In this blog post, the second of five in this series, we take a look at some of the underlying myths and misconceptions about menstrual health that might make ‘menstrual leave’- an employment policy that allows (all) female employees to take 1-2 days off work per menstrual cycle – seem like a good idea.

Menstrual Myth #1 – “Working during menstruation negatively affects fertility”

As discussed in the previous blog post, this was the original reasoning behind menstrual leave when it was first introduced in post-conflict states like Russia (1920s), Japan (1947), Indonesia (1951) and South Korea (1953).

While it is true that delayed or absent menstruation (amenorrhea) can be caused by extreme physical exertion or stress [1], resting during the first couple of days of menstruation does not protect fertility.

Menstruation refers to the part of the menstrual cycle when blood from the lining of the womb and any unfertilised egg(s) are discharged through the vagina. Female fertility mainly depends on a different part of the menstrual cycle called ovulation, which typically occurs 12-16 days prior to menstruation [2].

So, any intervention during a period (only) is too late in the cycle to have any effect on whether or not an egg is released, fertilised, or implanted in the womb!

Menstrual Myth #2 – “Most women experience severe menstrual symptoms”

By the late 1960s, it was well understood that variation in menstrual cycle length was normal and that the “fertility” argument was no longer plausible [3]. Instead, menstrual leave was reframed as helpful to those who experience severe period pain (dysmenorrhea) and or heavy menstrual bleeding (menorrhagia) [4].

While very few women will make it through their whole reproductive lives without experiencing severe period pain, or a particularly heavy period, at some point… only a small minority of people experience severe symptoms on a regular basis.

Current data for the prevalence of severe menstrual symptoms is of relatively poor quality [5], partly because people (regardless of gender) are more likely to recall the times when they were doubled over in pain than when they felt none, only very mild, or moderate cramps [6].

A good quality World Health Organisation (WHO) systematic review of 178 studies from 42 countries, demonstrated that the vast majority (86-88%) of UK study participants did not report severe period pain (across various study lengths from 1-72 months)- This rate was in line with other European studies, too [7]. Similarly, in another good quality UK study, 90% of participants surveyed did not experience heavy menstrual bleeding (over 80ml blood loss throughout period) [8].

So, if around nine out of ten people who menstruate do not experience severe cyclical symptoms, is there really a need for a special workplace policy? Migraine is known to affect around 15% of adults [9] and yet nobody is calling for a special ‘migraine leave’…

Menstrual Myth #3 – “It is normal to experience severe menstrual symptoms”

If your menstrual symptoms are severe enough that you regularly find yourself unable to work, this is NOT normal. It is probably an underlying health issue, such as anxiety or depression, PMDD, Heavy Menstrual Bleeding (HMB), iron-deficiency anaemia, fibroids, or endometriosis, and you should seek medical assistance.

Sometimes symptoms can be worsened by external factors like poor working conditions, but resting does not prevent their re-occurrence. Note: You may need to shop around to find a doctor who is properly trained in menstrual health issues. If you are dismissed and told that your severe symptoms are ‘normal’- seek a second opinion.

Menstrual Myth #4 – “You cannot treat severe menstrual symptoms”

If you experience severe cyclical symptoms, don’t worry; there ARE effective ways to alleviate them [10]. This is what Menstrual Matters is all about! Just look up your symptom under the ‘manage‘ tab and find out what dietary or lifestyle options may help alleviate your symptoms…

Alternatively, you could try taking non-steroidal anti-inflammatory drugs (Ibuprofen or Naproxen), which help to significantly reduce both menstrual bleeding and pain [11]. The critical part is this– start taking 200-400 mg daily, around 2-4 days before a period is due (although check first with your doctor if you have asthma, and always take with food, never on an empty stomach).

Note- aspirin and paracetamol are not anti-inflammatory drugs- so they are far less effective for period pain. Alternatively, hormonal medications or devices, tranexamic acid or iron supplements can help prevent cyclical symptoms entirely [12]. In the case of severe fibroids or endometriosis, surgery can also be used to improve symptoms (although usually only as a last resort).

Menstrual Myth #5 – “You shouldn’t take sick leave for menstrual symptoms”

Since the dawn of time, men and women have been distinguished by what is between their legs and so menstrual symptoms are mistakenly thought of as being fundamentally different to those that affect men. This is not true. Men know what cramps feel like, and have experienced constipation, diarrhoea, and perhaps even moderate blood loss. It’s perfectly acceptable to need some time off, or be temporarily away from your post, to manage these symptoms (just make sure you seek medical advice if they are severe).

