HomePsychology and Education: A Multidisciplinary Journalvol. 34 no. 8 (2025)

Menstrual Distress among Female Employees of the Private Sector: A Basis for Policy Development

Karyll Nicka Rivera | Floraels Leigh Frane | Princess Riofelle Ramiscal | Reyna Jane Secretario | Carl Steve Valmores | Kristel Joy Dapiawen | Shiellah Mae Barsicula | Lady Valen Charon DelaPeña

Discipline: others in psychology

 

Abstract:

Menstruation significantly impacts the quality of life and productivity of women, presenting different physical, psychological, and emotional challenges known as menstrual distress. This study focuses on the level of menstrual distress among female employees in the private sector, emphasizing the need for supportive workplace policies. In addition, the study utilized a mixed-method approach. This research combined descriptive-comparative-correlational designs with thematic analysis to explore the experiences of 50 female workers from private institutions in Bayombong, Nueva Vizcaya. A validated questionnaire was used to gather quantitative data on menstrual phases, distress levels, and their impact on productivity. On the other hand, qualitative data were analyzed to uncover common themes in participants' experiences of menstrual distress. Moreover, the study found a consistently high level of menstrual distress among participants, regardless of age, lifestyle, medical background, or frequency of OB-GYN visits. Coping mechanisms such as using hot compresses and resting were commonly reported. A significant finding was the massive support among female employees for enacting the Menstrual Leave Act (House Bill 7758), indicating a strong demand for policy intervention. This study found that factors like age, lifestyle, medical background, and OB-GYN visits do not significantly affect the level of menstrual distress experienced by female employees, which remains high during their menstrual cycles. It suggests that menstrual leave policies, such as House Bill 7758, should apply to all women. To fully grasp the scope of menstrual distress affecting female employees, it's crucial to conduct more research as this issue involves numerous factors that have a substantial effect on their health and work performance.



References:

