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Abstract

Guided by a trauma-informed feminist lens, this manuscript explores the often-overlooked impact of menstrual cycles on social workers. Menstruation remains a taboo topic across diverse contexts. The ways in which individuals cope—through personal professionalism—reflect broader societal expectations to minimize or silence normalized pain. This highlights a deeper, sexism-rooted injustice in the workplace, where the physical experiences of women and other gender identities—such as menstruation, pregnancy, pregnancy-related loss or recovery, and menopause—are often dismissed. Such attitudes perpetuate the myth of the “perfectly functional” professional body, shaped by male, able-bodied norms and neoliberal expectations.

Keywords

community gender/sex health and well being health effects of sexism physical health

We are speaking to people who menstruate—whether monthly or occasionally, lightly or severely. This is an invitation to envision the space to engage and exchange what our bodies go through, especially the discomforts and pains, as we navigate and strive to fulfill our professional commitments. The impact of intersectional identities on one's professional presence has been widely addressed in social work. However, the influence of our physical state while engaging in social work has received less attention. Menstruation remains a taboo topic across diverse contexts, creating disadvantages and exclusions. The ways we cope—through individual professionalism, effort, and even sacrifice—reflect the broader societal expectation to minimize or hide these natural parts of being human: highlighting a deeper, sexism-rooted injustice in workplace policies, where physical experiences of women and other gender identities—such as menstruation, pregnancy and pregnancy-related loss/recovery, and menopause—are often dismissed as personal rather than recognized as systemic matters deserving of acknowledgment and accommodation. Through a trauma-informed feminist lens, we challenge the myth of the “perfectly functional” professional body, shaped by male, able-bodied norms and neoliberal expectations (Goodley, 2014; Shakespeare, 2014). Focusing on the impact of menstrual cycles, we advocate for recognizing how hormonal and physical conditions influence therapeutic practice. While awareness of issues like premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is growing, such topics remain stigmatized and largely unsupported in professional settings. This paper urges social work to address these silences, promoting discussion as a collective, political, and professional concern rather than dismissing them as mere personal and normalized pain.

The Impacts of the Menstrual Cycle, PMS, and PMDD

On average, a person who has a menstrual cycle every month from puberty until menopause spends about six to seven years menstruating over their lifetime (Office on Women's Health, n.d.). Approximately 47.8% of women globally are affected by PMS (Premenstrual Syndrome) symptoms. Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS, affects about 3–8% of women of reproductive age (Geta et al., 2020; Nascimento et al., 2020). In the United States, studies estimate that approximately 75% of women of reproductive age experience some form of PMS symptoms. Around 20–30% of women report moderate to severe PMS symptoms that significantly impact their daily lives, including but not limited to the symptoms of bloating, breast tenderness, headaches, lightheadedness, fatigue, mood swings, irritability, anxiety, depression, and difficulty concentrating (Direkvand-Moghadam et al., 2014; Kumari & Sachdeva, 2016). A person with severe PMS or PMDD often experiences significant impairment in their personal, social, and professional lives. PMS symptoms can lead to absenteeism from work or school, with some studies estimating that PMS accounts for about 14% of lost work time among women (Khazdoozi et al., 2024; Liguori et al., 2023). Lastly, the growing body of evidence underscores the connection between PMS and trauma, particularly the heightened incidence of PMS symptoms among individuals with a history of trauma, including Post-Traumatic Stress Disorder (PTSD) (Jung et al., 2019) and early life emotional, physical, and sexual abuse (Bertone-Johnson et al., 2014; Yesildere Saglam et al., 2025).

Social workers and other helping professionals are often exposed to the risk of secondary traumatic stress. For example, social workers experienced depression, PTSD, and anxiety at alarming rates during the COVID-19 pandemic at a notably higher rate than in the general population (NASW, 2023). Furthermore, health and mental health and social workers exhibit higher rates of adverse childhood experiences (ACEs) compared to other professionals. A study from the National Association of Social Workers (NASW, n.d.) revealed that social work students report higher incidences of various forms of childhood trauma compared to students in other disciplines (Florida State University, 2020). Lastly, social workers with a history of childhood trauma are more vulnerable to secondary traumatic stress and burnout (Steen et al., 2021).

Given the high levels of stress and trauma exposure, it is essential to consider how these challenges intersect with other factors that affect professional performance. Recent work by Khazdoozi et al. (2024) explores how common PMS symptoms impact the clinical performance of nurses with 530 female nurses. PMS was found to predict 26.5% of the variance in clinical performance, demonstrating a significant inverse relationship. In the field of social work, while there is a significant amount of existing research on compassion fatigue and burnout among helping professionals, the linkage between professional performance and PMS and PMDD is a less explored area. It is reasonable to infer that experiencing physical pain and discomfort can make it more difficult to maintain high levels of compassion, focus, and other aspects of social work practice.

