Investigating the association of menstrual symptoms and work productivity with the mediating role of emotional well-being

Dipanwita Chattopadhyay, Suriyakala P. Chandran, Soumendra N. Bandyopadhyay

Abstract

Menstrual symptoms can have profound effects on the emotional health and professional lives of women. This study aims to explore the impact of menstrual symptoms on emotional engagement, self-regulation, negative affectivity, and cognitive functioning and to acknowledge the mediating role of emotional well-being on work productivity. A cross-sectional survey was conducted among 384 working, menstruating women using validated psychological and occupational health scales. Principal Component Analysis (PCA) and Structural Equation Modelling (SEM) were applied to test the hypothesized pathways. The findings revealed that emotional engagement, self-regulation and cognitive functioning were reduced by menstrual symptoms while negative affectivity increased. Emotional well-being significantly mediated the relationship between menstrual symptoms and work productivity (β = 0.79, p < 0.001). More than half of the participants (52.9%) reported their performance was interrupted by menstrual symptoms. These results emphasize the need for workplace interventions that address both the physical and emotional challenges of menstruation. Policies such as flexible leave, counselling services, and stronger peer support systems can enhance productivity and overall employee well-being.

Full Text:

PDF

References

Mihm M, Gangooly S and Muttukrishna S. The normal menstrual cycle in women. Anim Reprod Sci 2011; 124: 229–236.

Gonda X, Telek T, Juhasz G, Lazary J, Vargha A and Bagdy G. Patterns of mood changes throughout the reproductive cycle in healthy women without premenstrual dysphoric disorders. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32(8): 1782–1788.

Brock R, Rowse G and Slade P. Relationships between paranoid thinking, self-esteem and the menstrual cycle. Arch Womens Ment Health 2016; 19: 271–279.

Pinkerton JV, Guico-Pabia CJ and Taylor HS. Menstrual cycle-related exacerbation of disease. Am J Obstet Gynecol 2010; 202(3): 221–231.

Vengadavaradan A, Sathyanarayanan G, Kuppili PP and Bharadwaj B. Is menstrual psychosis a forgotten entity? Indian J Psychol Med 2018; 40(6): 574. doi:10.4103/IJPSYM.IJPSYM_205_18.

Iacovides S, Avidon I and Baker FC. What we know about primary dysmenorrhea today: A critical review. Hum Reprod Update 2015; 21(6): 762–778.

Schoep ME, Adang EMM, Maas JWM, De Bie B, Aarts JWM and Nieboer TE. Productivity loss due to menstruation-related symptoms: A nationwide cross-sectional survey among 32,748 women. BMJ Open 2019; 9(6): e026186. https://doi.org/10.1136/bmjopen-2018-026186.

Borenstein JE, Dean BB, Endo JO, Wong J and Begley CE. Health and economic impact of the premenstrual syndrome. J Reprod Med 2005; 50(2): 91–100.

Ju H, Jones M and Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev 2014; 36: 104–113. https://doi.org/10.1093/epirev/mxt009.

Laszlo KD, Gyorffy Z, Adam S, Csoboth C and Kopp MS. Work-related stress factors and menstrual pain: A nation-wide representative survey. J Psychosom Obstet Gynaecol 2008; 29(2): 133–138. https://doi.org/10.1080/01674820701804423.

Critchley HOD, Babayev E, Bulun SE, Clark S, Garcia-Grau I, Gregersen PK, Kilcoyne A, Kim JJ, Lavender M, Marsh EE, Matteson KA, Maybin JA, Metz CN, Moreno I, Silk K, Sommer M, Simon C, Tariyal R, Taylor HS, Wagner GP and Griffith LG. Menstruation: Science and society. Am J Obstet Gynecol 2020; 223(5): 624–664. https://doi.org/10.1016/j.ajog.2020.06.004.

Juang CM, Yen MS, Twu NF, Horng HC, Yu HC and Chen CY. Impact of pregnancy on primary dysmenorrhea. Int J Gynaecol Obstet 2006; 92(3): 221. https://doi.org/10.1016/j.ijgo.2005.12.006.

Bell RJ, Robinson PJ, Skiba MA, Islam RM, Hemachandra C and Davis SR. The impact of endometriosis on work ability in young Australian women. Aust N Z J Obstet Gynaecol 2023; 63(4): 556–563. https://doi.org/10.1111/ajo.13683.

Fredrickson BL. The role of positive emotions in positive

psychology: The broaden-and-build theory of positive emotions. Am Psychol 2001; 56(3): 218–226. https://doi.org/10.1037/0003-066X.56.3.218.

