"I remember being in the classroom teaching, and I was in so much pain that I was in tears. And I just didn't know what to do. And obviously, I had to leave."

This is how Judy Birch describes what it was like when she had severe menstrual symptoms.

Birch, who now runs the UK-based Pelvic Pain Support Network, is among billions of women who suffer from severe menstruation symptoms. Called dysmenorrhea, this could include heavy bleeding, severe cramping and fatigue; or even nausea, vomiting and diarrhea.

According to one comprehensive review of studies, up to 91% of women in reproductive age suffer from dysmenorrhea, including severe pain in among up to 29%.

Dysmenorrhea is severe enough to interfere with the daily activities of up to 20% of women, says the American Academy of Family Physicians.

So how do women cope?

"I just struggled through," Birch says, "not able to concentrate, not able to focus … and I just wasn't functioning properly at all."

In some countries around the world, women may draw upon legally allocated time off during their periods. Such "menstrual leave" policies are controversial — they're accused of fueling stigma and discrimination, end up a subject of intense debate and have difficulty gaining traction. Yet Spain could be poised to become the first such country in Europe to offer this kind of leave.

Three days extra leave per month

A leaked draft law, slated to head to Spain's ministerial council on Tuesday, would allocate up to three days every month for menstrual leave.

Although not all details are clear, women would need to be experiencing severe menstrual symptoms and likely be required to present a medical certificate to claim the leave.

Toni Morillas, director of Spain's Institute of Women, a government agency, told Spanish online news outlet Publico, "In our country … we have difficulty recognizing menstruation as a physiological process that must generate rights."

Morillas also cited data indicating that one in every two women experience painful periods.

DW did reach out to both the institute and the Spanish Ministry of Equality, where the institute is anchored, but both declined to offer comment at this time.

The policy proposal, which may still be changed, is part of a new reproductive health law that provides leave to women who terminate pregnancies and removes the requirement for parental approval in abortions among women aged 16 to 17. It would also eliminate sales tax on menstrual products, like pads and tampons, in supermarkets.

East Asian countries lead in menstrual leave

The Italian parliament had put forth a similar period leave proposal in 2017, which sparked extensive discussion around whether it might increase workplace discrimination. The bid ultimately failed to progress.

Only a handful of countries — Japan, South Korea, Taiwan, Indonesia and Zambia — currently have national policy frameworks that grant paid menstrual leave.

Veve Hitipeuw, CEO of Kiroyan Partners in Indonesia, is both an employer who must offer this leave — and has also taken advantage of it as an employee.

She says she's used this leave from time to time, as she suffered from severe abdominal pain during menstruation. "It was very difficult to sit down properly. I wasn't able to work if it has to be sitting in front of my desk or my laptop for eight or nine hours a day."

"It was really awful," Hitipeuw said of her painful periods, and she described the policy as "really helpful for me."

She says that although she never experienced any problems around taking or granting it, "There's still stigma or discrimination surrounding this leave, because people think: Women are just lazy, they don't want to work."

Especially for female workers in factories, she adds, where productivity is directly linked to time present on the job, the framework may exist mostly in theory.

Period leave can be problematic

A look at Japan, which introduced its period leave policy in 1947 as part of post-war industrial reforms, seems to uphold that viewpoint. A recent Nikkei survey found that less than 10% of women were claiming menstrual leave, although some 48% of those surveyed sometimes want to take it but never have, for example because they are reluctant to apply to their male boss or because so few other women take advantage of it.

Also in European countries with generous leave policies, it's not common to cite menstruation as the reason for taking time off. In the Netherlands, a 2019 survey of more than 30,000 Dutch women found that although 14% had taken time off work during their period, only 20% provided the true reason.

An extensive academic paper from 2020, published as part of a handbook on menstruation studies, outlined the benefits and drawbacks of menstrual leave in the workplace.

Negative implications of such policies include "perpetuating sexist beliefs and attitudes, contributing to menstrual stigma and perpetuating gender stereotypes, negatively impacting the gendered wage gap, and reinforcing the medicalization of menstruation," the paper says.

Such negative gender stereotypes include female fragility, unproductivity and unreliability, while "medicalization of menstruation" negatively portrays menstruation as a disease that needs "fixing," the paper explains.

As mentioned in the paper, menstruators may include nonbinary and transgender people, who should also have access to period leave.

In Birch's experience with the network in the UK, "A lot of women are actually penalized at work if they do take regular time off, as a monthly thing." They may be disciplined or even let go.

The ability to get a menstrual leave policy in place would vary greatly from country to country, she points out, and be much more difficult in countries like the US, which offer little paid leave in general.

For Birch, Spain's proposal is not enough. "When you have that type of pain every month, three days is nothing."

"I think it's pitiful."

She believes that the overall work environment needs to be made much more flexible to accommodate women with severe menstrual symptoms.

This is also one upshot of the 2020 paper, which stated that "some menstruators would benefit from workplace flexibility more generally (for example, more time off, the ability to work from home, customized work schedules)."

And some companies are picking up on this point, even building it into their company policies.

Supporting women in the workplace

Zomato, a platform based out of India with a core business of food delivery, has had a menstrual leave policy in place since August 2020. The company's communications head, Vaidika Parashar, describes the framework as granting 10 period leave days over the course of the year, in addition to other leave.

She describes an honor system where employees simply post an emoticon of a calendar with red droplets as their status on a team chat, no questions asked. She also uses this leave.

"On one of those days, I would literally put on the emoticon and be like, I am not available. And I've seen a lot of folks who respect it. It's taken very seriously here at Zomato."

The company has made efforts to promote a company culture where stigma does not get attached to period leave. The policy applies to "all applicable genders," including transgender people, she explains. "You should not feel uncomfortable about it, it's a biological function."

Implementing the policy has actually increased productivity at the company, she asserts. In the survey of women from the Netherlands, lost productivity due to "presenteeism," or occasions when about 81% of women showed up to work despite severe menstrual symptoms, amounted to almost nine days a year.

Parashar adds that at Zomato, menstrual leave has helped to build transparency, enabled a work environment where people are confident of being themselves, and increased employee retention — and it acts to recruit women. According to a government report from 2020, in India only about 16% of women participate in the labor force.

Perhaps some use menstrual leave when they are not doing that poorly, she adds, although "We've never had any case of misuse that's been reported formally to us."

Regardless, such misuse is not relevant, Parashar believes, since "We just feel that we need to enable workers to have the right mechanisms to always be at their best. Be it the parental leave, be it the menstrual leave — all these functions become a part of it."

For Hitipeuw, granting menstrual leave is also "basically a symbol of acknowledgement and support for women."

"Workplaces or companies have to enable women to perform their work and at the same time, their role in the society — and also as a human being, as a woman and a mother."