Menstrual Health Support

This guidance aims to assist with the creation of a workplace culture that is equally supportive and inclusive, and to ensure appropriate support is provided to any staff member who is experiencing symptoms from a menstrual health condition which is affecting them at work. It aims to raise awareness and understanding, to outline the provision available throughout Nottingham University Hospitals NHS Trust, and sets out how you, as a Line Manger, can best support a staff member when they feel comfortable initiating conversations with you about menstrual health in the workplace.

The Trust has an approximately 72% female workforce, for many menstrual health may not be an issue, but for some it will be and must be treated as a medical condition. The aim of this guidance is to make you feel comfortable when having these conversations and to ensure all staff who need it can access the support they are entitled too.

The Trust has a duty to ensure the health, safety, and wellbeing of all its employees under the Health and Safety at Work Act 1974. In addition, the Equality Act 2010 outlines that individuals must not be discriminated against due to sex or any form of disability, and the Trust recognises that in certain circumstances, some menstrual health conditions may constitute a disability.

The Trust is committed to ensuring that appropriate support is known about and offered to employees when needed to enable all employees to thrive at work.

We have an extensive wellbeing offer within NUH; we have a long history of supporting our staff. We have a large amount of support for Menopausal staff, and we are now wanting to increase that support to those with Menstrual Health Conditions too. This guidance is the first step towards that.

If you have any questions about the wellbeing of yourself or your staff, you can contact the Wellbeing Team, our office hours are Monday-Friday 8am-5pm. Each clinical care group has a Health Improvement Advisor, which one is assigned to your care group can be found on the intranet. Or you can contact our shared inbox on nuhnt.staffwellbeing@nhs.net or calling 84771 for QMC or 76242 for City Hospital.

If someone is experiencing symptoms impacting their ability to work, they are encouraged speak to you as their direct line manager. Discussing personal issues can feel awkward, and the staff member may feel uncomfortable talking to you. In these circumstances, do what you can to make the staff member feel as comfortable as you can, use the language they use and meet them in a place they feel comfortable, they can also reach out to others first for peer support (such as the Menstruation and Menopause Advocates, or they bring someone else with them to the conversation.

During this conversation you can do the following to help aid the conversation and ensure the best outcome

• Make sure you have a quiet and private space where you will not be interrupted.

• Switch off notifications on phones and laptops, hand over on call phones/bleepers to others. 

• Make sure you have sufficient time to talk without the staff member feeling rushed.

• Allow them to explain their situation in their own time and in their own way.

• Ask open, non-judgmental questions and avoid making assumptions. For more support on communicating well, and open questions please consider using the Key Skills Open Questions document. 

• Maintain good eye contact and focus on the person, not the problem.

• Listen actively and carefully and show empathy and understanding.

• Explore options for adjustments and support together and avoid being prescriptive.  

• Agree on an action plan and a timeline for review.

• Keep a secure record of the discussion, consider using the Ways of Working diary.

• Signpost to any internal support services that are available, Health Assured (EAP), the Occupational Health and Wellbeing Team, People Business Partners, and Employee Relations Teams. 
• Encourage staff to talk to others through established staff networks, such as The Staffability Network or the Menstruation and Menopause Advocates. Talking to others who may have/are going through a similar experience can empower staff and give them the confidence to discuss this topic further.
• Make sure to book in time for a follow-up conversation, this topic is very rarely completed after one conversation.
• Give information on external support services if appropriate, details can be found below.
• Encourage staff to seek professional medical advice through their GP if they are concerned about their health or continue to experience impactful symptoms.  This is typically not a quick or smooth process so you can offer support to the staff member while someone is going through the diagnosis/investigation process.
   

Line managers are usually the first point of contact if someone needs to discuss an issue or concern impacting their ability to work comfortably. However, we recognise that menstrual health are very personal issues. Some people may feel embarrassed or anxious about discussing them and how they might affect their health and work. Having a good quality and supportive conversation and signposting to the relevant support is a very good starting point and is a way as a Line Manager you can directly impact the wellbeing of the staff member. For more support on communicating well, and open questions please read the Key Skills Open Questions document. 

