Periods at work: is nurses’ health at risk through long shifts and lack of breaks?
Nurses are facing discomfort and anxiety because periods continue to be a taboo subject and employers fail to make workforce menstrual health a policy priority
- Leaving high absorbency tampons in place for longer due to lack of breaks or toilet access can increase risk of toxic shock syndrome
- Healthcare employers should create a workplace culture where nurses can discuss their menstrual health and concerns openly
- Charity Bloody Good Period works with organisations to help establish period-friendly practices
Nurses are potentially putting their health at risk if coping with heavy periods while unable to take break on shift.
One nurse told Nursing Standard staffing pressures mean she often uses a higher-absorbency tampon than she needs, which can increase the risk of the rare but potentially life-threatening toxic shock syndrome (TSS).
Factors that make nurses use tampons that are more absorbent than needed
The risk of TSS, which is triggered by bacterial infection releasing toxins into the bloodstream, can be increased with the use of tampons, particularly if left in for longer than recommended, or the use of ‘super-absorbent’ tampons.
‘It is tempting to go for the size-up tampon if you’re not sure what your flow will be like or how easily or often you can access a toilet in peace,’ the nurse said.
‘I'm guilty. I often stick even a light-flow one in when I know I’m only spotting because it’s preferable, safer and a cleaner option than risking overspill on a panty liner. Plus, I go from spotting to super heavy in a matter of hours.’
She continues: ‘Those who work in community locations, or perhaps those who work in surgery, or areas they need to be donning personal protective equipment (PPE) for lengthy periods of time are at significant risk of TSS and it’s not fair that our jobs literally force us to put our own health at risk.’
Social media sparks conversations about staffing pressures and repercussions on menstrual health
In 2017, Swedish midwife Petra Vinberg Linker shared an image of her menstrual blood-stained uniform on social media. The accompanying post explained how she was so busy during a night shift – when she delivered three babies – that she didn’t even have time to change her sanitary towel.
The post sparked discussions of staffing pressures and how healthcare staff can maintain their own dignity.
Four years on, those conversations continue.
Nurses struggling with periods at work
Following an appeal on social media, nurses have told Nursing Standard about the difficulties they have faced at work while being on their period, and the stress and anxiety this has caused them. From stained uniforms to severe pain, many are struggling each month.
One respondent said her experience each month could be ‘horrendous’ as she struggled to take time to go to the the ward’s sole toilet frequently enough, while nurses also highlighted the difficulty of accessing toilets in the community.
Another described carrying a spare uniform in her car in case of leaks.
Managing menstruation in a healthcare environment
37.5
Average number of years a woman will menstruate for
With nine out of 10 nurses being women and almost two-thirds (65%) aged under 50, just under the average age of menopause at 51, a significant proportion of nurses are having to consider how to manage their period at work.
Maura* [not her real name] is a 44-year-old cancer clinical nurse specialist working in the north west of England, who has had heavy periods since her late teens and was diagnosed with fibroids a decade ago.
‘I remember being a student on placement and having to wear a mint-green coloured dress,’ she told Nursing Standard.
‘I would be so paranoid about leaking through to my uniform that I would wear a pad as well as my usual tampon just in case.
‘As I’ve got older I’ve just learned to put up with it, I suppose, with painkillers. I find heat patches help but they can make you feel a bit hot all over, which isn’t great when you are working in a hot hospital.
She adds that, like most nurses she is on her feet all day, so it can be hard when pain is intense.
‘All I want to do is sit down,’ she says. ‘I know gentle exercise is supposed to be beneficial for pain but when you are faced with what seems like an endless hospital corridor to get from one department to another and you need to get to a loo, that is another matter.’
Normalising workplace conversations about menstruation
Belatedly, more thought is being given to nurses who are going through the menopause, with policies in place in many organisations intended to support them at work, women’s health experts say more consideration is needed for menstruating women.
A survey of 3,000 respondents by charity Bloody Good Period found nine out of 10 (89%) said they had experienced stress or anxiety at work because of their period. Having an employer who normalises discussion of menstrual health at work would help, according to 63% of respondents.
- RELATED: Well-being centre
RCN women’s health forum chair and consultant nurse in women’s health Katharine Gale says: ‘Periods are affecting nurses at work across all settings, with each having challenges around dealing with them in the workplace.
‘Having access to clean and safe toilets is particularly an issue in the community, while being able to access personal protection products can be difficult in the acute sector, as lockers can be a long way from the area that a nurse works in.’
Overcoming the stigma of discussing periods
Having to work long shifts, donning and doffing personal protective equipment and the relative lack of flexible working arrangements can all make it harder for nurses on their period, Ms Gale says.
‘Nurses are often under pressure to work longer hours than they expected,’ she says. ‘Getting regular toilet breaks can be hard and is often missed.’
Nurses continue to be affected by the taboo that surrounds discussing menstruation openly, according to Ms Gale.
‘There is still a huge amount of stigma, nurses and their colleagues feel embarrassed and unable to talk about it openly,’ she says.
Providing free sanitary towels and tampons in staff toilets would help nurses access what they need in a timely manner and also help those who find it difficult to meet the cost, Ms Gale says.
Worries about managing periods can cause anxiety and stress
Nurses told Nursing Standard how they used more protection than they needed as they did not feel confident they could get to a toilet in time.
Some doubled up, with tampons and towels, others used larger tampons than they needed.
Another says she needs to change her super-absorbency tampon every hour during the first 24 hours of her period as she has heavy bleeding.