Romans SE, Clarkson R, Einstein G, Petrovic M and Stewart DE. Mood and the menstrual cycle: A review of prospective data studies. Gender Med 2012; 9(5): 361–384. https://doi.org/10.1016/j.genm.2012.07.003.

Pope CJ, Sharma V and Mazmanian D. A systematic review of the relationship between menstrual cycle symptoms and daily emotional and physical health. J Psychosom Obstet Gynaecol 2015; 36(1): 16–28. https://doi.org/10.3109/0167482X.2015.1008034.

Pletzer B and Noachtar I. Emotion recognition and mood along the menstrual cycle. Horm Behav 2023; 154: 105406.

Thayer JF and Johnsen BH. Sex differences in judgement of facial affect: A multivariate analysis of recognition errors. Scand J Psychol 2000; 41(3): 243–246.

Montagne B, Kessels RP, Frigerio E, De Haan EH and Perrett DI. Sex differences in the perception of affective facial expressions: Do men really lack emotional sensitivity? Cogn Process 2005; 6(2): 136–141.

Hoffmann H, Kessler H, Eppel T, Rukavina S and Traue HC. Expression intensity, gender and facial emotion recognition: Women recognize only subtle facial emotions better than men. Acta Psychol 2010; 135(3): 278–283.

Rukavina S, Sachsenweger F, Jerg-Bretzke L, Daucher AE, Traue HC, Walter S and Hoffmann H. Testosterone and its influence on emotion recognition in young, healthy males. Psychol 2018; 9(7): 1814–1828.

Connolly HL, Lefevre CE, Young AW and Lewis GJ. Sex differences in emotion recognition: Evidence for a small overall female superiority on facial disgust. Emotion 2019; 19(3): 455–464.

Olderbak S, Wilhelm O, Hildebrandt A and Quoidbach J. Sex differences in facial emotion perception ability across the lifespan. Cogn Emot 2019; 33(3): 579–588.

Gamsakhurdashvili D, Antov MI and Stockhorst U. Facial

emotion recognition and emotional memory from the ovarian-hormone perspective: A systematic review. Front Psychol 2021; 12: 641250. https://doi.org/10.3389/fpsyg.2021.641250.

Conway CA, Jones BC, DeBruine LM, Welling LLM, Smith ML, Perrett DI and Al-Dujaili EAS. Salience of emotional displays of danger and contagion in faces is enhanced when progesterone levels are raised. Horm Behav 2007; 51(2): 202–206. https://doi.org/10.1016/j.yhbeh.2006.10.002.

Aldao A, Nolen-Hoeksema S and Schweizer S. Emotion- regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev 2010; 30(2): 217–237. https://doi.org/10.1016/j.cpr.2009.11.004.

Gratz KL and Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure and initial validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav Assess 2004; 26(1): 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94.

Mennin DS, Holaway RM, Fresco DM, Moore MT and Heimberg RG. Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behav Ther 2007; 38(3): 284–302. https://doi.org/10.1016/j.beth.2006.09.001.

Kumar S, Feldman G and Hayes A. Changes in mindfulness and emotion regulation in an exposure-based cognitive therapy for depression. Cogn Ther Res 2008; 32(6): 734–744.

Bargh JA and Williams LE. On the nonconscious of emotion regulation. In: Gross J (Ed). Handbook of Emotion Regulation. New York: Guilford Press; 2007: 429–445.

Mikhail ME, Klump KL, Racine SE and Hildebrandt BA. Negative affect and hormonal status interact to predict emotional eating across the menstrual cycle. Appetite 2021; 161: 105136. https://doi.org/10.1016/j.appet.2021.105136.

Manikandan S, Kumar A and Santhosh C. Role of emotion regulation in the experience of menstrual symptoms and anxiety-related events. J Affect Disord 2019; 256: 491–497. https://doi.org/10.1016/j.jad.2019.06.001.

Gingnell M, Bannbers E, Wikström J, Fredrikson M and Sundström Poromaa I. Premenstrual dysphoric disorder and prefrontal reactivity during anticipation of emotional stimuli. Eur Neuropsychopharmacol 2012; 22(1): 42–51. https://doi.org/10.1016/j.euroneuro.2011.05.001.

Liu Q, Wang Y, van Heck CH and Qiao W. Stress reactivity and emotion in premenstrual syndrome. Neuropsychiatr Dis Treat 2017; 13: 1597–1602. https://doi.org/10.2147/NDT.S138261.