Bodies in Social Work Through Trauma-Informed Feminist Lens

Historically, social work has been a field predominantly occupied by women. This gendered trend has created some “gendered vulnerability” in the so-called “helping professions,” which tend to receive lower compensation compared to male-dominated professions requiring similar levels of education and skill (Lane & Flowers, 2015; Lewis, 2018; Malinger et al., 2017; McCarthy, 2021). Moreover, despite the significant representation of women, men often still widely occupy leadership and management positions within these fields (Economic Policy Institute, 2021; Harvard Business Review, 2022; World Health Organization, 2021). This background, where men hold a significant share of decision-making power in a female-majority workforce, may contribute to the underrepresentation of issues such as menstrual health and the impact of PMS and PMDD. Trauma-informed feminist therapy integrates the principles of trauma-informed care with feminist frameworks, focusing on the empowerment of individuals by acknowledging sociopolitical factors such as gender inequality, patriarchy, and systemic oppression, which contribute to trauma and influence overall well-being (Brown, 2018; Pemberton, 2020). This approach not only addresses the impact of trauma but also emphasizes the broader systemic injustices that shape the lived experiences of marginalized populations. The state of one's body, including experiences such as menstruation, menopause, recovery from gender affirmation surgery, and injury, significantly shapes professional presence and capacity. Trauma-informed feminist therapy emphasizes the importance of integrating this bodily awareness into professional practices and organizational support systems. Institutions are urged to address these realities by providing structural accommodations and reducing the stigma, taboo, shame, and self-blame often associated with these conditions. A trauma-informed, feminist, body-conscious approach fosters an inclusive and empowering professional environment, ensuring that the diverse physical and emotional needs of practitioners are supported. Growing and promising work on therapy professionals with disabilities critically examines ableism and stigma within the field (Olkin, 2017), addressing barriers to employment and, on the other hand, highlighting the unique contributions that these professionals bring to their practice (Evans, 2017; Kiese et al., 2018). Professional bodies are not ‘invincible,’ and caring for our own bodies is not mutually exclusive with caring for others. Our narratives will reflect on the balance and challenges of navigating this dual caring.

Reflections of Authors

This section presents the authors’ reflections on their experiences practicing clinical social work during menstruation, utilizing an autoethnographic approach of personal storytelling, reflection, and dialogue (Ellis et al., 2011). Although this conceptual piece did not require a Research Ethics Board review, bringing our voices into this space aims to highlight nuanced struggles. This is not empirical data and does not present any findings; however, despite our years of field practice, our awareness of the menstrual cycle's impact as both a professional and political matter has only recently emerged. We believe that documenting and sharing this process may encourage readers to reflect on their own experiences.

First Author: As a cisgender, able-bodied, mixed Asian woman, I have lived and nurtured my family on the Indigenous lands of Tkaronto. I am currently navigating dual roles as a social worker providing psychotherapy and a PhD candidate. With consent from those involved, I share communications with my mentor and partner to reflect my growing awareness of menstruation's impacts on my practice.
I don’t know how to explain this exactly, but it almost feels like when doing counseling during menstruation, my emotional permeability uncontrollably increases… Like, the sadness of a client permeates my entire body, entering through each and every pore…

(personal communication, May 2024)
These were my words when I finally shared a long-held concern with a mentor—not in formal supervision, so it might feel easier to bring up a topic I feared might seem “unprofessional.” Prior to that, my partner's comment prompted me to reflect on the connection between my menstrual cycle and my therapy practice. I come home differently—more exhausted, emotionally withdrawn, and sad. My first thought to the concern was basically denial, minimizing and normalizing:
Well, the office is cold and gets super dry if I turn on the heater. Sitting in a chair all day is extra tiring during my period, and I have to constantly check if the washroom is available and cover up my broken-out skin with makeup, so I look professional and presentable….Yeah, everything feels a bit extra compared to a regular therapy day…but that's just what happens every month.

I did not even think about how I also cry almost every time my therapy day falls during my menstrual cycle—sometimes between sessions, sometimes in the washroom, on the way back home, or when I am taking a bath at the end of a long day. Feelings and stories shared felt closer and more intense. The professional boundary could not shield my body from the pain, loss, grief, hopelessness, anger, worry, and other emotions that seemed to seep into my skin. Showing up in the therapy space as a professional while tending to my own bleeding body is a lot to carry. It was quite surprising to accept that finally. Despite my decade-long career, I had never discussed this with my social work colleagues or supervisors. I shared this thought in the monthly peer supervision meeting at our collective therapist office, where both authors are members. This discussion inspired the initiation of this manuscript.

