The much-neglected issue of women’s menstrual health is in the spotlight because of Union Minister for Women and Child Development Smriti Irani’s latest comments opposing paid menstrual leaves. Irani’s stance is unequivocal: “As a menstruating woman, menstruation and the menstruation cycle are not a handicap; it’s a natural part of women’s life journey.”

The debate gained traction when Rashtriya Janata Dal (RJD) member Manoj Kumar Jha inquired about the government’s initiatives for mandatory provisions, ensuring employers grant a specific number of leaves to female employees during their menstrual cycles. Irani in response, cautioned against policies that might inadvertently create distinctions among employees based on biological factors.

However, the matter immediately invited many reactions on the internet. Supreme court advocate Karuna Nandi posted on X, “Folks, period leave is like maternity leave. 1. Don’t take it if your period isn’t painful and 2. Don’t deny others’ pain because you’re such a pain-free hero.”

A well-known media personality highlighted the concern about acute dysmenorrhea – extreme period pains. “Smriti Irani says period leave could end up women being ‘denied equal opportunity.’ So it’s okay to discriminate against those who have acute dysmenorrhea rather than making sure companies do not punish women for a debilitating physical condition?” she said.

While Irani is focused on ensuring equal economic opportunities for women and men, it’s important to recognize that menstruation is not merely a biological event that distinguishes one gender from the other. It has several health ramifications, involving various degrees of pain and discomfort experienced by women across all age groups. Numerous women contend with the challenges of Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD).

Health on Air (HoA) interviewed a diverse range of experts, including gynaecologists and psychologists, to delve into the physiological and psychological impacts of menstruation-related conditions and their prevalence among women. Let’s demystify these conditions for you.

What is Dysmenorrhea?

Dysmenorrhea is the term used to describe the severe pain and cramping that numerous women endure before, during, and after their menstrual cycle. On the other hand, PMS (Premenstrual Syndrome) encompasses a combination of emotional and physical symptoms experienced before menstruation. Unlike PMS, dysmenorrhea specifically denotes the physical pain and cramping associated with menstruation itself. PMS typically manifests a week or two before the onset of menstruation, concluding as soon as the period begins. In contrast, menstrual cramps, clinically known as dysmenorrhea, commence on the first day of a woman’s menstrual period and may persist throughout the entire duration of the period.

What is PMS?

Premenstrual Syndrome (PMS) is identified when a woman reports recurrent psychological and/or physical symptoms during the luteal phase of her menstrual cycle, typically resolving by the end of menstruation. Premenstrual syndrome (PMS) manifests with diverse symptoms such as mood swings, breast tenderness, food cravings, fatigue, irritability, and depression, says Dr. Manju Hotchandani, Gynaecologist and Obstetrician at Moolchand Hospital

The severity of symptoms varies among women, with approximately 95% of women of reproductive age experiencing premenstrual symptoms. However, for about 5% of these women, the symptoms can be severe and debilitating. Assessing symptom severity poses a challenge due to the lack of consensus, resulting in the use of various symptom scores and scales. This diversity in assessment methods complicates the synthesis of data on treatment efficacy.

What is PMDD?

Premenstrual Dysphoric Disorder (PMDD) stands as a heightened manifestation of PMS, marked by both physical and behavioral symptoms, typically alleviating with the onset of menstruation.

PMDD extends beyond typical PMS discomfort, inducing severe mood shifts capable of disrupting work responsibilities and straining interpersonal relationships. Key symptoms encompass profound feelings of sadness and hopelessness, heightened irritability or anger, along with conventional PMS indicators like breast tenderness and bloating. In some extreme cases the person can experience suicidal tendencies as well.

Regarding the prevalence of PMDD, Dr. Hotchandani shared, “PMDD is not very common. It’s estimated to affect about 1 to 2 percent of women, while PMS is more common, affecting 8 to 10 percent.”

Experts on pain management, better menstrual health and leave policy

Dr Manju Hotchandani also emphasized lifestyle changes for alleviating PMS symptoms, stating, “Maintaining a healthy diet, regular exercise during the premenstrual phase, and stress management can improve symptoms. However, complete alleviation may not be possible due to the biological nature of these changes.”

Addressing menstrual pain management, she expressed, “Meptal spas can be used occasionally, but frequent use poses risks. Natural methods include the use of hot bags, regular exercise, and local gels or patches. If pain persists, expert consultation is necessary.”

Regarding leave policies, Dr. Hotchandani emphasized the need for individualized approaches: “Policies should be tailored to the individual. A blanket policy for all women may not be practical. It’s crucial to assess the needs of each person because there is a great deal of variation in the way women experience menstrual pain. Sometimes, a woman can just take a pill and get through the day, but there are times when the pain can be extreme. They should ideally obtain a certificate from their doctor.”

Dr Rahul Manchanda of PSRI Hospital is of the view that if a woman is feeling so uncomfortable during period that she needs to lie down with a hotbag and it hinders her regular work, she must reach out to an expert. “Let’s avoid normalizing the practice of taking a pill to endure period pain while working. The decision to implement leave policies ultimately rests with the companies. Individuals should have the freedom to take a break when feeling unwell. However, if a woman is enduring significant discomfort and pain, it signals a deeper issue. Simply having period leave won’t address the root problem.”

Shweta Jhamb, Rehabilitation Psychologist, and Expressive Therapist, mentioned that PMS is a prevalent occurrence among her counseling clients. “Awareness among women that it is something to be taken seriously is very little. They often don’t even understand that many of their mood swings, irritability, or thought patterns are influenced by PMS. Poor lifestyle choices have resulted in a greater prevalence of PMS among women,” she says.

In her counseling practice, Jhamb has observed that a significant number of patients with menstrual disorders emphasize that menstruation continues to be a largely taboo subject in India. “Women are reluctant to speak to their bosses, especially if they are male, about it. Let alone asking for designated menstrual leave, they often give other reasons to avail their sick leaves, during their periods,” she adds.

About the necessity for leaves, she says, “More than rest, women need understanding and care when they experience the symptoms of PMS from their caregivers. Certainly, a high-pressure workplace is not conducive if one is irritable and experiencing physical discomfort. And workplaces must be mindful of it. In India though, such mindset changes among employers will take a long time,” she says.