Atlihan U, Duraklı Ulukök ME and Yavuz O. Relationship between menstrual cycle and cognitive functions in women with primary dysmenorrhea. Turk J Med Sci 2025; 55(1): 258–264.

Sundström-Poromaa I. The menstrual cycle influences emotion but has limited effect on cognitive function. In: Litwack G (Ed). Vitamins and Hormones. Vol. 107. Cambridge: Academic Press; 2018: 349–376. https://doi.org/10.1016/bs.vh.2018.01.015.

Beauregard TA. Emotional well-being and employee productivity: A review of the evidence. J Workplace Behav Health 2014; 29(4): 283–300. https://doi.org/10.1080/15555240.2014.956129.

Eisenlohr-Moul TA, et al. Toward the reliable diagnosis of

premenstrual dysphoric disorder. Psychoneuroendocrinology 2017; 77: 176–184. https://doi.org/10.1016/j.psyneuen.2016.12.014.

Yonkers KA and Simoni MK. Premenstrual disorders. Am J Obstet Gynecol 2018; 218(1): 68–74. https://doi.org/10.1016/j.ajog.2017.05.045.

Allen AM, Kim T and Smith CP. Managing menstruation in the workplace: A critical review of policies and practices. J Occup Health Psychol 2021; 26(2): 234–247. https://doi.org/10.1037/ocp0000262.

Moos RH. The development of a menstrual distress questionnaire. Psychosom Med. 1968 Nov-Dec;30(6):853-67. doi: 10.1097/00006842-196811000-00006. PMID: 5749738.

Topp CW, Østergaard SD, Søndergaard S, Bech P. The

WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom. 2015;84(3):167-76. doi: 10.1159/000376585. Epub 2015 Mar 28. PMID: 25831962.

Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993 Nov;4(5):353-65. doi: 10.2165/00019053-199304050-00006. PMID: 10146874.

Hayes, A. F. (2018). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach (Methodology in the Social Sciences) (2nd ed.). New York, NY: The Guilford Press.

Lee LK, Chen PCY, Lee KK and Kaur J. Menstrual cycle among adolescent girls in Malaysia. Singapore Med J 2017; 57(11): 612–617. https://doi.org/10.11622/smedj.2016152.

Brougham RR, Zail CM, Mendoza CM and Miller JR. Stress, sex differences and coping strategies among college students. Curr Psychol 2009; 28(2): 85–97. https://doi.org/10.1007/s12144-009-9047-0.

Wang J, Lesage A and Schmitz N. Detrimental effect of poor mental health on work functioning in the Canadian population. Can J Psychiatry 2011; 56(11): 707–715. https://doi.org/10.1177/070674371105601104.

Schulte P and Vainio H. Well-being at work – overview and perspective. Scand J Work Environ Health 2010; 36(5): 422–429. https://doi.org/10.5271/sjweh.2916.

Farage MA, Osborn TW and MacLean AB. Cognitive, sensory and emotional changes associated with the menstrual cycle: A review. Arch Gynecol Obstet 2009; 280(4): 555–567. https://doi.org/10.1007/s00404-009-1152-8.

Armour M, Ferfolja T, Curry C, Hyman MS, Parry K and Smith CA. The cost of menstrual pain and related absenteeism in Australian women: A national online survey. BMJ Open 2022; 12(1): e054186.

Rittenhouse CA, Schaubroeck JM and Spector PE. Workplace relationships and emotional well-being: Their impact on performance. J Health Psychol 2021; 26(11):1878–1890. https://doi.org/10.1177/1359105320932345.

Green P and Rafaeli E. Emotional support in the workplace:

Understanding its role in job performance. J Organ Behav 2020; 41(3): 261–276.

https://doi.org/10.1002/job.2432.

Ozgoli G, Goli M and Simbar M. The effect of social support on menstrual distress among women. Iran Red Crescent Med J 2016; 18(7): e29922. https://doi.org/10.5812/ircmj.29922.

Bertone-Johnson ER, Ronnenberg AG, Houghton SC, Nobles C, Zagarins SE, Takashima-Uebelhoer BB and Farland LV. Association of depression and premenstrual syndrome with menstrual cycle characteristics in young women. J Womens Health 2014; 23(10): 781–787. https://doi.org/10.1089/jwh.2014.4789.