Second Author: I am a cis woman of Korean descent living in Tkaronto. As a therapist, I work primarily with queer refugee claimants as well as youth and adults of diasporic identities with intergenerational trauma. My practice is centered around the beliefs that everything is political including our feelings, and that what is pathologized as mental illness is most often adaptations to unsafe, traumatic environments, especially for people of colour.

When I am in session with a client, I want to be present and grounded. I try to take care of myself to get to this state, but it takes triple the effort when menstruating. Every month, I am in debilitating pain for three days straight. I often feel depleted in energy, and it feels like my mind is working more slowly. I’m uncomfortable in general – feeling too hot then too cold, hungry but also nauseous. I feel the weight of responsibility for this work and it feels like I’m expending way more energy than usual to keep up the same standards. As a private practice therapist, it is not sustainable to cancel on clients at the last minute every month. When I was working at a nonprofit, I had paid sick days available, but I didn’t take them for menstruation, because I had to meet the quota. It was hard for me to justify days off for a pain that medical professionals called normal. It was hard for me to value taking care of my “normal pain” when that would be at the inconvenience of the people whose very real pain was my job to be deeply aware of and compassionate towards. I often talk with my clients about their mental health in the context of the capitalist system we live in. I’m realizing my own profession is no exception, where I have to compromise my emotional and physical needs for productivity and profit. I find myself both working against and profiting from a world that produces suffering, while I suffer through it myself. I don’t have all the answers, but I am continuously reminded that our liberation is deeply tied to one another.

Both reflections reveal the often-unspoken challenges menstruation brings to our work. The first author describes how, during her cycle, emotions from her clients feel more intense in ways that push the limits of her professional boundaries. Exhaustion and physical discomfort often linger, making daily tasks daunting. The second author shares a similar struggle, experiencing debilitating pain and fatigue that conflict with her desire to be fully present for her clients. Both authors reflect on how the high demands of therapeutic work, combined with their care for the people they work with, make it challenging to view their own needs as important.

Moving Forward

We propose a trauma-informed feminist framework that promotes inclusivity, validates diverse embodied experiences, and emphasizes safety, empowerment, and equity. This approach fosters workplace cultures and environments that holistically and humanely support individuals and communities while maintaining awareness of the potential presence and impact of various forms of trauma. It also critically reflects on systemic factors, such as sexism, ableism, and rigid productivity standards. At the institutional level, advocacy must extend beyond normalizing conversations about menstruation and related challenges. Concrete policies, including flexible scheduling, paid menstrual leave, and physical accommodations, such as access to comfortable rest spaces, are necessary. Professional associations must also take responsibility for supporting diverse bodily needs, including self-employed practitioners, by promoting standards that ensure equity and care. In clinical practice, it is essential to acknowledge how practitioners’ bodily experiences can affect their capacity to provide care. This challenges the pervasive expectation of the “invincible” body, fostering a more human-centered approach that prioritizes the well-being of both clients and practitioners. To advance these discussions, social work training should explicitly address topics such as PMS, PMDD, and other physical and mental health challenges faced by practitioners. Lastly, we advocate for further research on “normalized and silenced pains” experienced by social work professionals, including menstruation, pregnancy and pregnancy-related loss/recovery, and menopause.

Footnotes

Acknowledgements

We acknowledge that this manuscript is profoundly communal. Academic writing is made possible by privileges such as university affiliation, health, ability, skills, time, and exemption from more urgent life demands, which often remain inaccessible to many. We are grateful to Victor Huynh, a social worker and facilitator of our peer consultation circle, and Azin Heydari, a psychotherapist who courageously shared her experiences with PMDD. Lastly, we extend our gratitude to Dr. Ran Hu, assistant professor at the College of Social Work, Ohio State University, for guiding us in the art of academic writing.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Viveka Ichikawa

Author Biographies

Viveka Ichikawa resides in Tkaronto as an immigrant and is a PhD candidate at the Factor-Inwentash Faculty of Social Work, University of Toronto. As a trauma-informed psychotherapist, she works with racialized refugee claimants, migrants, and mixed-race individuals, couples, and families through social justice, anti-oppressive, anti-racist, and critical feminist lenses.

Elise Suk Young Yoon is a therapist in private practice who works primarily with youth and adults of diasporic identities with intergenerational trauma and queer and trans refugee claimants under the Interim Federal Health Program. She received both her BA in English and MSW at the University of Toronto.

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“I'm Feeling and I'm Bleeding”: The Unspoken Impact of Menstrual Cycles on Social Workers Through a Trauma-Informed Feminist Lens

Abstract

Keywords

The Impacts of the Menstrual Cycle, PMS, and PMDD

Bodies in Social Work Through Trauma-Informed Feminist Lens

Reflections of Authors

Moving Forward