The good news is that most UK workplace sick leave policies allow all employees to take time off for any health issue that impairs their ability to work [13]. So, this certainly includes period pain (aka muscle cramps), Heavy Menstrual Bleeding, migraine, or any other symptoms, for that matter! The point is to seek medical advice for severe menstrual issues, don’t just cope with them alone at home, or struggle through them at work. Don’t be afraid to take ibruprofen to help manage pain, there are no prizes for being ‘macho’ (or should it be ‘femcho’?!).

Menstrual Myth #6 – “Women take more sick leave than men due to menstruation”

While it is true that women (on average) take slightly more sick leave than men, this difference is not very large. In 2016, the average UK  sick leave rate for working women was only 0.9% higher than for men [14]. That is less than a 1% difference.

More importantly, the reason for this difference is not because of the menstrual cycle.

The disparity in sick leave uptake between men and women is wholely explained by (1) more women than men working in jobs that put them at a greater risk of catching coughs and colds – think, healthcare and care work jobs; (2)  people are more likely to take sick leave when they earn less and more women are in low paid jobs; and (3) single parents are more likely to get ill than parent couples, and there are more single mums than dads [15].

Menstrual Myth #7 – “ALL women menstruate”

Menstrual leave policies are typically applied to all female employees. But not every woman menstruates.

By definition, those who have reached menopause do not menstruate. Indeed, a quarter of the UK’s working female population is not of reproductive age [16]. Women who are pregnant or who are on long acting contraceptive medications or devices, also may not menstruate.

As we have covered before, some women are unable to menstruate because of genetic, physiological or hormonal conditions. Women with Turner syndrome, for example, or transgender women [17]. It is also important to note that there are some people who do menstruate but are not women, for example, non-binary people and transgender men.

In a nutshell, periods are not an ‘all women’ thing.

Menstrual Myth #8 – “Periods are shameful”

When a marketing company in India implemented menstrual leave in 2017, it suggested that employees should not be forced to have “awkward conversations” in order to request time off work. Instead, menstrual leave should be “something that is a given, that’s understood” [18].

But this only reinforces the idea that getting your period is shameful, rather than a perfectly normal, human experience.

By applying menstrual leave as a blanket policy for all women, regardless of whether they menstruate or not, policymakers are (albeit unintentionally) implying that there is something shameful (or disabling- see point below) about the normal functioning of the female body.

Menstrual Myth #9 – “Menstruation is an illness itself”

Another reason why menstrual leave is applied to ‘all women’ workers (regardless of their reproductive status) is that periods have been positioned historically as an ‘illness’ or ‘disability’ [19]. This menstrual myth is further reinforced by the others listed above, especially the widespread belief that ‘most’ people who menstruate experience severe symptoms and that they are ‘natural’ or ‘untreatable’.

But while severe menstrual symptoms may indicate a health problem, menstruation itself is a perfectly healthy experience.

---

Despite good intentions, then, menstrual leave policies rely on fundamentally incorrect assumptions about menstrual health. Resting during menstruation does nothing to protect fertility and is even unhelpful for those suffering from severe menstrual symptoms (please seek medical support instead!). Moreover, menstrual leave is inappropriately applied to all and only women and this reinforces gender inequalities in the workplace.

In the next blog post, we will look at how menstrual leave is partly a response to sweatshop working conditions and why, although better than nothing, it is still not an effective intervention for menstruating workers.

---

NOTE: This blog series is a summary of a forthcoming book chapter by Menstrual Matters Director, Sally King- “Menstrual leave; good intention, poor solution”, in The Handbook of Gender and Employment Policies. Sage; London

Summarised by: Tsara Crosfill Morton

---

References:

[1] See this page for more information- https://menstrual-matters.com/tips-and-tricks/lack-of-period/

[2] Interestingly, a Japanese doctor – Kayusaku Ogino- co-discovered the role of ovulation in fertility waaay back in 1930… That’s 17 years before ‘menstrual leave’ was introduced in Japan- apparently in order to ‘protect fertility’…! See: Ogino, K. (1930). Ovulationstemin und konzeptionstermin. Zentralbatt Fur Gynakologie, 54, 464–479

[3] Find out more about the natural variation in cycle length here- https://menstrual-matters.com/blog/cycle-length/

[4] Read about this ‘reframing’ of the purpose of menstrual leave in the previous blog in this series.