Bajalan Z, Moafi F and Alimoradi Z. Mental health and primary dysmenorrhea: A systematic review and meta-analysis. Prz Menopauzalny 2019; 18(2): 110–116. https://doi.org/10.5114/pm.2019.89374.

Logue CM and Moos RH. Perimenstrual symptoms: Prevalence and risk factors. Psychosom Med 1986; 48(6): 388–414. https://doi.org/10.1097/00006842-198607000-00002.

Fernández M, Carrillo B, Fernández ML and Díaz M. Premenstrual symptoms and work productivity: A study in Spanish working women. Int J Environ Res Public Health 2021; 18(4): 1671. https://doi.org/10.3390/ijerph18041671.

Green P and Rafaeli E. Emotional support in the workplace: Understanding its role in job performance. J Organ Behav 2020; 41(3): 261–276. https://doi.org/10.1002/job.2432.

Ozgoli G, Goli M and Simbar M. The effect of social support on menstrual distress among women. Iran Red Crescent Med J 2016; 18(7): e29922. https://doi.org/10.5812/ircmj.29922.

Brougham RR, Zail CM, Mendoza CM and Miller JR. Stress, sex differences and coping strategies among college students. Curr Psychol 2009; 28(2): 85–97. https://doi.org/10.1007/s12144-009-9047-0.

Koh, Sumire MD; Okawara, Makoto MD, PhD; Hirashima, Keiki MD; Kuwazuru, Tomoichiro MD; Yamashita, Satoshi MD; Ohkubo, Naoaki MD, PhD; Tateishi, Seiichiro MD, PhD; Fujino, Yoshihisa MD, MPH, PhD. Association of Menstrual-Related Symptoms and Presenteeism: A Cross-sectional Study of Working Women in Japan. Journal of Occupational and Environmental Medicine 67(5):p e311-e316, May 2025. | DOI: 10.1097/JOM.0000000000003340

Ponzo S, Wickham A, Bamford R, et al. Menstrual cycle-associated symptoms and workplace productivity in US employees: A cross-sectional survey of users of the Flo mobile phone app. DIGITAL HEALTH. 2022;8. doi:10.1177/20552076221145852

Iqbal, W., Naz, N., Taj , T., Aurang Zeb, Abdullah, Faisal , S., & Arshi. (2024). Association between Premenstrual Syndrome and Job Performance among Nurses Working in Tertiary Care Hospitals Peshawar. Journal of Health and Rehabilitation Research, 4(2), 1644–1648. https://doi.org/10.61919/jhrr.v4i2.1170

Nwosu, C. O., & Okafor, C. U. (2022). Menstrual Health Challenges in the Workplace and Consequences for Women's Well-being. PMC. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10021399/

McDonald, C., & McDonald, M. (2021). Socio-cultural Implications for Women's Menstrual Health in the Pacific Islands. PMC. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC9164467/

Castro, S., & Czura, K. (2025). Managing Menstrual Hygiene: The Economics of Period Poverty. VoxDevTalk. Retrieved from https://voxdev.org/topic/health/managing-menstrual-hygiene-economics-period-poverty

Iris Group International. (2024). Workplace Menstrual Health in the Private Sector: Results from a Pilot Study. WASH Development. Retrieved from https://iwaponline.com/washdev/article/14/7/473/103255/Workplace-menstrual-health-in-the-private-sector

Chalada MJ. Workplace menstrual product policies and worker well-being: Insights from Queensland, Australia. Dialogues Health. 2025 Apr 20;6:100219. doi: 10.1016/j.dialog.2025.100219. PMID: 40322585; PMCID: PMC12049839.

Negriff S, Dorn LD, Hillman JB, Huang B. The measurement of menstrual symptoms: factor structure of the menstrual symptom questionnaire in adolescent girls. J Health Psychol. 2009 Oct;14(7):899-908. doi: 10.1177/1359105309340995. PMID: 19786516; PMCID: PMC4301608.

Liu Y, Ma S, Chen Y. The impacts of learning motivation, emotional engagement and psychological capital on academic performance in a blended learning university course. Front Psychol. 2024 May 9;15:1357936. doi: 10.3389/fpsyg.2024.1357936. PMID: 38800675; PMCID: PMC11119290.

Endicott J, Nee J. Endicott Work Productivity Scale (EWPS): a new measure to assess treatment effects. Psychopharmacol Bull. 1997;33(1):13-6. PMID: 9133746.

Giovannetti ER, Wolff JL, Frick KD, Boult C. Construct validity of the Work Productivity and Activity

Refbacks

  • There are currently no refbacks.