The stereotypical image of menstruation: a woman grabbing her belly in pain. But how much pain and trouble do periods really cause women? An online survey among more than 42,000 Dutch women aged 15 to 45, led by gynaecologist Bertho Nieboer of the Radboudumc, tried to find out. About time, as the impact of periods on everyday life hasn’t really been researched before. Pretty weird, especially when realising that half of the world’s population menstruates. The first results of this menstrual study have been published in the American Journal of Obstetrics & Gynecology. The study is the largest of its kind.
An update was published recently, in the BMJ Open medical journal. For this the researchers surveyed 32,748 online questionnaires about lost productivity associated with menstrual symptoms. They measured both time off from work or school, as well as working or studying while feeling ill at school or work; what the study termed ‘presenteeism.’ Some 81% of the Dutch women said they had been less productive as a result of their menstrual symptoms. On average, the researchers calculated, women were absent from work or school 1.3 days per year because of their period and, on average, productivity loss was equivalent to 8.9 days per year.
The researchers found that around 1 in 7, just under 14%, had taken time off from work or school during their period and 3.5% said that this happened during every, or nearly every, menstrual cycle. From the respondents, 68% said they wished they had the option of more flexible working or studying hours during their period. Women under the age of 21 were around three times more likely than older women to say they had taken time off because of their menstrual symptoms.
A third of the surveyed women quit daily activities due to menstrual symptoms
A third of the surveyed women quit daily activities due to menstrual symptoms, is the main conclusion. They can’t exercise, call in sick, or stay in bed. Month after month. ‘And half of the women with menstrual complaints don’t talk about it,’ says Nieboer to the Dutch TV programme NOS op 3. ‘For example, they don’t tell their family that they can’t do certain things because of their periods. It’s possible this leads to medical conditions being overlooked.’
More data: 85% of the women suffer from dysmenorrhea (painful periods), 77% have psychological complaints, 71% experience fatigue, 59% have a backache, 56% deal with heachaches, 54% suffer from a too heavy menstruation and 38% experience so many menstrual complaints that they’re unable to perform all their regular daily activities. Only 48,6% of those women tell family our friends the real reason for having to reschedule appointments or tasks.
‘There’s a bigger need for improvements than I previously expected’
‘The problem is even bigger than I thought,’ Nieboer already said to Dutch broadcaster Omroep Gelderland in 2017, after the first inventarisation of the completed surveys. ‘The majority of these women spend a couple of days a month suffering from serious complaints. Half of them have severe tummy pain. Three in four feel irritated or depressed. Many women experience tiredness. There’s a bigger need for improvements than I previously expected. Also with regards to the lack of understanding of women with complaints.’
In total, 42,879 women filled in the extensive nationwide internet-based survey. And it really was extensive. Responding to all the questions took about 15 minutes. Apart from questions one might expect when it comes to this subject, like how often do you menstruate, which symptoms do you experience, which medication do you use, do you visit a doctor for your complaints, etc., the survey also included questions about work. Actually, the section with work-related questions was that large, we momentarily thought we’d ended up in the wrong study.
As predicted, the results show that yes, it’s really that bad.
That’s because a main goal of the research was to gain a better understanding of absence due to menstrual complaints. Something which has never been researched before. Women call in sick more often than men, the Nationale Enquête Arbeidsomstandigheden from 2017 by the Dutch organisations CBS and TNO already proved. In all age brackets. When looking at employees aged 25-45, the female absence percentage is twice as high as the male. This difference can partly be explained by sickness during pregnancy and childbirth.
How much of the sick leave is menstruation-related isn’t clear. Party because company doctors aren’t allowed to ask about this. Unlike pregnancy leave, it’s therefore totally unknown how much money a problematic menstruation costs society. Same goes for menopausal-related sick leave, although this subject is higher on the agenda.
Ignoring menstrual complaints can lead to serious health risks
As predicted, the results show that yes, it’s really that bad. Almost every expert on female health has experienced women who just carry on with gynaecological problems. They only consult a doctor when their complaints have become so bad that ignoring them is no longer possible. Nieboer – chief editor of the magazine Medisch Contact – previously tweeted about a patient who only decided to make a doctor’s appointment when she couldn’t attend the funeral of a loved one because of heavy blood loss. And that isn’t the only example.
Shame is a possible explanation for this behaviour. But also the deeply ingrained belief that a painful menstruation is normal, and not a reason to call in sick. Male employers don’t recognise the complaints, but also female managers can be a problem. Because they don’t experience menstrual complaints themselves or because they stubbornly decide to ignore the influence of the hormonal cycle. For centuries, hormonal influences have been a reason to ban women from becoming a judge, minister of Defence or astronaut. Complaining about your period isn’t a quick way to get to the top in your career.
Menstrual complaints like pain or heavy blood loss can be caused by other medical problems
But carrying on while suffering from serious complaints isn’t a good idea either. ‘Standard’ menstrual complaints like pain or heavy blood loss can be caused by other medical problems. The numbers don’t lie: one in five women suffer from menorrhagia (abnormally heavy or prolonged bleeding) and endometriosis affects one in every ten women. Some experts even say it’s one in eight. Half of all women suffer from period pain. However, there are also studies that indicate it’s 90%; it all depends on the age group. PMS is an issue one in every four women deal with. When looking at the long list of premenstrual symptoms, it seems almost impossible to not suffer from anything at all.
So, do we now know exactly what’s the deal with the impact of menstrual symptoms on everyday life? Yes and no. An online survey isn’t exactly the first choice of method when it comes to scientific research. That’s because of the so-called selection bias: people with ‘issues’ will be more likely to take part in the study, just because the subject is on their radar. Here at Period!, we found certain questions a bit suggestive. The way they were phrased already assumed that women experience medical complaints during their menstruation. Also, we missed some things. Where was the menstrual cup in the product section? There are more ways to manage your menstruation than just tampons and pads.
Other percentages that made us curious were about coping. How do Dutch women actually experience their menstruation? Psychologically we mean, not physically. As something positive? Something negative? Would they perhaps like to delete their menstruation altogether if this wouldn’t cause any health issues? In this context, a study by the Association of Reproductive Health Professionals (ARHP) from 2005 makes for interesting reading: 40% of the 1,021 participants in this research would prefer to never have a period again and 55% expressed an interest in menstrual surpression.
If you can’t work because of your menstruation, there’s probably a medical condition
Back to Nieboer’s study. The results of Radboudumc’s menstrual research certainly call for more dialogue about the impact of menstrual symptoms on everyday life. Expect interesting discussions – many of them will probably include the words ‘menstrual leave’. Discussion is a good thing. More medical-scientific research is also good. Because there must be another, better answer to ‘menstrual complaints’ than hormone therapy.
However, the aforementioned potential for selection bias means the results of the study have to be interpreted with caution. Do the participants really reflect the entire Dutch female population? Menstruation isn’t a disease. And if your period is making you feel too ill to do your job, there’s probably an underlying medical condition that’s causing the complaints. And that’s what needs to be investigated. Otherwise we’re just creating a nice red coloured glass ceiling.
Illustrations are from the book Mooi rood is niet lelijk