In Mexico, people who menstruate and have been diagnosed with debilitating primary or secondary dysmenorrhea will soon be entitled to 2 days of paid leave per month, if the Congress of the Union approves the proposal by the Mexico City Congress to amend article 132 of the Federal Labor Act and article 28 of the Federal Law on State Workers.
The proposal also includes 1 day of paid leave per year for mammograms and Papanicolaou tests (Pap smears) for working women, and a half-day for prostate exams for men.
Wendy Sánchez, PhD
“This initiative is a milestone in the fight for women’s rights in the workplace, as well as in health. Menstruation is becoming more visible, giving us a starting point for understanding the menstrual cycle as a whole,” said Wendy Sánchez, PhD, research professor at the National School of Higher Education (ENES)’s Morelia Unit, Mexico City, Mexico, and menstruation activist.
Paola Dávila, PhD
According to Paola Dávila, PhD, and specialist in occupational and civil issues, this initiative will set the stage for gender equality. “I think this initiative is really advanced. They are demystifying the issue and overcoming the idea of discrimination. I’m sure they will approve it so that they can establish more of the rights that we still lack. This is a big step toward eliminating gender inequality in the workplace, where Mexico still has a long way to go.”
Dysmenorrhea is chronic, cyclic pelvic pain that begins just before or at the start of a menstrual period, in the form of cramping in the lower abdomen that may spread to the back and thighs, and typically lasts from 8 to 72 hours. It can also cause various other systemic symptoms: nausea, vomiting, diarrhea, headaches, fatigue, dizziness, and insomnia. Depending on its intensity, it can be just as problematic as surgical pain. It is called primary dysmenorrhea when no related illness is identified, while secondary dysmenorrhea refers to cases with an identified pathologic cause such as endometriosis, adenomatosis, myoma, or pelvic inflammatory disease.
Sánchez believes that this initiative should be a starting point for discussion and education about the menstrual cycle. “It’s important to note that the explanatory statements do not distinguish between menstruation and the menstrual cycle. They treat them as the same thing, but we know that menstruation is just a part of the whole cycle. This needs to be raised as an issue for education.”
To take this leave, women will have to submit a medical certificate issued by a gynecologist, confirming the dysmenorrhea diagnosis. The certificate will be valid for 1 year, after which a new assessment will be needed to confirm the diagnosis.
The specialist should preferably work at a public institution; for private specialists, the certificate must include the doctor’s full name and professional license number, the date of issue, and the medical status of the menstruating worker.
Dávila noted that the mechanisms for implementing this are yet to be established. “There needs to be some oversight to prevent discrimination, like penalties for employers who do not respect this type of leave. On the other hand, it needs to prevent workers from abusing the ability to miss work. We also need regulated mechanisms for validation. If the person who menstruates must go to a medical department and wait for 5 or 6 hours to get a doctor’s note…that won’t work. It can also be very expensive to see a specialist, putting it out of reach for most people.”
Regarding the feasibility of implementing this system, Sánchez explained, “It will take time to find out how much of this can be implemented properly, how well companies will comply, and how many women will use this as an opportunity for self-awareness, whether they will actually use it as a health-related right or just as a way to skip work. We will see which economic, social, and cultural factors affect compliance or noncompliance with these regulations. Once the amendment has been published, we will have to wait and see how these processes fit in with the companies and groups involved. Will it work as expected? Only time will tell, and more research may be carried out in future.”
To request a day off for a mammogram and Pap smear or a half-day for a prostate exam, workers will have to give their employers 5 working days’ notice and submit the appointment details as evidence.
Dr Verónica Reyes
Verónica Reyes, MD, a gynecologist specializing in minimally invasive gynecologic surgery and president of the Specialist Gynecology health clinic, thinks that although this initiative is important, it could perpetuate the idea that menstrual pain is normal. “Letting patients take leave when they are in pain is the right thing to do. The valuable part is that patients with dysmenorrhea will be looked at again, that they will have a voice. But many patients normalize this pain, and that’s not good, because it could lead them to believe that they need time off because it’s normal to be in pain. But that’s not the case. There is a whole range of diseases that cause dysmenorrhea which could be involved: they could have endometriosis, myoma, or some other condition that is causing their persistent pain.”
This is reflected by the high prevalence of dysmenorrhea in Mexico, which is reported by 28%-90% of menstruating women, although few of them seek medical care.
Reyes pointed out that one of the main challenges for implementing this proposed initiative is deciding who will be granted leave. “Pain is subjective; on a scale from one to 10, what could be a two for one person could be a 10 for someone else. It can’t be measured. If we connect you to a heart monitor, we can see that the figures are off and we can tell that you are in pain, but we can’t tell how bad it is.”
She added that dysmenorrhea is also difficult to diagnose. “For example, the gold standard for diagnosing endometriosis, which is the main cause of dysmenorrhea and is extremely common among Mexican women, is a laparoscopy. But we can’t perform a laparoscopy on every patient who has dysmenorrhea and suspected endometriosis. If we do diagnose them, we must treat them. If a patient already knows what is causing the pain, we need to control the disease to decrease it. I think that granting leave will lead these patients to focus on their pain and get an early diagnosis,” concluded Reyes.
Sánchez, Dávila, and Reyes report no relevant financial relationships.
This article was translated from Medscape’s Spanish edition.
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