Written by: Giselle Saati, Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
Spain’s recent proposed bill to offer paid menstrual leave for women got me thinking about women’s performance. As an athlete, learning how to manage my menstrual cycle during competition or even during training was always a nerve-wracking experience. It wasn’t until I started tracking my menstrual cycle in relation to my “PRs” Personal Records that I discovered how I can utilize it to my advantage. In the athletic world, periodizing resistance training over the course of the menstrual cycle needs further research, especially in how it relates to growth hormone and testosterone levels.¹ Every woman is different and there are other variables at play when it comes to athletic performance. This led me to ask the following questions. I asked myself, “How is this any different from managing your menstrual cycle in the workplace? What severity of pain is tolerable? What causes menstrual pain?” and the golden question, “Is menstrual leave the solution?” Even the feminist can’t even answer that question. On one hand, they want to support women’s health and be inclusive, on the other, it could lead to discrimination, making it easier and more cost-effective for employers to hire men.
The true answer to the golden question is NO and the real solution is that every woman must be handled on a case-by-case basis. I do not intend to be pejorative and to be clear, I am very sympathetic to women’s health, but there are two major problems with policies like this. One, there is no data supporting that these policies work and second it doesn’t really address the real issues behind painful menstruation. Policies like this are a one-size-fits-all approach to make the political party who’s pushing it “look better”.
Let’s take a step back and look at the science of menstruation. During menstruation, the body releases chemicals such as Prostaglandins and Leukotrienes to mediate inflammation and cause the uterus to contract to shed the lining.² Higher than normal amounts of these chemicals can lead to greater and more prolonged pain. Unlike the usual menstrual discomfort and cramps, painful menstruation is known as dysmenorrhea and there are two types: primary and secondary. According to The American College of Obstetricians and Gynecologists, Primary dysmenorrhea is painful menstruation in the absence of pelvic pathologies³ — such as endometriosis, uterine fibroids, pelvic inflammatory disease (PID), or adenomyosis. Primary dysmenorrhea is usually reoccurring pain that begins a few days before or during menstruation and lasts 12-72 hours.⁴ It is prevalent among adolescents or between the ages of 13 to 24. Secondary dysmenorrhea is painful menstruation due to pelvic pathologies and normally occurs between the ages of 25 to 30 years.² It is more severe in nature and the pain can last 6 months or longer and be constant, intermittent, cyclic, or acyclic.³
To be clear, the severity of the pain does not distinguish between primary and secondary dysmenorrhea. Although one has a better prognosis than the other, both are debilitating and can cause occupational and educational absenteeism. It can also cause negative effects on work performance, sleep, and mood, resulting in anxiety and depression.⁵ There is no question that a woman should seek medical attention if she has painful menstruations, especially if it’s secondary dysmenorrhea. But how is that any different from any other disease or medical problem? An employer should always encourage their employees to seek medical attention for any illness such as cancer, multiple sclerosis, diabetes, etc. Secondly, giving one to three days' leave won’t resolve secondary dysmenorrhea as the pain can last for months.
Interestingly, a lot of the research on dysmenorrhea does not distinguish between primary and secondary. In many sample sizes, women merely rate their pain intensity using a visual analogue scale (VAS). An article published in the Journal of Pain Research on the prevalence of menstrual pain in young women, reported that pain intensity was highly correlated with the following: menstrual flow length, history of abortions, and gynecological pathologies; and negatively correlated with the use of contraception.⁶ Furthermore, dysmenorrhea is also associated with inadequate physical exercise, genetic predisposition, smoking, poor diet, low socioeconomic status, stress, and mental illness.⁶
Dr. Gabor Maté in his book When the Body Says No, writes several case studies proving that many of the critical illnesses we face such as cancer, IBS, Alzheimer’s, are very much connected to chronic stress from emotional suppression.⁷ Stress, emotions, and hormones are interconnected, and could the excess secretions of Prostaglandins be the result of our bodies coping with a stress that is conscious or unconscious. Going back to my point earlier about dealing with the underlying issue behind painful menstruation, based on the facts mentioned, wouldn’t it be better if we made women healthier both mentally and physically? Lifeworks, a global human resource consultancy, who offers services to promote mental health and wellbeing to other organizations, recently published an article applauding Spain’s initiative. The only statistic the article presented was that 47% of employees in the UK reported doing their job when feeling unwell.⁸ In reading their Mental Health Index, there is no mention that this 47% is attributed to women and their menstrual cycle. For all we know, this could have been a man working while he has the sniffles. Of course, perhaps they are trying to focus on the “stigma” behind working while ill. It is appalling that a large organization such as Lifeworks, did not use the current scientific research, nor put more resources into exploring the real issues behind menstrual pain.
