Counting the cost of period pain

Cramps so bad you’re throwing up from the pain. Bleeding so heavily that you flood through period products in an hour. Periods so unpredictable you never know when they’re going to start — at work, on the train, or in a traffic jam.

Around three-quarters of women, girls and those who menstruate have experienced a problematic period in the past five years. For some, it renders them incapable of going to work, while others do their best to soldier on in pain, discomfort and anxiety.

Now a study from researchers at Western Sydney University and the not-for-profit organisation Jean Hailes for Women’s Health has put a dollar figure on how much problematic periods cost the Australian economy: an incredible A$14.2 billion dollars every year, and even that is probably an underestimate.

“This just accounted for absenteeism — so days taken away from work — and presenteeism, which is feeling affected whilst at work,” says Dr Millie Mardon, first author of the study and a postdoctoral research fellow in reproductive health at Western’s National Institute of Complementary Medicine (NICM). “So, we’re not accounting for healthcare costs, we’re not accounting for payment to use period products, and we’re not accounting for loss of superannuation because of time away from work.”

It’s the first time the economic burden of menstrual disorders has been quantified in Australia. The study, which is part of a bigger series of work exploring how menstruation contributes to gender inequity, used data from the Jean Hailes National Women’s Health Survey, an annual survey of around 3,500 Australian women aged between 18 and 50 years.

The analysis, published in December 2024 in the Australian and New Zealand Journal of Obstetrics and Gynaecology, revealed that the economic burden of menstruation weighs more heavily on some groups than others. Just over 40% of women aged 18–24 years reported missing work or study due to menstrual symptoms, compared to just 30% of women aged 35–44 years.

“Younger women tend to have more problematic periods, and these young women are the ones that do not have a voice in the workplace,” says Dr Sarah White, CEO of Jean Hailes for Women’s Health. “If you’re earning less because you’re working less at 18 — or you’re unable to perform some roles — by the time you get to midlife, the impact is compounded.”

ANTIQUATED WORKPLACES

At the heart of the issue is the fact that workplaces and work schedules were originally designed for men, says Associate Professor Mike Armour, a reproductive health expert at NICM, who led the study and brought the interdisciplinary research team together.

“When you think about the modern workplace, many of the policies have their roots in an era when women were not a large part of the full-time workforce and so were designed around the needs of men,” he says. “Often we try and make women fit into the modern work schedule and workplace, rather than making the workplace fit around them.”

So, what would a working environment which better supports the challenges of menstruation look like? “ It can be as simple as having a quiet space where people who are on day one or two of their period, and things aren’t super-fun, can go,” Mardon says. It could also be standing desks, so people can keep moving, or access to a microwave to warm a heat pack.

But the biggest influence is workplace flexibility — something that, since the COVID-19 pandemic, has become more normal for many people. But even with the flexibility to work from home, mornings might be worse for some sufferers of problematic periods, meaning they would benefit from being able to start a few hours later than usual, while others might get worse in the afternoon and need to leave earlier.

Another issue is addressing menstrual stigma, which would also make it easier for people to ask for support in the workplace. “The shame and the stigma are so ingrained in all of us that we hide our period products up our sleeves; we don’t talk about it for fear of being diminished, being insulted,” says Dr Sarah Duffy, senior lecturer at Western’s School of Business.

The researchers also found that male and female bosses can be equally unsympathetic to staff needing flexibility. “If you have a female boss who hasn’t experienced difficult periods, they can often be very unsympathetic because they’re worried that it’s going to make women look weak, and they just can’t understand that somebody else’s experience is different to theirs,” Duffy says. Antiquated attitudes to menstruation are changing, albeit slowly. “Workplaces really do need to act, because many of their future employees are coming from schools where they’ve had access to free period products and are used to having more open conversations,” Duffy says.

“I think they will demand more from their employers on this front.” Supporting reproductive needs and choices isn’t just good for individual health – it’s also a productivity imperative.

CRITICAL CONVERSATIONS

Mardon says conversations about menstruation need to be normalised. “If you work in an office with women and people assigned female at birth, there’s going to be someone on their period, and they shouldn’t feel ashamed.”

Legislative and policy reform has been identified as one approach to redress menstrual inequities. But it’s not straightforward, as the case of Spain’s paid menstrual leave entitlement shows.

“The legislation’s there, and the entitlement is available but it’s not being taken up; women aren’t making use of it,” says Dr Michelle O’Shea, senior lecturer and interdisciplinary gender equity scholar at Western. “It speaks to the unintended consequences or the fear of, ‘how will I be perceived if I use that entitlement?’” In response, O’Shea and colleagues are researching other workplace interventions, including the utility of both paid reproductive leave and flexibility to manage reproductive health more broadly.

This example highlights the many dimensions of menstrual inequity, and why it requires a multidisciplinary approach, O’Shea says. “My colleague Mike is the conduit and has brought people together with different and complementary knowledge and skills,” she adds.