[5] Prevalence rates for period pain, PMS, or even Heavy Menstrual Bleeding are tricky to calculate, and study estimates range enormously. Only ‘prospective’ studies- i.e. those that get people to record their symptoms on a daily basis for at least 2-3 cycles can produce high quality data. Unfortunately, people find tracking their health very dull and so there is a high drop out rate, plus this sort of study is VERY expensive to conduct. This is why a ‘systematic review’ study like the one referenced below [7]- is currently the best way to get a feel for the ‘actual’ prevalence rate, even if the vast majority of the studies included rely on recall (which means the reported rate is probably slightly higher than it is in reality…)

[6] Research shows that if you ask people to recall menstrual experiences, they will tend to overstate the frequency and severity of symptoms. Some studies have even compared individuals’ recalled experiences to those tracked everyday- and found significant differences. e.g. Ruble, D. N. (1977) ‘Premenstrual symptoms: A reinterpretation’, Science. doi: 10.1126/science.560058. All this means is that we have to be careful when evaluating studies that have relied on recall to judge the prevalence of symptoms.

[7] Latthe, P., Latthe, M., Say, L., Gülmezoglu, M., & Khan, K. S. (2006). WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health, 6, 177. https://doi.org/10.1186/1471-2458-6-177

[8] Scambler, A., & Scambler, G. (1985). Menstrual symptoms, attitudes and consulting behaviour. Social Science and Medicine, 20(10), 1065–1068. https://doi.org/10.1016/0277-9536(85)90264-3

[9] Migraine affects approx. 14.7% of UK adults- Stovner Lj, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, Steiner T, Zwart JA. (2007) The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. Mar;27(3):193-210.

[10] This is what Menstrual Matters is all about- check out the ‘manage’ section for evidence-based tips and tricks on how best to manage cyclical symptoms.

[11] See: Lethaby, A., Duckitt, K., & Farquhar, C. (2013). Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database of Systematic Reviews, (1), CD000400. https://doi.org/10.1002/14651858.CD000400.pub3 and;

Marjoribanks, J., Ayeleke, R. O., Farquhar, C., & Proctor, M. (2015). Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database of Systematic Reviews, (7). https://doi.org/10.1002/14651858.CD001751.pub3

[12] See: NHS. (2018). Heavy periods – Treatment – NHS. Retrieved 3 May 2019, from https://www.nhs.uk/conditions/heavy-periods/treatment/ and;

NICE, (National Institute for Clinical Excellence. (2018). Dysmenorrhoea. Retrieved 3 May 2019, from https://cks.nice.org.uk/dysmenorrhoea#!topicSummary

[13] Sick leave is provided to most workers, unless you are self-employed, temporary, or vulnerable e.g. on a ‘zero hours’ contract. Also, some UK employers use sick leave absences against the employee- e.g. to prevent a pay rise or job promotion. I think this should count as a type of employment discrimination but as far as I know, it isn’t currently covered by the workplace Equality Act (2010) 

[14] ONS, (Office for National Statistics). (2017). Sickness absence in the UK labour market: 2016. London. Retrieved from https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2016

[15] Ercolani, M. G. (2006). UK Employees’ Sickness Absence: 1984-2005 Watching the watchmen: A statistical analysis of mark consistency across taught modules View project UK Employees’ Sickness Absence: 1984-2005. Retrieved from https://www.researchgate.net/publication/4987168

[16] Approximately 26% based on UK population statistics – taking working age to be 16-65 years old, and reproductive age to be 12-52 years old. Source: UK Office for National Statistics, mid-2016 population dataset- https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/populationestimatesanalysistool

[17] Check out these previous blog posts for more information; https://menstrual-matters.com/blog/maths-people/ and https://menstrual-matters.com/blog/sex-and-hormones/

[18] See Dhillon, A. (2017, July 19). ‘Silly and regressive’: Indian firms introduce period days. The Guardian. Retrieved from https://www.theguardian.com/global-development/2017/jul/19/silly-regressive-indian-firms-under-fire-over-introduction-of-menstrual-leave

[19] Feminist research shows that over the past few decades, menstruation has become increasingly ‘medicalised’. That is, the normal changes associated with the menstrual cycle (i.e. for the maintenance of good reproductive health) are categorised as a form of ‘illness’, in order to justify gender inequalities. For more info see;

Chrisler, J. C., & Gorman, J. A. (2015). The medicalization of women’s moods: Premenstrual syndrome and premenstrual dysphoric disorder. In The wrong prescription for women: How medicine and media create a ‘need’ for treatments, drugs, and surgery (pp. 77–98). Santa Barbara, CA: Praeger

Ehrenreich, B., & English, D. (2011). Complaints and disorders : the sexual politics of sickness. Contemporary classics (2nd ed.)

Lupton, D. (2012). Medicine as culture: Illness, disease and the body. Medicine as Culture: Illness, Disease and the Body. https://doi.org/10.4135/9781446254530

Ussher, J. M. (2005). Managing the monstrous feminine: Regulating the reproductive body. London: New York: Routledge. https://doi.org/10.4324/9780203328422