“The memory I have is of being in 7th grade — when the period appeared — and it was so painful that I had to leave the room and go to the infirmary… I couldn’t even go home, I couldn’t walk,” begins Ana Almeida. The solution was to lie on a stretcher “waiting for things to get better”. At the same time as she was suffering, Ana, 12, still had to deal with mocking comments and looks: “Everyone asked what was going on and suddenly the subject became public. The boys, of course, started laughing and teasing.
Facing ao invoice Presented and voted recently in Spain, the screenwriter, now 46 years old, has once again analyzed what she has experienced. “When I saw the furlough news, I thought it would have made sense to me.” The heavy bleeding and “awful pain” she was experiencing lasted around three days and was “very debilitating”. “It was really knockout,” he recalls.
The proposal, which still has to be approved by the Spanish parliament, includes, as main measures, the possibility of abortion from the age of 16 without parental consent and disabling menstruation leave.
the gynecologist Irina Ramilo clarifies that “there may be some discomfort or pain” during the menstrual period. However, “it is not normal to have intense pain which persists and which can reduce the quality of life of the woman, preventing her from maintaining a professional activity”.
This was the case of Ana who, even when she arrived in the world of work, did not see her situation improve. “I remember having to tell my boss – who was a man – that I had to leave because I couldn’t stand my period pain. And he kept looking at me. It was such an embarrassing situation that he just agreed and let me go.
The screenwriter, who says she has “no particular clinical situation”, was limited to suffering and enduring. But the pain in the pelvic area was so intense that sometimes, even with ibuprofen, it did not go away.
Pain “is always subjective”
“We cannot measure pain; it’s always subjective”, assures the doctor. Irina Ramilo continues: “It’s something difficult to assess; there is no concrete data. Even in consultation, we try to apply scales, but it is there are different scales, all with advantages and disadvantages”. And he adds: “If in the exams we see [o problema]we know you are suffering from debilitating menstrual pain and need to take some time off.
The moment Ana Almeida really understood the dimension of her pain was after having children, because she realized that what she felt during childbirth was easily comparable to the menstrual pains that she regularly felt.
But even then, he did not explore his condition. “I couldn’t go to the doctor, but maybe I should have, at the time… I thought it was banal, that it was like that, that it wasn’t even valued to the point of going to the doctor. “The situation only calmed down when she became sexually active and started using contraceptives, which gave her ‘more quality of life’ and eased her pain. — but also menstruation.
Is menstrual leave a sign of greater inequality?
When we imagine the implementation of a menstrual license in Portugal, several questions torment the gynecologist Irina Ramilo: to what extent will there be rules to establish the license? Just be a woman and be in pain? How is the license defined and what is its duration?
Along with these ethical and moral concerns also arise. “The truth is that there can be bad intentions and fraudulent situations… Even at the level of feminism, questions arise. Will we have more work difficulties? Will there be more gender inequalities? he wonders.
Also the right to decide on the use (or not) of a contraceptive method can end up being affected, explains the specialist. It all depends on whether, in response to the pain she feels, “the woman wants to undergo treatment or not” (if applicable), and whether before that “she wants to do, first, analgesic drugs or contraception” .
Despite all the questions or uncertainties that can trigger menstrual leave, its implementation “can be important”, imposing itself as an alternative to medical declarations or the use of vacation days. “Should we give it away? If there are rules and limits, yes, it should”, defends the doctor.
The opinion of the Portuguese Society of Gynecology (GPS), coincides with that of gynecologist Irina Ramilo. “SPG supports this type of measure, provided it is properly framed and justified. You have to be careful that not all menstrual pain justifies absence from work,” explains Margarida Martinho, general secretary of the association.
For Ana Almeida, the idea of having a permit arouses a “mixed feeling”, since it is necessary “to admit that women have a biological fragility that happens every month”. Basically, with the license, “there is a private thing that becomes public”. “But at the same time we legitimize a particularity of women.
How many women suffer in Portugal?
There are no figures that represent the Portuguese reality regarding women of childbearing age who suffer from menstrual pain or the diseases that cause them, explains Margarida Martinho. However, “it is a fact that this is a problem that has a great impact on the quality of life of women”.
The neighboring country, however, has values. Spain’s Secretary of State for Equality, Ángela Rodriguez, published that “53% of women suffer from painful menstruation and, in younger women, this percentage reaches 74%”.
These painful periods can occur due to specific pathologies. Gynecologist Irina Ramilo highlighted five that impact a woman’s menstrual period: endometriosisadenomyosis, chronic pelvic pain, pelvic inflammatory disease and polycystic ovary syndrome.
The first is “the one that causes the most pain, from zero to ten, 12”, simplifies. In endometriosis, the tissue that lines the inside of the uterus (called the endometrium) is found outside the uterus, usually in the ovaries. It is an incurable chronic disease. According to the Secretary General of the SPG, “endometriosis affects at least 10% of Portuguese women of childbearing age”.
Adenomyosis is a uterine alteration which, the gynecologist explains, differs from the previous condition. “In fact, they are often associated, but they are different.” In this disease, the walls of the uterus become thicker, which can cause pain, bleeding and severe cramping. It can be cured, but for that you have to remove the uterus, explains doctor Irina Ramilo.
Pelvic pain, on the other hand, is intermittent or constant pain that is felt below the navel area and can lead to disability. Pelvic inflammatory disease, on the other hand, is an inflammation of the female reproductive organs, which does not always lead to pain during menstruation. The disease begins in the vagina and progresses to the uterus, fallopian tubes and ovaries and in most cases occurs as a result of an infection that has not been properly treated.
Finally, polycystic ovary syndrome causes changes in hormone levels, causing small cysts to form on the ovaries that cause pain. This does not necessarily have to be felt every period, adds the gynecologist.
Despite these five conditions, there are still cases like Ana Almeida’s, in which there is no diagnosed problem, but the pain persists.
Menstrual leave in Portugal: reality or utopia?
In Portugal, the debate on menstrual leave has also started. The kick-off was given by the PAN, which proposelast Friday, May 13, the creation of a menstrual leave that was “up to three days”.
In the proposed amendment to the state budget for 2022, the party defends: “to allow these people to [com útero que sofrem dores graves durante a menstruação]quite rightly, if they are absent from work for a period during which they are not able to work under ideal conditions, it is a matter of social and labor justice”.
Although the proposal has been presented, it will still be discussed in the parliamentary committee.
The Portuguese Association of Support for Women with Endometriosis has also mobilized to defend the creation of a menstrual license. THE petition created – to which gynecologist Irina Ramilo has already contributed – has already collected more than 8000 signatures. Among the seven points it presents, in the fifth we can read the “creation of a menstrual license for patients diagnosed with endometriosis and / or adenomyosis”, taking as an example South Korea, Taiwan and the ‘Indonesia, a country where the license is already in force. .