Hi there!
After Italy’s failed attempt to bring forward a similar law in 2017, Spain will soon become the first western country to implement a menstrual leave, a law granting time off due to period cramps. In part 1 of this series, we inspected all existing legislation around the globe. We learnt that it will also be the first to incorporate medical terminology: only menstruating individuals suffering from debilitating secondary dysmenorrhoea will hold menstrual leave benefits. But what does all this medical mumbo jumbo mean to begin with? And, most importantly, will this addition help menstrual leaves become fairer?
Our red friend
How extensive is your knowledge about periods? I am not talking about your period (hopefully, those years of teen period panic are well behind you), but about the period – the natural result of the 28-day-long hormonal cycle healthy menstruating individuals navigate. During menstruation, the thick muscular walls of your womb contract rhythmically, as if partaking into a well-timed waltz, to shed from the lining layering its insides, which results in bleeding. This coat is assembled to nest a potentially fertilised egg and has everything an embryo might need to develop. Once every month, your body assesses whether you are pregnant. If not, the dancing starts, alongside the bleeding. The preparation of this layer and its eventual elimination is orchestrated by a group of hormones (estrogen, progesterone and prostaglandins, among others) and tends to go hand in hand with mood swings and other symptoms such as dysmenorrhoea. Dysmenorrhea (from the Latin ‘dys-‘ = abnormal, and -menorrhoea = blood flow) is the medical term for what we know as period cramps, and might fall into two categories: primary dysmenorrhoea, which are the cramps arising from a physiological period; and secondary dysmenorrhoea, when the root of the pain is an underlying disease.
In the past, researchers aimed to associate period pain with lifestyle choices, from cigarette and alcohol consumption to educational level and marital status. However, their efforts proved fruitless, and nowadays, primary dysmenorrhoea is, despite its misleading etymology, considered an inherent characteristic of menstruation. It would be challenging to provide an exact number since proportions vary widely between studies (due to differences in population or interviewing techniques). Still, it has been estimated that between 2 and 9 out of 10 menstruation individuals experience menstrual pain. Excessive production of prostaglandins is to blame. This hormonal overload confuses your womb, causing it to miss some of the steps of its monthly dance, and ultimately contract out of rhythm. This failure to stay in tempo prevents the normal delivery of oxygen through the network of blood vessels of your uterus. Although transient and harmless, this drop in the oxygen levels is readily detected by your uterine nerves, which inform your brain of what’s going on using one of the languages they know how to speak: the feeling of pain.
In her book, ‘Conversations with Friends’ Sally Rooney’s protagonist, Frances, describes an agonising pain that causes her to pass out on her bathroom floor. Upon awakening, the tiles around her are tainted with her menstrual blood. She is later diagnosed with endometriosis, one of the underlying conditions causing secondary dysmenorrhoea. According to the Spanish legislation, only menstruating individuals suffering from this type of menstrual pain, that is, the one that can be linked to a disease that can be diagnosed, will be eligible for menstrual leave. The Spanish document includes a list of examples: endometriosis, uterine fibroids (or myomas), pelvic inflammatory disease, adenomyosis, uterine polyps, polycystic ovaries syndrome or abnormally heavy bleeding. These kinds of illnesses are a heavy burden on patients’ well-being. They can lead to other problems such as infertility, or pelvic pain outside of the menstrual time-window, therefore requiring the use of sick leave.
Got a secret, can you keep it?
Spanish law-makers wrote their law to fight negative biases – the incontestability of secondary dysmenorrhoea might hush the talk of sceptics (is period pain that bad, really?) and help avoid conflict between those who consider menstrual leave fair and those who don’t. However, justifying period pain only in the context of an illness boosts the misconception of menstruation as a disease – the term used to describe this phenomenon is medicalisation and was coined in 1972 by Irving K. Zola – something that needs to be fixed and concealed.
In 2015, Kiran Gandhi was ready to run her first London Marathon when she noticed her period had started. Such bad timing could have discouraged her but after a whole year of training, she was not going to let this stop her from crossing that finish line. She assessed the situation (will I have cramps? will a tampon or a pad be too uncomfortable to run?) and decided that the most convenient solution was to take some painkillers and free-bleed during the race. During those 26.2 miles, she felt liberated, not having to adapt her actions to hide her bleeding; and powerful, realising everything she could achieve despite the situation – her menstruation needn’t be as incapacitating as she had been led to believe.
Gandhi’s free-bleeding run became a source of joy for many, but it was also met with a lot of backlashes, judging her choice as ‘disgusting’, ‘unladylike’ and ‘unsanitary’. They wanted to humiliate her the same way females are shamed all around the world, shamed into hiding something natural. Likewise, the addition of medical terms to the Spanish law has the potential of further stigmatising individuals whose quality of life is affected by primary dysmenorrhoea by dismissing the validity of their suffering, since there is no disease to diagnose at all. You are healthy, and if you are healthy and your pain is deemed normal, society says that you should learn to put up with it. The problem is that, in most circumstances, society’s view of normality puts menstruating individuals at disadvantage.
Alarms are ringing, Kill Bill style: is then society the issue?
Stay tuned for Part 3!
Bibliography
Institute for Quality and Efficiency in Health Care (IQWiG). Period pain: Overview. (2008)
Hong, J. et al. The Prevalence and Risk Factors of Dysmenorrhea. Epidemiologic Reviews, Volume 36, Issue 1, 2014, Pages 104–113 (2014)
Dawood, MY. Primary Dysmenorrhea: Advances in Pathogenesis and Management. Obstetrics & Gynecology: August 2006 - Volume 108 - Issue 2 - p 428-441
Sally Rooney. Conversations with Friends (Faber and Faber, 2017)
K. Gandhi. Going with the flow: Blood & sisterhood at the London Marathon (2015)
ABC Health & Wellbeing. Breaking the menstrual taboo: Why period stigma still holds women back (2017)
Levitt, RB. The Palgrave Handbook of Critical Menstruation Studies. Chapter 43. Addressing Menstruation in the Workplace: The Menstrual Leave Debate (Singapore: Palgrave Macmillan, 2020)
Zola, IK. Medicine as an Institution of Social Control. The Social Review, Volume 20, Issue 4 (1972)
