Globally rising female labour force participation represents one of the most noteworthy economic developments of the last century. Despite this continued growth and acknowledging that women do not participate in the labour force on equal terms or outcomes (Rees 2022; Olivetti and Petrongolo 2016; World Economic Forum 2023), little is known about the individual and broader economic costs tied to the menstrual symptoms experienced by working women. Despite covid-19 labour market effects including women’s employment in sectors hardest hit by pandemic job losses. Women were also disproportionately burdened by work intensification in contexts such as health (Kabeer, Razavi and van der Meulen Rodgers 2021) women have achieved near proportionate representation in the workforce across North America, United Kingdom (UK), Europe and Australia the geographical focus of this research (World Economic Forum 2023). These figures demonstrate the salience of the present research for almost half of the workforce in the countries mentioned, who are likely to manage menstrual symptoms through their paid working lives.
Like other Western countries, in Australia, menstrual periods (menarche) may commence at 12 years (Armour, et al., 2020) and continue until menopause, which typically occurs between ages 45–55 (Duralde, Sobel, and Manson 2023; Talaulikar 2022). Across these 39 years, menstruation commonly occurs every 29 days, with bleeding lasting (on average) 4 days unless a woman is pregnant, breastfeeding, menstrual suppression, or other hormonal treatments are used (Bull, et al., 2019).
Both period pain, and heavy menstrual bleeding (HMB) are common menstrual disorders. Dysmenorrhea (period pain) is the most common gynaecological condition (MacGregor, et al., 2023), affecting around 71% of women worldwide (Armour, et al., 2019), and over 90% of young women under 25 in Australia (Armour, et al., 2020), while 20–25% report experiencing HMB (Mena, Mielke, and Brown 2021). Both conditions can significantly impact attendance, engagement, and performance in education (school/tertiary) and paid work (Armour, et al., 2022té, Jacobs and Cumming 2002; Cotropia 2019; Grandey, Gabriel and King 2020; Munro 2021; Ponzo, et al., 2022).
Scholars have recently turned their attention to the impact of menstrual symptoms at work, which have received limited critical scholarly attention (Herrmann and Rockoff 2013; Howe, et al., 2023; Sang, et al., 2021). There has been a disinclination to explore menstruation owing to concerns that doing so strengthens patriarchal conceptualizations of the female body as a ‘problem’ in the workplace (Baird, Hill and Colussi 2021; Jack, Riach, and Bariola 2018). Critical research concerned with ‘the body at work’ is emerging and is usefully challenging normative constructions of the ‘ideal worker’ (Acker 1990, 2006). This worker is characteristically ‘a man; men's bodies, sexuality, and relationships to procreation and paid work are subsumed in the image of the worker’ (Acker 1990, 139). Counter to this norm, and further contributing to problematising the deeply embedded stigma and taboos associated with women’s leaky, messy, painful bodies in the workplace (Grandey, Gabriel and King 2019; Remnant, Sang, Chowdhry and Richards 2023; Sang, Remnant, Calvard and Myhill 2021; Stern and Strand 2022) feminist framed research concerned with women’s nuanced and embodied experiences of mothering, breastfeeding, perimenopause, and menopause at work is also increasing (Burns, Gannon, Pierceand and Hugman 2022; O’Shea, Duffy and Gilbert 2023; Whiley, et al., 2023 Quental, Gaviria and del Bucchia 2023).
This paper seeks to illuminate how owing to gendered and intersecting workplace norms women typically conceal menstruation and its symptoms at work. Relatedly, scholars have also reported how menstrual symptoms impact women’s career development and hiring practices (Grandey, Gabriel and King 2020; Ponzo, et al., 2022; Price 2022). This sits starkly against a backdrop of gender-neutral and disembodied organizational structures (Wood 2020). Dysmenorrhea and its associated symptoms include but are not limited to bloating, headaches, nausea, fatigue, dizziness, and gastrointestinal symptoms including diarrhea, especially when severe, which can influence classroom performance and increase absenteeism at school and tertiary education (Armour, et al., 2019; Fernández-Martínez, et al., 2020). Similarly, in employment contexts, menstrual symptoms have significant economic implications for women and health-related quality of life effects with most women not seeking medical advice. Instead, women attempt to personally manage their symptoms through self-medicating (Chen, Shieh, Draucker, and Carpenter 2018), or opting out of work and/or education (Karin 2021; Hong, Jones and Mishra 2014). Problematically, this pathway does not secure women sufficient relief with a cycle of discomfort, pain, and negative school, higher education, and employment impacts persisting (Frick, et al., 2009; Armour, et al., 2022), put simplistically yet aptly ‘menstrual stigma harms’ (Bobel 2020, 4).
Similar effects can be found in those with HMB, with 68% of women reporting attendance at work or school impacts, and 80% reporting productivity effects (Bitzer, Serrani, and Lahav 2013). These effects are especially concerning because if a woman enters the workforce at eighteen (or earlier), a conservative estimate suggests that most will experience more than 400 periods during their working life, a significant proportion of these menstrual cycles may include pain, heavy bleeding, or other negative symptoms.
Women are a significant component of the labour force, thus difficult menstrual symptoms are likely to impact at the micro (individual), meso (organizational/ workplace), and macro (societal) levels. Though (before the present research) the economic effects of menstrual symptoms remain unexplored, existing research has found that in Australia, endometriosis and other forms of chronic pelvic pain incur a significant economic burden both for individual sufferers (micro level) and societally (macro level). The total cost is estimated to fall between $16,970- $ 20,898 Int per woman per year, with pain severity as the strongest predictor of cost (Armour, et al., 2019). Consistent with other studies, the bulk of these costs (84%) are attributed to productivity loss, either due to absenteeism or presenteeism, in both circumstances productivity is reduced due to pain, fatigue, and/or associated/additional symptoms. It is expected that this will be similar to primary dysmenorrhea (Schoep, et al., 2019), however, the current impact in Australia has not been calculated. Accordingly, this study contributes to a growing body of literature that sheds light on taboo issues shaping women’s employment access, experience, and development such as sexual orientation (Drydakis, 2011), obesity, and the “beauty premium” (Sarrias and Iturra, 2021).
By calculating and interrogating the economic impact of primary dysmenorrhea and menstrual symptoms on the Australian economy key stakeholders (governmental policymakers, unions, and employers) have a quantified economic evidence base to inform policy and related decision-making. Meaningful action could include intentional and participant-informed interventions to reduce gender discrimination and promote a more inclusive workplace culture or to ensure access to flexible work and/or reasonable adjustments/accommodations to working conditions (Ponzo, et al., 2022; Schoep 2019). By doing so workplace productivity improvements can be fostered. Further and importantly these and related accommodations value women’s agency by enabling them to manage their menstrual symptoms in dignified ways (Howe, et al., 2023), a fuller discussion of which we return to later.
The study aims and cost of illness (COI) analysis is twofold. First, to determine the prevalence of period pain and other menstrual symptoms for Australian women in paid employment over 18 years. Second, to assess the impact of menstruation on work productivity (presentism and absenteeism) to estimate the economic impact in Australia of lost productivity due to menstruation. In conclusion, we offer a feminist-framed discussion of how women’s economic participation and working lives might be improved through legislative and policy developments associated with menstruation and menstrual symptom management while at work.