Dr Deborah Lancastle

Dr Deborah Lancastle is a Health and Care Professions Council Registered Health Psychologist and a British Psychological Society Chartered Psychologist. Her research has focused on infertility, uterine fibroids and ovarian cancer screening. Deborah is the course leader for the MSc Clinical Psychology course at USW. 

The psychological and social aspects of women’s reproductive health has been my primary focus as a psychologist for 20 years. I first became interested in the subject during my undergraduate studies at Cardiff University, when I was investigating the effects of a medically induced mini-menopause on women’s mood, attention, and work performance (1). 

I was very taken at the time by a paper I’d read which spoke of women being at the ‘mercy of their bouncing oestrogen’! That might sound quite humorous and is in line with jokes that shifts in women’s moods, work performance, energy levels, and patience, are because of ‘hormones’, ‘the day of the month’ or ‘their age’. However, the reality of the impact of reproductive health problems on women’s lives is far from funny. 

Problems caused by uterine fibroids (2), polycystic ovaries, endometriosis, heavy menstrual bleeding (3), premenstrual syndrome, infertility (4), female cancers (5), and the menopause (6) can be miserable to live with. 

Some of these cause pain and heavy bleeding which can affect women’s attendance and performance at work. For example, in one of my surveys (3), around two-thirds of women with heavy periods said their work suffered for 1-5 days each month compared to less than one-third who had lighter periods. 

In addition, more than one-third of those with heavy periods missed 1-5 days of work each month because of their periods, whereas the attendance of women with lighter periods was pretty much unaffected by menstruation. 

When such disruption to some women’s employment is a monthly occurrence, it is naturally going to have an ongoing impact on their careers. In addition, women’s social lives are affected by pain and bleeding, and research shows that they tailor their activities around the behaviour of their reproductive system. 

Worries about accessing a toilet or bleeding through sanitary protection and staining clothes and furniture are powerful deterrents for women that can prevent them from leading the lives they would choose every day of the month. For example, women make holiday plans, and decisions about social events, sports activities, the use of public transport, and clothing around their menstrual cycles. 

Knowing about the issues associated with reproductive health problems is one thing, but strategies and solutions that will help women is quite another. 

Embarrassment and secrecy surrounding menstruation remains in the 21st century, and research also shows that women can be very stoical and deal with considerable menstrual disruption without seeking help for the gynaecological conditions that might be causing the problem. 

One solution, therefore, would be to educate women and encourage them to seek medical help for reproductive health issues quickly, thereby minimising the length of time they live with the negative consequences. Indeed, some of my ongoing research involves the development of a brief, validated Quality of Life tool to assist women in deciding when to seek help for menstrual problems (7). 

The National Institute of Health and Care Excellence (NICE) guidelines for heavy menstrual bleeding emphasise that health professionals should consider the impact of bleeding on women’s Quality of Life when deciding on a course of action, and the tool I’ve developed reliably discriminates between women on the basis of gynaecological diagnoses and heavy periods. 

Further evaluation is required, but in time I hope this tool becomes a widely used indicator of the disruption caused to women by period problems which alerts women and their doctors to the possibility of an underlying gynaecological condition. 

Beyond the actions of women and their doctors, however, it is time to realise that employers should have strategies in place to support women in the workplace. 

Until 1946, female civil servants in the UK were made to stop working when they got married and as recently as 1975, only about 50% of working age mothers were employed. Being close to home and therefore close to toilets and clean clothes would have enabled women in past decades to deal with menstrual problems in the privacy of familiar surroundings. 

In contrast, women in the present day wish to and/or are expected to be in paid employment and need to deal with their periods in whatever facilities are available to them at work. Not all workplaces offer the same access to private facilities such as showers, toilet cubicles containing sinks, or facilities for changing and storing clean or soiled clothing, meaning that women who need to clean themselves and change their clothes might have to go home or stay at home to do so. 

One practical solution, to help women overcome the career implications of ongoing menstrual disruption is the provision of facilities that allow them to attend and remain in the workplace every working day of the month.  

It really isn’t acceptable or equitable for women of reproductive age to be at any disadvantage in the workplace because of a natural phenomenon that occurs repeatedly through the majority of their working lives! 

References

(1) Lancastle, D., Boivin, J., & Bhal, K. (2001). Effect of oestrogen on mental processes and work performance in women with pharmacologically induced menopause. Annual Meeting of the European Society for Human Reproduction and Embryology, Lausanne, Switzerland, June. Human Reproduction, 16, s201

(2) Lancastle, D., Arriagada, P., & Skouby, S. (2016). Long term treatment of uterine fibroids with Ulipristal Acetate improves health-related quality of life: Findings from the PEARL-III (ext) randomised controlled trial. Poster presented at the European Society for Human Reproduction and Embryology (ESHRE), Helsinki, July 2016

(3) Lancastle, D. (unpublished data presented to Wales TUC). Work-related disruption associated with heavy menstruation and gynaecological diagnoses. University of South Wales, February 2020.

(4) Lancastle, D., & Boivin, J. (2008). Feasibility, acceptability and benefits of a self-administered positive reappraisal coping intervention (PRCI) card for medical waiting periods. Human Reproduction, 23, 2299-2307. 

(5) Lancastle, D., Brain, K., & Phelps, C. (2011). Illness representations and distress in women undergoing screening for familial ovarian cancer. Psychology and Health, 26, 1659-1677. 

(6) Andrews, R., Hale, G., John, B., & Lancastle D. (2021). Symptom monitoring benefits menopausal health outcomes: a systematic review and meta-analysis. Frontiers in Global Women’s Health. 

(7) Lancastle, D., Hale, G., Wood, B., Ashcroft, L., Driscoll, H., & Kopp-Kallner, H. (in prep). Development and validation of a brief Quality of Life measure for women experiencing heavy menstrual bleeding.