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Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women
  1. Mark E Schoep1,2,
  2. Eddy M M Adang3,
  3. Jacques W M Maas4,
  4. Bianca De Bie5,
  5. Johanna W M Aarts1,
  6. Theodoor E Nieboer1
  1. 1Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
  2. 2Department of Obstetrics and Gynaecology, Hospital Rijnstate, Arnhem, The Netherlands
  3. 3Department of Health Evidence, Radboudumc, Nijmegen, The Netherlands
  4. 4Obstetrics & Gynaecology, Maxima Medical Centre locatie Veldhoven, Veldhoven, The Netherlands
  5. 5Dutch Patient Endometriosis Foundation, Numansdorp, The Netherlands
  1. Correspondence to Dr Theodoor E Nieboer; bertho.nieboer{at}


Objective To evaluate age-dependent productivity loss caused by menstruation-related symptoms, measured in absenteeism (time away from work or school) and presenteeism (productivity loss while present at work or school).

Methods Design/setting: internet-based, cross-sectional survey conducted in the Netherlands from July to October 2017.

Participants: 32 748 women aged 15–45 years, recruited through social media.

Outcome measures: self-reported lost productivity in days, divided into absenteeism and presenteeism; impact of menstrual symptoms; reasons women give when calling in sick; and women’s preferences regarding the implications of menstruation-related symptoms for schools and workplaces.

Results A total of 13.8% (n=4514) of all women reported absenteeism during their menstrual periods with 3.4% (n=1108) reporting absenteeism every or almost every menstrual cycle. The mean absenteeism related to a woman’s period was 1.3 days per year. A total of 80.7% (n=26 438) of the respondents reported presenteeism and decreased productivity a mean of 23.2 days per year. An average productivity loss of 33% resulted in a mean of 8.9 days of total lost productivity per year due to presenteeism. Women under 21 years were more likely to report absenteeism due to menstruation-related symptoms (OR 3.3, 95% CI 3.1 to 3.6). When women called in sick due to their periods, only 20.1% (n=908) told their employer or school that their absence was due to menstrual complaints. Notably, 67.7% (n=22 154) of the participants wished they had greater flexibility in their tasks and working hours at work or school during their periods.

Conclusions Menstruation-related symptoms cause a great deal of lost productivity, and presenteeism is a bigger contributor to this than absenteeism. There is an urgent need for more focus on the impact of these symptoms, especially in women aged under 21 years, for discussions of treatment options with women of all ages and, ideally, more flexibility for women who work or go to school.

  • menstruation
  • community gynaecology
  • menstrual cycle
  • presenteeism
  • absenteeism

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  • Contributors TEN, BDB and JWMA conceived the study. MES wrote the first and successive drafts of the manuscript. MES, TEN and EMMA modelled and analysed the data. TEN, EMMA, JWMM, BDB and JWMA contributed to study conception and design. MES and TEN collected the data. All authors revised the manuscript for important intellectual content. MES and TEN had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. TEN is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Approval for this study was obtained from the local medical ethics committee ‘Commissie Mensgebonden Onderzoek (CMO)’ under number file number 2017–3387 on 12 July 2017.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data from this study are available from a repository. Data are available on request from the corresponding author.

  • Patient consent for publication Not required.