‘This is generally manageable,’ she says. ‘[But] I remember a patient getting so sick. I had to take her to the catheter lab and the doctors insisted I should be there and I didn’t want to leave her. Four hours later I had to wash and change my uniform. It was awful on all counts.’
A number of nurses said they had found reusable menstrual cups helpful as they could go longer between needing to change and they found they had less leakage.
For some nurses, worrying about having their period at work and being able to manage it, causes significant anxiety.
One nursing student said: ‘As a student with horrific periods, this is something I stress about a lot.’
Another said the low mood, tiredness and headaches she experienced made it harder to function at work.
Menstrual health problems
For women with conditions that give them particularly painful or heavy periods, the experience of menstruating at work can be even worse.
Endometriosis – where tissue similar to the lining of the uterus starts to grow in other places, affects one in ten UK women. It can cause unrelenting pain and heavy periods.
According to the NHS, almost a third of women of reproductive age have uterine fibroids – benign tumours which can cause heavy bleeding and pain.
Heavy menstrual bleeding is a common debilitating problem affecting one in three women at some stage in their life, particularly over age of 35. In 60% of cases, there is no known cause.
One nurse told Nursing Standard that she often resorted to continence pads for her heavy flow, as it can be hard to access the staff toilet.
She says: ‘As someone who has endometriosis and adenomyosis [lining tissue that grows in the muscle of the uterus], the pain can be unbearable and I can’t take strong painkillers while at work.
‘It’s a case of getting on with it and sometimes having to wear incontinence pads as we only have one staff toilet and it can be in use a lot. The ward is so busy, sometimes you don’t get the chance to go to the toilet.’
Another said her heavy periods caused by endometriosis were a ‘nightmare’ at work.
Impact of shift work on menstrual cycles
Research suggests that periods and period pain are a significant problem for nurses, and that working conditions can have an impact on menstrual cycles.
Night shifts increase the risk of irregular periods, with a study of more than 70,000 nurses in the United States finding the risk of an irregular menstrual pattern increased the longer someone worked rotating shifts.
For every year of shift work, there was a 13% increase in risk of irregular cycles. Asian nurses were more likely to have irregular cycles than white participants, the study said.
‘Not supporting people on their periods can affect their mental health, their productivity and their satisfaction at work. We have seen a shift in people’s willingness to talk about periods over the last few years but there is a long way to go’
Rachel Grocott, Bloody Good Period
A survey of 420 nurses in Taiwan found that 71% (298) had had dysmenorrhoea, which is pain caused by menstruation, in the past six months. Rates were more than double in nurses who worked a rotation of a day shift, night shift, and a rest day, than those who did not.
The study, published in BMJ Open points out there is menstrual leave available in Japan, Indonesia, South Korea and Taiwan, but that previous research has found it is rarely taken.
‘The high prevalence rate of dysmenorrhoea severely affects nurses such that they may not be able to focus on their work, thereby affecting the quality of patient care,’ researchers said.
Finding ways to support employees through periods
Employers need to consider how they can support their staff, the RCN’s Ms Gale says.
One difficulty that many women face is that needing to take sick leave frequently for short periods, as may often happen with menstrual health problems, means their record can quite rapidly be deemed to require sickness absence management.
‘The NHS uses the Bradford Score for sickness absence, which penalises people who have short amounts of time off with a higher frequency,’ Ms Gale says.
‘If a nurse needs one or two days off a month, this can be escalated quite quickly to a nurse receiving a written warning.’
Managers who notice a pattern of monthly, short absences should speak to the nurse about it, Ms Gale says.
‘It might not feel like a comfortable conversation to have but it’s important and can help employees feel more at ease working on their period, discussing the challenges they face,’ she says.
‘There may be an agreement to adjust the roster and trigger points on the sickness policy for women with menstrual conditions while treatment is sought. This can only happen if women and managers feel comfortable discussing the impact of periods at work.’
Nurses need to be informed about menstrual health and know what symptoms lie outside the norm, so that they can get the help they need. For those in need of extra help or support, the GP or occupational health service are a good first port of call.
‘Knowing about menstrual health empowers nurses,’ says Ms Gale. ‘Higher levels of knowledge in the profession also benefit patients. Nurses working in virtually any setting will care for women who are menstruating.’
Creating a period-friendly work environment
Bloody Good Period works with organisations to help them develop period-friendly policies, in a similar way that many employers are now embracing menopause policies.
At least one NHS trust is working with the charity’s Bloody Good Employers programme on developing such a policy, which seeks to raise awareness of issues that can be connected to an employee’s menstrual cycle. This includes supporting practical changes such as flexibility about working hours and uniforms, improving access to toilets, and encouraging adequate breaks so that women can sit down and rest while on their period.
- RELATED: Endometriosis
Rachel Grocott from Bloody Good Period says more than anything, these policies seek to foster a cultural change where women can talk openly about their menstrual health.
‘We have found that there are concentric circles of silence around periods at work, where no-one feels able to talk about them,’ she says.
‘Not supporting people on their periods can affect their mental health, their productivity and their satisfaction at work. We have seen a shift in people’s willingness to talk about periods over the last few years but there is a long way to go.
‘People still think it is not an appropriate subject to talk about, and we need to change that.’
Further information
- Toxic shock syndrome – NHS
- Bloody Good Period
- Dysmenorrhoea among hospital nurses – Taiwan survey
- RCN sickness absence advice