New research has found half of women experienced menstrual symptoms that negatively affected them at work in the past year, yet only 16% received employer support.

The research, led by the Autonomy Institute and the Equality, Diversity and Inclusion Caucus at Heriot-Watt University, analysed responses from 1,205 UK women.

It also found 39% had been negatively affected at work by perimenopause or menopause symptoms. While 42% had taken time off because of symptoms, 77% had continued working through them on at least one day. More than a quarter had considered leaving their job.

For NHS employers, these findings raise an important question. When an employee tells a line manager that menstrual, perimenopausal or menopausal symptoms are affecting their work, what happens next?

NHS England has published menopause guidance for line managers and colleagues. NHS organisations may also offer policies, occupational health support, staff networks, flexible working and wellbeing services.

However, having these resources does not guarantee employees can access support quickly or consistently.

This is particularly important in healthcare, where many employees work shifts or hold patient-facing roles. Home working may not be possible and temporary changes must be considered alongside patient care, staffing requirements and the demands of the role.

That does not mean flexibility is unavailable. It means managers need a clear process for exploring what is practical.

Managers do not need to make a diagnosis

A line manager should not be expected to determine whether symptoms are caused by menstruation, perimenopause, menopause or another health condition. Their role is to listen and understand how the employee's work is being affected.

An employee may be struggling with heat, fatigue, pain, concentration, access to facilities, uniform requirements or the timing of breaks. Another may find night shifts, long shifts or consecutive working patterns make symptoms harder to manage.

Beginning with the impact on work allows relevant options to be discussed without requiring an unnecessarily detailed account of the employee's health.

Practical support could include better access to breaks, a temporary change to duties, adjustments to shift patterns, access to a quiet space or a referral to occupational health. The response will depend on the employee's circumstances, role and service.

Managers need to know where their authority ends

A manager may be able to agree some immediate changes but require HR, rostering or occupational health input for others. This should be clear before an employee asks for help.

Otherwise, the employee may be passed between departments, receive an inconsistent response or wait unnecessarily for a decision. In a large NHS organisation operating across several wards, services and locations, such inconsistencies can be difficult to identify.

A policy gives people somewhere to start, but practical support depends on the conversation that follows. Managers need current guidance, suitable training and a defined route for further advice.

Record the arrangement, not a medical history

A consistent process does not require NHS organisations to create detailed menstrual-health records or collect unnecessary information.

In many cases, the useful record will be the practical action agreed, who needs to know and when it will be reviewed. The employee should understand what information will be recorded, why it is needed and who will have access to it.

A review date prevents a temporary arrangement from being forgotten and allows the employee and manager to assess whether it should end, continue or change.

Support should not begin only when symptoms result in sickness absence. The research shows many employees continue working while affected.

Evalu-8 HR Software's four-point guide for NHS Employers

1. Prepare managers

Make sure managers can find the current policy, understand the available support and know when to involve HR, rostering, or occupational health.

2. Focus on the impact at work

Ask which aspects of the role are currently difficult. Managers should explore practical support without attempting to diagnose symptoms.

3. Agree and record the action

Confirm what has been agreed, who needs to know and when it will begin. Record only the information required to manage the arrangement.

4. Review whether it is working

Set an appropriate review date. Check whether the support is helping the employee and remains practical for the role, service and patient-care requirements.

The Heriot-Watt research found 40% of respondents believed greater manager understanding would help them work at their best, compared with 29% who selected a formal policy.

NHS employers should therefore test the complete support route, not simply whether guidance has been published. A women's health policy is valuable, but it is only the beginning. For NHS employees caring for patients while managing symptoms, the response that follows the conversation is what turns written guidance into practical workplace support.