PMDD could be impacting some of your employees’ performance: Here’s how to help.

If an employee’s menstrual cycle is so severe that it’s interfering with their ability to work—and they’re not just saying that in a “I don’t want to run laps” in gym class kind of way—they could be entitled to job-protected leave under the Family Medical Leave Act or to reasonable accommodation under the Americans with Disabilities Act.

Donna Walton, founder and president of the Divas with Disabilities Project, an organization dedicated to increasing the participation and representation of brown and Black women with visible disabilities, told HR Brew that employers might not be familiar with “every medical condition,” including Premenstrual Dysphoric Disorder (PMDD). Walton said that PMDD is not a disability that is “going to always be on the radar.” However, once an employee asks for accommodation, Walton said, that’s when HR can turn to disability program managers to “give ideas of what an accommodation could be.”

We talked to consultants about what PMDD is, how HR can accommodate employees through their worst symptoms, and why there are barriers to seeking support in the workplace.

What’s PMDD? PMDD, a chronic condition related to PMS that can cause severe tension and irritability, depression or anxiety,pain, headaches, joint/muscle pain, fatigue, and difficulty focusing, affects 3%–8% of people with PMS.

How’s HR involved? During a May Job Accommodation Network training on accommodations for reproductive disorders and pregnancy, Tracie DeFreitas, principal consultant and ADA specialist, walked viewers through the hypothetical case of Ally, a fictional worker who experienced “severe anxiety and difficulty with time management, focus, and memory” as a result of her PMDD.

DeFreitas rattled off a litany of potential accommodations, from allowing a support animal, to modifying the work environment (performing tasks remotely or in a hybrid format), to the timing of work (offering flexible scheduling or uninterrupted work time), to the structure of work (providing “written instructions and checklists”).

What could be stopping employees from asking for help? The consultants we interviewed for this piece said that people suffering from PMDD have a weighty decision to make about disclosure. There are potential risks to doing so—including those universal to disclosing any disability, such as the potential for illegal retaliation and discrimination, and those specific to broaching a topic that’s long been considered taboo.

Tricia Callender, the head of diversity, equity, and inclusion at Thinx, a period-underwear company, explained that the social messaging around menstruation can often discourage conversation about menstruation.

Callender said that periods are a “normal bodily function [but] it’s certainly not on that level socially.” According to Callender, many conversations about periods occur in “hushed tones, like it’s something to be embarrassed about.”

Hitchen told HR Brew that being comfortable disclosing may be easier said than done—in part because of the cultural stigmas Callender referenced.

“I have a feeling that a lot of people may think…they might be the only one at their company [suffering]...maybe they don’t want to have to kind of fight about that, like go to bat for [themselves] about pain related to having a uterus,” Hitchen said. “I mean, shoot, I work in HR. Would I want to talk to an HR person for an hour or two about how painful something related to my period was? It wouldn’t be my first choice in meeting topics.”

What’s another approach? A few countries and individual organizations offer “menstrual leave,” which generally permits menstruating employees to take additional days of paid leave on top of the company’s allotted sick time and PTO—no approval required.

Sonya Passi, CEO of Chani, an LA-based astrology app that offers “unlimited menstrual leave,” told the Washington Post that at her company, if employees request leave, “it’s an automatic yes.”

Menstrual leave has been around in some form since 1922, according to the BBC, but it’s far from common, in part because critics worry that those who take leave will be perceived as weak.

Jessica L. Barnack-Tavlaris, a psychology professor at the College of New Jersey, led a recent study about Americans’ attitudes toward menstrual leave policies and told the Washington Post that successful programs must include education about menstruation.

Without it, Barnack-Travlaris told the Post, “we feed into this myth that people who menstruate can’t function, or that they’re emotionally unstable and unfit for the workplace.”

What next? Absent menstrual leave, Molly Hitchen, an HR consultant, wants employers to proactively talk about accommodations and disabilities because “the average non-HR person, whether you’re a manager or not, doesn’t have even a partial understanding of what reasonable accommodation and disability means in the workplace.”—SV

Do you work in HR or have information about your HR department we should know? Email [email protected] or DM @SusannaVogel1 on Twitter. For completely confidential conversations, ask Susanna for her number on Signal.