“I lose myself for two weeks, then spend two weeks trying to rebuild before it starts again” 

This is the reality for many who suffer with PMDD. Trying to explain to your colleagues why you're bright and focused one week, then dark and withdrawn the next. And then trying to explain that to your employer. It can get complicated.

PMDD isn’t Linear

PMDD is cyclical and episodic in nature. But workplace timelines, schedules and social expectations are linear and built for consistency. 

Symptomatic weeks:

With PMDD, for 1-2 weeks every month, debilitating symptoms take over. These aren’t “bad moods” - it’s severe anxiety and depression, debilitating brain fog, uncontrollable irritability and anger, intense fatigue. Every single month.

Some with PMDD resort to remote work. Some take days off during hell week and make up the hours during the good weeks. This creates a constant loop of exhaustion. 

The “good” weeks:

The weeks when symptoms have lifted? They aren’t really a break. There’s no real recovery, just a different kind of pressure:

➣ Catch up pressure: The expectation to compress missed work, overperform and prove reliability before the next cycle begins.

➣ Anticipatory dread: Spending symptom-free days with anxiety and dread for the upcoming luteal phase.

PMDD Has a Measurable Career Cost (1,2,3,4,5)

Those with PMDD have:

◉ 5x higher risk of regularly missing work

◉ 40% higher risk of sick leave, and a 69% increased risk for prolonged sick leave (more than 90 days)  

◉ 27% higher risk of unemployment  

And what else?

◉ Over half of those with PMDD didn't take days off, but still experienced a 30% or greater decline in their performance  

◉ Those with PMDD experience on average over 8 hours of absenteeism per menstrual cycle

 

When sick leave was recorded, the most common diagnoses noted on certificates were depression, anxiety, PTSD, and pregnancy complications, never PMDD itself. The condition driving the absence was effectively invisible in the records. Another sign of how consistently it goes unrecognised. Women are being signed off sick, losing jobs, and accumulating long-term absences, but the underlying contributor never makes it onto the paperwork.

With over 8 hours of absenteeism per cycle, this provides a quantitative reality behind hours lost during the luteal hell week, and the hours that might be spent working extra in the good weeks.  

This creates real, lasting damage.

1. Strained work relationships

2. Burnout from chronic catch up cycles

3. Presenteeism - working while unwell

4. Career stagnation and missed opportunities

5. And for some? Leaving jobs altogether.

This is a significant and underrecognised socioeconomic burden. It is not a problem of willpower, dedication, or productivity. It is the reality of a complex and serious condition affecting 3-8% of those with a menstrual cycle worldwide - and it is urgent that it is taken seriously.

 

What can workplaces do to support those with PMDD? (6,7)

50% of women with PMDD worry that taking time off will negatively impact their careers. The burden shouldn’t fall on those who are already suffering.

1. Awareness in the workplace
The starting point is awareness. Do managers actually know what PMDD is? Training managers to have confident, informed conversations about cyclical health rather than treating it as a taboo, can change the entire culture of a team. A listening ear and a basic understanding go a long way.

2. Education that reduces stigma
So people with PMDD don’t have to justify their condition to access support.

3. Workplaces can choose to do better
From there, it’s about creating a safe space within the organisation. Fostering a culture of openness means people don’t have to suffer in silence or mask what they are going through. Women are already routinely dismissed by the healthcare system but the workplace can choose to do better. 

4. Mandatory workplace adjustments
Practical adjustments matter too. Flexible scheduling, options to work from home when symptomatic, phased return policies and offering private spaces in the office.

For employers reading this? The goal isn't to lower the bar - it's to remove the obstacles. With the right support in place, someone with PMDD can contribute at the level their skills deserve. 

Suffering in silence has never helped anyone. When the support is there, the talent is too.

 

References: 

1. Yu et al. Premenstrual disorders and risk of sick leave and unemployment: a prospective cohort study of 15 857 women in Sweden. BMJ Mental Health. 2025.

2. Habib et al. Off-Label: Lived, Embodied, and Temporal Experiences of Premenstrual Dysphoric Disorder (PMDD) in Canada. Womens Reprod Health. 2024.

3. IIDA et al. Association of severity of premenstrual disorders with absenteeism and presenteeism among Japanese working women: a cross-sectional study. Industrial Health. 2025.

4. Maeda et al. Menstruation-Related Diseases, Work Performance, and Oral Contraceptive: Nationwide Online survey. Journal of Occupational and Environmental Medicine. 2025.

5. Islas-Preciado D, Ramos-Lira L and Estrada-Camarena E (2025) Unveiling the burden of premenstrual dysphoric disorder: a narrative review to call for gender perspective and intersectional approaches. Front. Psychiatry 15:1458114. doi: 10.3389/fpsyt.2024.1458114

6. Endometriosis UK. Menstrual Health at Work. PMDD at work. https://www.endometriosis-uk.org/sites/default/files/2025-01/Menstral%20Health%20at%20Work%20-%20PMDD%20at%20Work%20.pdf 

7. The PMDD Project. Managing Work with PMDD. https://thepmddproject.org/wp-content/uploads/2025/01/MANAGING-WORK-WITH-PMDD-Digital-02-1.pdf