen-only therapy is prescribed to people who have undergone a hysterectomy because of the increased risk of endometrial cancer.

Blackmore also said the study focused exclusively on women taking oestrogen-only hormone therapy, which “differs substantially from how hormone replacement therapy is typically used today.”

Although early studies suggested menopausal hormone therapy might help protect menopausal women from dementia, later research produced inconclusive results.

A large analysis published in 2003 suggested the opposite, finding that oestrogen-plus-progestin formulations appeared to increase dementia risk, particularly when started at an older age.

Hosseini said: “There have been a lot of conflicting findings about MHT’s [menopausal hormone therapy’s] effects on Alzheimer’s disease outcomes.”

He added: “Different studies may have involved different age ranges of initiating MHT.”

Hosseini said studies may also have examined different clinical outcomes and biomarkers, combined different hormone therapy formulations or looked at different routes of administration and treatment durations.

Blackmore added that the findings “are not a reason for women to start or stop hormone replacement therapy with the aim of reducing dementia risk.”

He added: “Instead, the study provides valuable clues about the biology underlying dementia and highlights the need for more research into women’s brain health.

“Larger and more diverse studies will be needed to determine whether hormone-based treatments could play any role in reducing dementia risk.”

According to Alzheimer’s Research UK, an estimated 982,000 people are living with dementia in the UK, with around 65 per cent of those affected being women.