2023-08-30 12:29:01
Work leave due to dysmenorrhea, a conquest for the health of women and trans people
“Not even many people know what the word dysmenorrhea means,” says Dr. Carmen Sala Salmerón, an obstetrician at the Gine-3 Clinic in Barcelona and a specialist in women’s quality of life, wherever she lives, thanks to the connectivity of the social networks.
Dysmenorrhea is a more or less acute pain caused by menstruation that appears in the belly area and spreads to the kidneys and thighs.
Some women also suffer from headache, nausea and dizziness, even diarrhea.
Period pain symptoms can also be described as severe cramping in the lower abdomen.
These pains can even begin a few days before the bleeding, reaching its maximum expression 24 hours after the menstrual onset and continuing insidiously for several days.
“I always explain to women that dysmenorrhea, unless there is a hidden disease, is due to an uncontrolled secretion of prostaglandins in the cervix during this period. The more prostaglandins, the more pain”, indicates the Dr. Carmen Sala.
Prostaglandins are hormone-like substances that are involved in the reproductive system to trigger uterine muscle contractions that help expel the menstrual compound that usually lines the endometrium. every 28 days.
“For this reason, when we guide treatments against dysmenorrhea, we prescribe antiprostaglandin drugs, which inhibit both the secretion and the action of prostaglandins,” he points out.
Mefenamic acid, naproxen, ibuprofen, paracetamol, and aspirin reduce or disguise menstrual pain, but the underlying problem is not resolved in many cases.
“Likewise, for patients who do not wish to become pregnant, we offer the possibility of eliminating menstruation (amenorrhea) with hormonal contraceptives”, points out the Catalan doctor.
Primary and secondary dysmenorrhea, such for which
“Beyond the discomfort associated with a normalized menstruation, with its corresponding cycle, the most frequent cause of primary dysmenorrhea is idiopathic, that is, we do not know why this pain occurs,” he points out.
“A good example would be that of the woman who says in the gynecology clinic that her period hurts like her mother’s. She is a woman used to periodic pain… and that’s where the thing stops, ”she exposes.
From the Spanish Society of Gynecology and Obstetrics (SEGO) it is pointed out that between 15% and 20% of women suffer from primary dysmenorrhea, that is, menstrual pain without a recognized reason.
But sometimes it is essential to search and find the origin of the period pain: secondary dysmenorrhea.
“When 14, 15 or 16-year-old girls come to the clinic with their mother for dysmenorrhea, it is common for them to describe extremely intense pain, which sometimes makes it impossible for them to go to school or institute,” our ‘gyne’ from reference.
“I determine, then, that the reproductive system of these girls generates a large amount of menstruation, since the first menstruations are usually very abundantforming, in some cases, small coagulated“, Explain.
“These menstrual clots, when passing through the cervix, force the body to produce more uterine contractions for expulsion,” he details.
These girls not only have a heavy period, but also often suffer from some anemia and lack of iron, “something logical due to the characteristics of their period,” she clarifies.
In women with an age range between 30 and 40 we must look at a hidden pathology.
“To diagnose your dysmenorrhea we will look for the primary intervention of fibroids (uterine fibroids) and, above all, of the endometriosis; two problems of the female reproductive system closely related to infertility and sterility ”, she highlights.
The first are non-cancerous tumors on the walls of the uterus; the second develops endometrial-like tissue in the fallopian tubes, ovaries, or lining of the pelvis.
Another possibility is the adenomyosisa disease very unknown to women and difficult to diagnose.
“The tissue that lines the uterus begins to grow into the uterine muscle layer, or myometrium. These small pockets of tissue bleed with the period and produce intense pain”, describes Dr. Sala Salmerón.
“In these cases, hysterectomy (uterus removal surgery) will be the only solution for these women. A really difficult treatment to assimilate ”, she underlines.
Similarly, these women may suffer from pelvic inflammatory disease (bacterial infection of the reproductive organs through sexual transmission) and cervical stenosis (narrowing of the cervix that prevents menstrual flow).
Menstrual pain, personal, family, work and social obstacle worldwide
“Until the new sexual and reproductive health law came into force on June 1, 2023, my experience in primary dysmenorrhea consultation is that very few women, two or three each year, have required a specific review. ”, notifies the gynecologist.
They are women with standard rules who know what they have to do to soften the monthly pain.
“They do not hesitate to take medication because they add to their own experience that of their mothers, sisters, friends and co-workers. It is a custom inherent to women; a wrong normalization ”, she warns.
“And what do these patients need from me?… That you tell him that everything is fine; they want to rule out endometriosis or fibroids. They arrive at the consultation scared, thinking that a mutilating pathology may be stalking them, ”she warns.
“Of course, when faced with a woman who claims to have dysmenorrhea, it is essential to carry out a complete gynecological examination, which will include an ultrasound to rule out any type of health problem,” he says.
For a good number of women, dysmenorrhea is serious enough to influence their usual activities, even more so in the workplace, where they have to deal with the lack of understanding from HR departments or from their colleagues.
In a globalized world, where only a few Asian countries had set the course to follow, the Spanish law means a before and after, a breath of freedom for billions of women who suffer, every month and another, headaches. ruler.
In Italy and France they continue to try with different initiatives and bills, despite the legislative failures to date.
In Mexico City, congressmen and women deputies seek with their votes to reform the Federal Labor Law and the Federal Law of State Service Workers: they want it to be mandatory for companies to grant two days a month, without salary reduction, women and menstruating people with disabling dysmenorrhea.
In Colombia, a draft law establishes that menstruating women and people have the right to a paid leave of one day per month due to symptoms generated by their menstrual period.
In Zambia, an exceptional country in Africa, a day of paid leave is granted for painful menstruation.
But it is in Asia where the issue has been legislated for many years through policies that affect maternity leave.
Measures against endometriosis are regulated to a greater or lesser extent in Japan, South Korea, Indonesia, China, Taiwan or in the State of Bihar in India.
Notes on the Law against period pain in Spain
Women and transgender people who suffer from disabling menstruation can request paid sick leave from the first day of their period, but they must present a medical diagnosis of secondary dysmenorrhea.
In this sense, painful menstruation will be associated with endometriosis, fibroids, adenomyosis or other ailments such as pelvic inflammation, endometrial polyps, polycystic ovaries or difficulty in the outflow of menstrual blood.
Leave for disabling menstruation is added to the leave for voluntary or involuntary interruption of pregnancy, and leave granted from the 39th week of gestation, which will not be deducted from the 16 weeks of leave that correspond to the birth of a child.
In the three types of leave, the subsidy will be received from the first day of leave, unlike other types of temporary disabilities, where the remuneration begins from the fourth day.
What does not change are the percentage of the salary received, which will continue to be less than 100%, and the contribution requirements to be able to access these disabilities, since it is necessary to have worked 180 days in the five years prior to the leave.
This sick leave will be covered directly by Social Security to avoid possible discrimination and will not entail an extra expense for companies.
The Law does not establish a specific number of days off, but it is assumed that it will be approximately three days, based on the general length of the menstrual cycle.
Women with primary dysmenorrhea would be left without these job benefits, despite the fact that often this period pain is as painful or as disabling as secondary dysmenorrhea.
For this reason, SEGO proposes that the leaves for disabling menstruation be managed by gynecologists, who will carry out the pertinent tests on people who suffer from this ailment and, if they do not improve with treatment, can offer them lowers it
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