Another important point concerns contraception. In 2019 the United Nations published a report on Contraceptive Use by Method. The report covers 195 countries, and it is a compilation of 1,247 surveys. Female sterilization and male condoms are the most common contraceptive methods used worldwide. In North America and Europe, the Pill is ranked the highest at 17.8%, whereas IUDs are at 7.9%.⁹ The IUD, specifically the Mirena, is not only far more effective at preventing pregnancy it also reduces uterine blood flow and pain levels.¹⁰ I would even recommend it to a woman who doesn’t have dysmenorrhea, because it would reduce blood flow, menstrual cramps, and discomfort, prevent pregnancy, it’s hassle free, and it doesn’t have the nasty side effects of the pill. It’s lack of popularity in North America makes me wonder how powerful and influential pharmaceutical companies have, as it is much more profitable for them to sell pills. A New York Times news piece, gynecologist Hortensia García Briz, states, “I really don’t understand why we need this new law when there are now so many options available for most women to avoid suffering the kind of debilitating pain that could make it impossible for them to work. I think that the feminist movement in this country has been pushing things to the extreme and out of context, which is not actually helpful to women. I believe that the aim should be precisely to demystify a woman’s period as something that needs to be painful, and make it clear instead that gynecology has already designed many products to make it comfortable.¹¹ "The bill for Menstrual leave in Spain is part of a reformation to the existing abortion laws. As far as I’m concerned, they could “kill two birds with one stone” by reducing abortion rates and dysmenorrhea, if they provided women with appropriate contraception.
Although Spain might be the first European country to push this through, many countries in the east such as Indonesia, South Korea and Japan have passed similar laws. Japan being the oldest with its menstrual leave policy dating back from 1947. Menstrual leave was granted after WWII for female factory workers under poor sanitary conditions and harsh labour. Interestingly, the acceptance rate has been declining over the years.¹² According to local media, the take-up rate in 1965 was 26% and 0.9% in 2017. Many reporters are suggesting that stigma is to blame for the decline in usage of menstrual leave, but I think it’s far more complicated than that. For example, in Japan, the work culture is more formal with the emphasis on the group. So, if a woman were to leave because of menstrual pain, it might be perceived culturally as letting the team down. Every country has different cultural, socioeconomic factors, and policies regarding menstruation and menstrual leave; thus, impossible to come up with conclusive evidence that these policies work.
Let’s be honest, there is not a single woman out there that loves having their menstrual cycle. Whether it is painful or not, when you’ve got a one-week vacation in the Maya Riviera, you are praying to God you don’t get your period. Luckily for us women living in the 21st century, we have good options available to us to help regulate our menstrual cycles and we can make choices to live healthier lives. Menstrual leave is not the solution to the problem, as scientific evidence points out clearly. It is only a band-aid remedy. It looks good on paper, but it does not address the fundamental problems related to women and menstruation.
Giselle Saati, Executive Contributor Brainz Magazine
Giselle Saati is a performance consultant with over 10 years of experience in counseling and personal training. Her unique career path along with her academic background has enabled her to create the Fortitude platform that is unparalleled to any HR consultancy. She has a deep passion for helping individuals maximize their full potential and embodies the slogan "Strength of character and resoluteness that permits one to face adversity and suffering courageously."
 Dr. Kraemer, W. J., Dr. Vingren, J. L., & Dr. Spiering, B. A. (2016). Endocrine Responses to Resistance Exercise. In G. G. Dr. Haff, & T. N. Dr. Triplett, Essentials of Strength Training and Conditioning (pp. 81-82). Champaign, IL, USA: Human Kinetics.
 Pakpoor, A. H., Kazemi, F., Alimoradi, Z., & Griffiths, M. D. (2020, March 26). Depression, anxiety, stress, and dysmenorrhea: a protocol for a systematic review. PubMed Central.
 Grandi, G., Ferrari, S., Xholli, A., Connoletta, M., Palma, F., Romani, C., . . . Cagnacci, A. (2012, June 21). Prevalence of menstrual pain in young women: what is dysmenorrhea? Dove Press, Journal of Pain Research , 169-174.
 Dr. Maté , G. (2003). When the Body Says No. Toronto: Alfred A. Knof Canada.
 United Nations. (2019). Contraceptive Use by Method. United Nations Department of Economic and Social Affairs.
 Dr. Ramazanzadeh, F., Tavakolianfar, T., Dr. Shariat, M., Firuzabadi, S. J., & Hagholahi, F. (2012). Levonorgestrel-releasing IUD versus copper IUD in control of dysmenorrhea, satisfaction and quality of life in women using IUD. PubMed Central, 41-46.