We recognise that other factors, such as cultural backgrounds or neurodivergence, can make it harder for someone to disclose their situation or to seek support. As a line manager, you should be willing to discuss openly with staff who disclose they are experiencing menstrual health related symptoms. You should respond sensitively and appropriately, and work with staff to find the most appropriate level of support for their wellbeing needs. If you need further assistance or support, then you can contact the People Business Partnering and Employee Relations Team or the appropriate staff network for additional information and support.

If you need assistance in these discussions, talk to the Health Improvement Advisor for your Care Group as they me able to offer you some additional resources or training. Regular informal monthly conversations help build a rapport with staff. These discussions also provide a ‘safe space’ where they can talk about anything affecting their ability to carry out their work, including their personal health.

Every individual’s experience of their menstrual health condition is unique to them. Only some people will need additional support at work to help them manage symptoms. However, those who require help should be supported as they would for any other issue impacting their health, wellbeing, and workplace experience. As the direct line manager, you are in a unique position to be able to make a real difference to that staff members experience and increase the chances of them staying well and in work. #

To assist employees in their daily duties, you can explore adjusting their role or working environment with the aim of reducing the effect that their menstrual health is having on them. This can be done informally or via risk assessment. Workplace adjustments are either formal or informal, if you need some extra support or more information please contact the Occupational Health and Wellbeing Team (nuhnt.city.occhealth@nhs.net or nuhnt.staffwellbeing@nhs.net). If you are unsure about workplace adjustments or have tried some and they haven’t helped the staff member then please, with the staff members consent, make a management referral to Occupational Health. More information on making a Management Referral can be found here.

There are workplace adjustments that as a Line Manager you can put in place without any need for approval, for some more complex adjustments you may need approval from your Line Manager, People Business Partner or suggestions from Occupational Health. If this is the case, be open and honest with the staff member and do not promise anything until you know you can offer that support.

This will not be a one and done conversation, you will need to regularly review and support put in place to ensure it is both effective and still needed. As the staff members symptoms change, they may need the support they receive changing. You may have to start with very regular reviews (every 4 weeks), these can then stretch out as the support works but need doing as a minimum every 12 months.

During this process there should be an acknowledgement that menstrual health conditions affect everyone in different ways so no adjustment will be made without fully discussing it with the employee first. There is no exhaustive list of workplace adjustments, some examples of reasonable workplace adjustments are below.

• Conducting a risk assessment to identify any particular areas that are detrimental to individuals, consider using the Ways of Working diary.

• Assessing how work is allocated and whether additional support can be provided at certain points of the month, or at certain times of the day.
• Additional rest breaks, or micro breaks throughout the shift.
• Consider flexible or hybrid working arrangements or home working; this can be on an ad hoc basis to cover intermittent symptoms and may include compressed hours. Please see the Trust’s Flexible Working Policy for more information.
• Changes to working hours or patterns e.g. start/finish times, changes to working days or patterns, opportunity to self-roster.
• Providing lighter duties or amended responsibilities during particularly challenging times.
• Requesting lighter weight uniforms from the linen room when appropriate.
• Making appropriate allowances under the Wellbeing and Attendance, and the Special Leave policies.
• Providing access to a quiet space where employees can retreat when needed to manage symptoms like fatigue, discomfort or pain.
• Providing easy access to toilets with sanitary bins, and ensuring they are emptied regularly and easy access to drinking water. More information can be found in the Staff Hydration Policy
• Providing access to temperature control such as ventilation, desk fan etc. If you work in a clinical area, please contact the Infection Control Team before agreeing to any fans. 
• Changing the location of the employee so they are closer to toilet facilities or away from hot and cold spots around the office/ward/clinic.

• Consideration of uniform – there are lighter weight uniforms for clinical staff this can be requested through the Linen Room.

If an employee needs time off work to attend a medical appointment due to menstrual health matters, they should inform their manager, giving as much notice as possible. Managers may need to be flexible to allow staff to prioritise medical appointments as they may be synced with their menstrual cycles and need to be conducted on specific dates.

As with any medical appointment, an employee may be required to provide medical evidence of the time and date of appointments. They may be asked to make up the work time missed, use annual leave or take the time unpaid if appointments cannot be accommodated outside of working hours. Managers can also engage with Occupational health if the employee has significant number of medical appointments impacting work/support needs due to menstrual health conditions. Time off to attend those appointments may then be deemed as “reasonable adjustments” under EDI policy.