Menstruation, maternity, and menopause: How they affect women’s work performance and how employers can help
There is growing attention to what “the three M’s” (menstruation, maternity, and menopause) mean for women’s careers. In the run-up to World Menopause Day on Sunday 18 October, we therefore systematically brought together the existing scientific literature on the topic in a new study.
Specifically, we looked for answers to the following three questions. First, what is the impact of menstruation, maternity, and menopause on work performance, absenteeism, and presenteeism? Presenteeism refers to women choosing to go to work even though their complaints are serious enough to call in sick. Second, how does this impact come about? Third, which solutions are proposed in the scientific literature?
To answer them, we set up a state-of-the-art systematic literature review that included every scientific article able to shed light on these questions. In total, we brought together insights from 57 scientific articles. Systematic literature reviews help to map what earlier research really shows. Think of such a study as completing the whole puzzle rather than adding yet another piece.
Lower work performance, more presenteeism, and more absence from work
The results show that all three M’s go hand in hand with a negative impact on work performance and on attendance, but each in a slightly different way.
Presenteeism mainly occurs with menstruation: women often keep working despite considerable complaints. With pregnancy, we instead see more absenteeism: a substantial share of pregnant women take sick leave at some point. With menopause, we see a broader pattern of reduced workability, resulting in lower work performance as well as more presenteeism and more absenteeism.
Positive consequences of the three M’s exist, but they are rarer. Certain phases of the menstrual cycle, for instance, are linked to better cognitive performance, such as switching more easily between tasks. Some studies also find that pregnant women better meet their supervisors’ expectations.
Why is that?
Across the three M’s, a similar pattern stands out: the more severe the biological complaints (such as abdominal cramps during menstruation, lower back pain during pregnancy, or hot flushes during menopause), the greater the impact on work.
These biological complaints also often come with psychological consequences. The cognitive complaints (such as memory and concentration problems) and the physical complaints (such as hot flushes) that accompany menopause, for example, can lead to feelings of shame and reduced self-confidence. These, in turn, weigh on work performance and attendance, and lead to more absence.
The work context also plays an important role in the extent to which biological and psychological complaints translate into poorer work outcomes. The three M’s are often still seen as too personal, whether by women themselves or by their colleagues, so these topics remain undiscussed at work. Because of these cultural taboos, women may feel forced to hide their symptoms, which in turn affects their attendance. Practical factors, such as inadequate sanitary facilities or a lack of menstrual products, can also amplify the negative impact of menstruation at work.
What can employers do?
The literature points to three complementary measures.
Flexibility in working hours and workplace. Flexibility proves particularly beneficial for women with menstrual or menopausal complaints, because they can align their work with fluctuations in their symptoms and are therefore less inclined to keep working despite considerable complaints. Flexibility does not mean working less, but working smarter. Those who can take a short break during a peak in their complaints can often get back to work productively afterwards.
Concrete workplace adjustments. These matter especially during pregnancy and menopause. Think of avoiding heavy lifting, prolonged standing, and shift work during pregnancy, and of rest breaks, temperature control, and a lower physical workload during menopause.
A supportive workplace culture. These measures need to be embedded in a supportive organisational culture. Across the three M’s, the literature stresses the importance of open communication and awareness of women’s reproductive health. This encourages women to raise their complaints in time and makes appropriate support at work possible. In this way, the negative influence of the three M’s on work performance and attendance can be limited. In other words: those who feel supported at work can more easily combine these life stages with a job. Employers (and policymakers) who take this insight on board take an important step towards a workplace where women do not have to choose between their health and their career.
This post also appeared in Dutch via UGent@Work. It is based on joint work with Jana Decuyper, Eline Moens, Stijn Baert, and Elsy Verhofstadt. The full paper is available here. This page was last updated on 14 October 2026.