PMDD/PME at Work
A Practical Guide to FMLA, ADA, and PFML (United States)
This guide helps employees navigating Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME) understand key United States workplace protections and benefits. It’s written for workers and people leaders.
This information is provided for educational purposes only and does not constitute legal advice.
What are PMDD and PME?
→ PMDD is a cyclical, hormone-sensitivity disorder that causes severe mood, cognitive, and physical symptoms in the luteal phase of the menstrual cycle.
→ PME means an existing condition (e.g., depression, anxiety, migraine, ADHD) becomes markedly worse before menstruation.
Symptoms can include intense mood changes, irritability, anxiety, depression, brain fog, sleep disruption, and pain. For many, symptoms significantly affect daily activities—including work—several days each month.
Key workplace takeaway
PMDD/PME can be episodic yet substantially limiting when active. U.S. law recognizes that some disabilities are episodic and still qualify for protection under the law. You do not need to share your diagnosis with your manager; medical certification can be handled confidentially through HR or a leave administrator.
Your Legal Toolkit
FMLA — Family and Medical Leave Act (Federal)
→ Up to 12 workweeks of unpaid, job-protected leave in a 12-month period for a serious health condition (your own or a family member’s).
→ Available as continuous, reduced schedule, or intermittent leave (for example, a few days each cycle).
→ Health benefits must continue during leave; your job (or an equivalent one) must be restored afterward.
FMLA for PMDD/PME — How It Works
Eligibility:
→ Employer has 50+ employees within 75 miles.
→ You’ve worked there for 12 months.
→ You’ve worked 1,250 hours in the past 12 months.
Qualifying Condition:
PMDD/PME can qualify when your provider certifies it as a serious health condition. Chronic conditions may qualify if they require periodic treatment, continue over an extended period, and may cause episodic incapacity.
Types of Leave:
→ Intermittent: only on days when symptoms flare.
→ Reduced schedule: temporarily fewer hours/days during symptom periods.
→ Continuous: for surgery, treatment changes, or severe episodes.
Process:
→ Apply through HR/leave administrator (you don’t have to tell your supervisor your diagnosis).
→ Provide medical certification by the deadline (often 15 days).
→ Give advance notice if symptoms are predictable; otherwise, notify as soon as possible.
→ Recertification may be required if your use differs from your provider’s estimate.
Pay & Benefits:
→ FMLA is unpaid unless you use PTO/short-term disability or state PFML.
→ Employer must maintain your group health insurance during FMLA.
Tips:
→ Ask your provider to note that symptoms are cyclical/episodic and may cause unpredictable incapacity.
→ Track episodes for a few months to support your request.
→ Consider combining FMLA with ADA accommodations.
ADA — Americans with Disabilities Act (Federal)
→ Requires reasonable accommodations for qualified employees with disabilities unless it causes undue hardship.
→ Covers many episodic conditions that substantially limit a major life activity when active.
→ Examples: flexible scheduling, remote work, shift swaps, noise-reduction tools, time off as an accommodation, and more.
ADA Accommodations for PMDD/PME
Coverage:
Applies to private employers with 15+ employees and all state/local governments. Covers many episodic impairments that substantially limit life activities when active.
Interactive Process:
Tell HR you need a workplace adjustment for a medical condition (no diagnosis to your supervisor).
Provide documentation of functional limitations.
Work with HR to explore and trial options.
Possible Accommodations:
→ Flexible start times or compressed schedules.
→ Remote/hybrid work.
→ Short, as-needed breaks; quiet space for decompression.
→ Adjusted workload or duties.
→ Leave as an accommodation.
→ Written instructions, checklists, and recorded meetings.
PFML — State Paid Family & Medical Leave
→ Some states/DC provide paid leave for an employee’s own serious health condition or family caregiving.
→ Funded via payroll contributions; rules and benefit levels vary by state.
→ PFML can run concurrently with FMLA and may also support intermittent or reduced-schedule leave.
PFML for PMDD/PME
Several states and DC offer paid leave for your health condition, bonding, or caregiving. Programs vary but often allow intermittent/reduced-schedule leave, which suits cyclical conditions.
Examples of states with PFML or similar programs (mid-2025):
California, Colorado, Connecticut, DC, Delaware (2026), Maine (2026), Maryland (2026), Massachusetts, Minnesota (2026), New Jersey, New York, Oregon, Rhode Island, Washington.
Always check your state’s PFML website for current eligibility, benefit amounts, and timelines.
How the Laws Work Together
→ FMLA + PFML: Wage-replacement often runs at the same time as FMLA’s job protection.
→ ADA + FMLA: You can use accommodations and still take FMLA leave when needed.
→ Leave as an accommodation: Even without FMLA eligibility, the ADA may require unpaid time off if reasonable.
→ State sick leave laws: Many states/cities require paid sick time for episodic symptoms or appointments.
Practical Steps for Employees
Track your symptoms for 2–3 cycles.
Ask your clinician to document limitations and frequency/duration of episodes.
File requests:
→ FMLA/PFML for job-protected leave.
→ ADA for on-the-job accommodations.
Keep your medical information private with HR.
Learn your workplace’s policies for notice and certification.
FAQs
Do I have to use PTO first?
Possibly—employers may require PTO to run with FMLA. Please refer to your employee handbook for additional information. PFML programs have their own rules.
Can my employer ask for recertification?
Yes, especially if your absences differ from your provider’s estimate.
Is PMDD/PME a disability under the ADA?
It can be—episodic conditions can qualify if they substantially limit major life activities when active.
What if my company is too small for FMLA?
You may still have rights under the ADA or state/local laws.
Templates
ADA Accommodation request (to Human Resources or Leave Administrator):
Hello HR, I’m requesting a reasonable accommodation for a medical condition that is episodic. During certain days each month, I experience symptoms that limit my ability to concentrate and work a standard schedule. My clinician can provide documentation. I’m requesting flexible start times during symptomatic days, the ability to work remotely up to two days per cycle, and brief as-needed breaks. I’m happy to discuss alternatives.
Intermittent FMLA notice (to Human Resources or Leave Admininstrator):
Hello, I’d like to open an intermittent FMLA claim for a chronic, cyclical health condition. My provider will complete the certification describing the expected frequency/duration of episodes (e.g., 2–5 days per month). I will follow call-out procedures and submit recertifications as required.
Disclaimer
This resource is educational and reflects U.S. rules current as of mid-2025. Laws change, and state programs differ. For advice on your situation, consult HR, your state PFML agency, or an employment attorney.