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Menstrual leave, for or against women?

A woman's reproductive cycle can be divided into three distinct stages: (1) early years (e.g., menstrual period); (2) reproductive years (e.g., pregnancy); and (3) later years (e.g., menopause). In each phase, women experience a variety of conditions, which cause changes in their mood and might require clinical attention, given the negative impact on their mental health and well-being.

During the early years, menarche occurs, i.e., the moment that marks the beginning of a woman's menstrual cycles. Then, there is a periodic loss of blood through the vagina from the non-pregnant uterus that occurs from puberty until menopause, which is called menstruation or menstrual period. Throughout the menstrual cycle, the levels of female reproductive hormones fluctuate (i.e., estrogen and progesterone), which can affect the levels of brain chemicals (neurotransmitters) that play an important role in mood regulation (e.g., serotonin). Thus, women are vulnerable to the development of several mental health conditions associated with menstrual period and the menstrual cycle.

In a diagnosis of Premenstrual Dysphoric Disorder, classified in the Diagnostic and Statistical Manual of Mental Disorders - V (DSM-V) as a depressive disorder (625.4 [N94. 3]), several symptoms might be presented, such as emotional lability, irritability, fatigue, depressive and anxious symptoms, marked change in appetite, altered sleep pattern, pain, which repeatedly occur during the premenstrual phase of the cycle and remit around the onset of menstrual period or soon. For the diagnosis to be confirmed, at least five of these symptoms must occur, and they must have occurred in the majority of menstrual cycles during the past year and be associated with clinically significant distress and/or clear and marked impairment in social and professional functioning, in the week before menstrual period.

There is yet another mental health condition, which must be differentiated from Premenstrual Dysphoric Disorder - Premenstrual Syndrome. Premenstrual Syndrome does not require the presence of a minimum of five symptoms, nor affective symptoms, and it is a much more common condition.

Even though a diagnosis cannot be established, in general, symptoms associated with menstrual period are very common in adolescents and women in a reproductive age. For many women, the physical and psychological changes are just uncomfortable and transitory, while for others they are intense and interfere with their daily routine, and may even be camouflaging a more serious health problem.

For this reason, the idea of a menstrual leave came about, a leave that offers women the right to not work during the menstrual cycle, when properly justified.

Spain was the first country in Europe to adopt menstrual leave, which already exists in some countries, such as Indonesia, Japan and Zambia. The Spanish Secretary of State for Equality and Against Gender Violence, Ángela Rodriguez, shared some data on the prevalence of women who could benefit from this measure - "53% of women suffer from painful menstrual period and, among the youngest, this percentage reaches 74%. This painful menstrual period, which may arise due to specific pathologies (e.g. endometriosis, adenomyosis, polycystic ovarian syndrome), should be clarified as it does not consist just in a mild discomfort, but in the presence of serious symptoms such as diarrhea, severe headaches and fever, for example. In fact, there may be some discomfort or some pain during the menstrual period, even when intense and persistent pain is not expected, which diminishes the woman's quality of life, preventing her from working. This leave must be properly justified through a declaration from a hospital establishment, healthcare center, or a medical certificate.

In Portugal, this topic was also recently politically debated. Formally, the People, Animals, Nature (PAN) political group was the first to propose the creation of a menstrual leave that was up to three days. In the proposal the group argues: "allowing these people [with a uterus that suffers severe pain during menstrual period], with a proper justification, to not work for a period during which they are not able to function in their profession under ideal conditions is a matter of social and labor justice”. However, this proposal was rejected by most of the political groups, because a woman can already ask for sick leave "for incapacitating menstrual pains" when presenting a medical statement. Finally, ignorance about the prevalence of women in reproductive age who suffer from menstrual pains or illnesses led to the rejection of this propose.

Opinions and policies on menstrual leave are divided and generate some controversy. If on one hand, there are those who argue that women's menstrual period is introduced as part of the fundamental right to health, stopping the taboo, ending the need to work with pain, take pills to go to work or hide this condition, on the other hand there are those who argue that feminism has been fighting for decades for menstrual period not to be considered an illness, and this may mean a limit to the hiring of women in reproductive age.

After all, is it menstrual leave for or against women?

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