Influence of menstrual pain and symptoms on activities of daily living and work absenteeism: a cross-sectional study

A cross-sectional and descriptive study was conducted in July and August 2022.

The study population was comprised of women aged from 15 to 49 years old. The average age of sexual initiation, often referred to as 'sexarche', is approximately 15 years old, which is why it has been established as the minimum age threshold [14]. According to the updated data available, this population group accounts for 11,267,550 women in Spain, which represents 57.5% of the total female population and 24.2% of the entire Spanish population. The study’s geographical scope is nationwide, thus allowing the representativeness of the sample. The questionnaire was applied to 1,800 women representative of the entire Spanish population. The distribution of the sample was proportional to the actual distribution of the population with an adjustment system by age quotas, with a random last selection of the interviewees. Specifically, the sample size proposed provided a statistical error for global data of ± 2.31% for a 95.5% confidence level (Two Sigma) and a population distribution of p/q = 50/50.

The interviews were conducted following a mixed methodology: via telephone calls, using the CATI (Computer Assisted Telephone Interviewing) system, and online, by using the CAWI (Computer Assisted Web Interviewing) system. Using this mixed methodology allowed for optimizing access to population segments that are increasingly more difficult to reach via telephone calls and are usually under-represented in samples. They are mostly young people who either have no landline, are very hard to locate on family landlines, or tend not to answer telephone calls on their mobile devices. This technique ensured maximum efficiency in research studies of a sociological nature by combining its ability to target large population groups, attain full geographical amplitude and diversification, and work with complex questionnaires. The entire survey process was in charge of the Sigma Dos company, which specializes in digital marketing.

A telephone-based structured questionnaire comprised of questions about sociodemographic variables: age group (15–19 years old; 20–24 years old; 25–20 years old; 30–34 years old; 25–39 years old; 40–44 years old; 45–49 years old), marital status (living with partner; with steady partner, not living together; no steady partner), children (yes/no), nationality (born in Spain; born abroad, Spanish nationality; born abroad, non-Spanish nationality), schooling level (Less than elementary school; elementary school; high school; pre-University higher education; university studies), family income per month (Less than € 1100; from € 1100 to € 1800; from € 1801 to € 2700; from € 2701 to € 3900; more than € 3900), work situation (freelance; public administration, private company (fixed job position); private company (eventual worker); unemployed and looking for a job; student; housewife; retired o disabled) and about sexual and contraceptive habits (contraceptive methods used), as well as related to menstruation (if use of hormonal contraception for pain, for bleeding, for both reasons, for other reasons), bleeding duration (in days) and amount (scarce, moderate, intense, very intense)) and pain (no; mild pain; moderate pain; intense pain)). In addition to its repercussions in their daily activities (none; it does not limit me; it limits me to lead a normal life; it prevents me from leading a normal life) and professional activities (requested sick leave (yes/no) and had consequences on work of this sick leave due to menstruation (yes/no)) [14].

Descriptive statistics were used to determine the prevalence of painful menses among the participants. The participants’ characteristics were reported using frequencies and percentages. The relationship between sociodemographic variables menstrual signs and symptoms and work-related variables was reported using frequencies, percentages, and the x² test. Cramer´s V was calculated for effect sizes.

A threshold of p < 0.05 was established to consider an association significant. The statistical analyses were performed in IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, NY, USA).

A total of 1,800 participants were included in the study. Table 1 shows the sociodemographic characteristics of the sample corresponding to the average profile of women of reproductive age in Spain. Most of the women were born in Spain, belong to different age groups, have a partner (although not always living together) and slightly more than half of them have not had any children.

As can be seen in Table 2, when we asked about the usual signs and symptoms associated with the participants' menstruation, 72.6% asserted that their menses were painful and defined bleeding as intense or very intense in 35.9% of the cases. The pain reported by the women can even affect their daily life and performance of their duties in 38.8% of the cases, with a mean of 2.95 days affected by this condition and requiring pain relief medications in 45.9%. At least 34.3% had to request sick leave or not attend work at some moment due to menstrual pain or bleeding; however, only 17.3% confirm that they have eventually requested leaves due to this reason. More than half of the women think that requesting sick leave for this reason could lead to negative work outcomes, such as being fired.

Table 3 shows the characteristics associated with the participants' menstruation according to age groups. We can see that the youngest women are the ones reporting more menstrual pain and bleeding amount. In addition, they refer to more limitations to performing their usual activities during the menstrual period, even with the need to request sick leave or not to attend work due to pain and/or bleeding. It is noticed that this entire symptomatology and limitations are reduced as the age group increases (p < 0.01). Nevertheless, no statistically significant differences are observed between the women belonging to the different age groups and the repercussions that requesting sick leave due to menstruation-related reasons might have on their professional lives.

In Table 4, the results indicate that experiencing painful menstruation has a significant effect on daily activities, χ²(3) = 454, p < 0.001, R2 Nagelkerke = 0.193, with a stronger effect when the pain is severe and requires medication (Z = 17.42, p < 0.001). Similarly, having painful menstruation is associated with the need to request sick leave, χ²(3) = 251, p < 0.001, R2 Nagelkerke = 0.186, especially with severe pain (Z = 13.69, p < 0.001). Finally, an impact on the probability of requesting sick leave is also observed, χ²(3) = 129, p < 0.001, R2 Nagelkerke = 0.119, with a higher incidence when there is more pain (Z = 9.52, p < 0.001).

Table 5 shows that there are no differences in the women's menstrual profile according to their schooling level but, rather, in the repercussions they consider that having to request sick leaves due to the symptoms associated with the menstrual period might have on their professional life. The women with university studies have requested sick leaves due to this reason to a lesser extent and consider that taking them would have work-related repercussions.

Table 6 shows that the women with more intense menstrual pain and/or bleeding resort more to some hormonal contraceptive method as treatment. Half of the women who requested sick leave or not attending their activities due to pain were already on hormonal contraception due to menstrual pain and abundant bleeding. The women who asserted more limitations to developing their daily activities are those who take more hormonal contraceptives, especially for pain, as well as those who have already requested sick leave due to this reason.

As can be seen in Table 7, the women who resort to condoms mostly stated having felt the need to request sick leave or not attending their work activity as a consequence of menstrual pain and/or bleeding.