More than a million women mask period-related sick days every year, unable to tell their manager the real reason for their absence. It is a striking statistic, and one that says something important not just about women's health but about the workplace cultures in which that health is navigated. The conversation has come a long way. The infrastructure, in too many organisations, has not kept up.

Dr Samantha Wild has seen this gap up close in her work as Women's Health Clinical Lead at Bupa Health Clinics. The most common issues she sees women struggling to manage alongside work are heavy and painful periods, menopause, and fertility challenges. What connects them is not just their physical impact but the silence that tends to surround them. "Women's health has become less of a taboo topic over recent years, thanks to some high-profile campaigns," she says, "but it's still hard for employees to raise the issue at work."

The hormonal dimension of this is particularly underappreciated. During the luteal phase before a period, PMS symptoms including mood changes, low mood and headaches can be genuinely debilitating, affecting concentration and making it difficult to function at full capacity. Perimenopause brings its own set of challenges: brain fog, impaired concentration, and mood fluctuations that many women describe as among the hardest symptoms to manage alongside a demanding job. "They can knock your confidence and make you feel less sharp and capable," Dr Wild says. Her advice to women navigating this is direct: speak to your manager, ask for what you need, and be kind to yourself in the process. "Women are not robots. It's okay for your output on certain days to be less than on others. We can't work at 100% all month long."

The question of what employers can actually do, beyond acknowledging that a problem exists, is where the conversation gets practical. Dr Wild's starting point is manager training. Not because managers are expected to become healthcare professionals, but because giving them the knowledge and language to have these conversations removes one of the biggest barriers women face: the fear that raising a health issue will be met with blankness or discomfort. Access to guides, webinars, and clear frameworks for how to approach sensitive topics makes an enormous difference to whether those conversations happen at all.

Alongside training, she points to the value of women's health champions within organisations: people outside of an employee's immediate team who can be approached confidentially. Internal campaigns, speaker events, and the visibility of senior people sharing their own experiences all contribute to the kind of culture where women feel safe enough to ask for support before a situation becomes a crisis.

Flexible working is the most tangible structural change, and the data on its importance is clear. Research from the Bupa Wellbeing Index found that 14% of employees say caregiving impairs their ability to concentrate at work, rising to 18% among millennials. Almost half of workers report losing sleep worrying about the health of family members. Nearly a third are actively seeking flexible arrangements to manage the balance. Flexibility is not a perk in this context. It is the difference between a workforce that can show up fully and one that is quietly managing an impossible load.

The broader point Dr Wild returns to is culture rather than policy. Policies matter, but they are only as effective as the environment in which they operate. "Employers should invest in creating a culture of openness where everyone feels comfortable to talk about what they are experiencing and bring their whole self to work every day," she says. "It's impactful when people at all levels of the organisation share their personal experiences. It's a great way of encouraging women to open up and ask for support when they need it most."

The workplaces that are getting this right are not necessarily the ones with the most comprehensive wellbeing packages, though access to private healthcare and mental health support does feature consistently in what employees say they value most. They are the ones where the culture makes it possible to say, simply and without consequence, that you are not at your best today and that you need some flexibility. That is a low bar. It is also, still, not universally cleared.

This feature was produced in partnership with Bupa Health Clinics.