  1. Al-harbi AS, Alrahili M, Al-harbi SS (2019) The Impact of Menstrual Periods on Performance of Female Workers. J Women’s Health Care 9:483. doi:10.35248/2167-0420.20.9.483.
  2. AlQuaiz, A., Albugami, M., Kazi, A., Alshobaili, F., Habib, F., & Gold, E. B. (2022). undefined. International Journal of Women’s Health, 14, 1709-1722. https://doi.org/10.2147/ijwh.s387259
  3. Armour, M., Dahlen, H., & Smith, C. (2015). A change of perspective: Treatment for period pain using acupuncture alters how women view their menstrual cycle. Integrative Medicine Research, 4(1),    12. https://doi.org/10.1016/j.imr.2015.04.315
  4. Armour, M., Parry, K., Al-Dabbas, M. A., Curry, C., Holmes, K., MacMillan, F., Ferfolja, T., & Smith, C. A. (2019). Self-care strategies and sources of knowledge on menstruation in 12,526 young women with dysmenorrhea: A systematic review and         meta-analysis. PLoS   ONE,   14(7),   e0220103. https://doi.org/10.1371/journal.pone.0220103
  5. Asgari, S., Alimoardi, Z., Soleimani, M. A., Allen, K., & Bahrami, N. (2020). The effect of psychoeducational intervention, based on a self-regulation model on menstrual distress in adolescents: A protocol of a randomized controlled trial. Trials, 21(1). https://doi.org/10.1186/s13063-020-04629-z
  6. Barnard, K., Frayne, S. M., Skinner, K. M., & Sullivan, L. M. (2003). Health status among women with menstrual symptoms. Journal of Women’s Health, 12(9), 911-919. https://doi.org/10.1089/154099903770948140
  7. Bernstein, M. T., Graff, L. A., Avery, L., Palatnick, C., Parnerowski, K., & Targownik, L. E. (2014). Gastrointestinal symptoms before and during menses in healthy women. BMC Women’s Health, 14(1). https://doi.org/10.1186/1472-6874-14- 14
  8. Bertone-Johnson, E. R., Hankinson, S. E., Willett, W. C., Johnson, S. R., & Manson, J. E. (2010). Adiposity and the development of premenstrual syndrome. Journal of Women’s Health, 19(11), 1955-1962. https://doi.org/10.1089/jwh.2010.2128
  9. Bhavsar, K. P. (2023). Menstruation leave. Perspectives on Coping Strategies for Menstrual and Premenstrual Distress, 262-281. https://doi.org/10.4018/978-1- 6684-5088-8.ch014
  10. Bobel, C., Winkler, I. T., Fahs, B., Hasson, K. A., Kissling, E. A., & Roberts, T. (2020). The palgrave handbook of critical menstruation studies. Springer Nature.
  11. Bookshelf: Menstrual hygiene matters: A Resource for improving menstrual hygiene around the world by Sarah house, Thérèse Mahon, sue Cavill Co-published by WaterAid and 17 other organizations, 2012 www.wateraid.org/mhm. (2013). Reproductive Health Matters, 21(41), 257-259. https://doi.org/10.1016/s0968- 8080(13)41712-3
  12. Bozdag, G., Mumusoglu, S., Zengin, D., Karabulut, E., & Yildiz, B. O. (2016). The prevalence and phenotypic features of polycystic ovary syndrome: A systematic review and meta-analysis. Human Reproduction,        31(12), 2841-2855. https://doi.org/10.1093/humrep/dew218
  13. Career development. (2024, August 16). indeed; Jamie Birt. https://www.indeed.com/career-advice/career-development/private-sector
  14. Chauhan, S., More, A., Chauhan, V., & Kathane, A. (2022). Endometriosis: A review of clinical   diagnosis,   treatment,   and   pathogenesis.           Cureus. https://doi.org/10.7759/cureus.28864
  15. Chothe, V., Khubchandani, J., Seabert, D., Asalkar, M., Rakshe, S., Firke, A., Midha, I., & Simmons, R. (2014). Students’ perceptions and doubts about menstruation in developing countries. Health Promotion Practice, 15(3), 319-326. https://doi.org/10.1177/1524839914525175
  16. Cicek, G. (2018). The effect of regular aerobic exercises on premenstrual syndrome in sedentary women. Baltic Journal of Health and Physical Activity, 10(2), 34–42. https://doi.org/10.29359/bjhpa.10.2.04
  17. Ciołek, A., Kostecka, M., Kostecka, J., Kawecka, P., & Popik-Samborska, M. (2023). An assessment of women’s knowledge of the menstrual cycle and the influence of diet and adherence to dietary patterns on the alleviation or exacerbation of menstrual distress. Nutrients, 16(1), 69. https://doi.org/10.3390/nu16010069
  18. Coast, E., Lattof, S. R., & Strong, J. (2019). Puberty and menstruation knowledge among young adolescents in low- and middle-income countries: A scoping review. International    Journal    of    Public    Health,    64(2),    293-304. https://doi.org/10.1007/s00038-019-01209-0
  19. Committee Opinion No. 651. (2015). Obstetrics and Gynecology, 126(6), e143–e146. https://doi.org/10.1097/aog.0000000000001215
  20. Corey Whelan. (2024, September 18). Luteal phase of the menstrual cycle. Verywell Health. https://www.verywellhealth.com/luteal-phase-8709492
  21. Crawford, N. M., Pritchard, D. A., Herring, A. H., & Steiner, A. Z. (2017). Prospective evaluation of luteal phase length and natural fertility. Fertility and Sterility, 107(3), 749-755. https://doi.org/10.1016/j.fertnstert.2016.11.022
  22. Critchley HOD, Babayev E, Bulun SE, Clark S, Garcia-Grau I, Gregersen PK, Kilcoyne A, Kim JJ, Lavender M, Marsh EE, Matteson KA, Maybin JA, Metz CN, Moreno I, Silk K, Sommer M, Simon C, Tariyal R, Taylor HS, Wagner GP, Griffith LG. Menstruation: science and society. Am J Obstet Gynecol. 2020;223(5):624–64. https://doi.org/10.1016/j.ajog.2020.06.004.
  23. De Arruda, G. T., Driusso, P., De Godoy, A. G., Rodrigues, J. C., & Avila, M. A. (2024b). Presenteeism and associated factors among women with menstrual symptoms. Archives of Gynecology and Obstetrics, 309(5), 2071–2077. https://doi.org/10.1007/s00404-024-07425-1
  24. Diagnosis and treatment of luteal phase deficiency: A committee opinion. (2021). Fertility and Sterility, 115(6), 1416-1423. https://doi.org/10.1016/j.fertnstert.2021.02.010
  25. Domingo, L. C. (2023, July 28). Nueva Vizcaya provincial board passes menstrual privilege ordinance.        The      Manila Times. https://www.manilatimes.net/2023/07/27/regions/nueva-vizcaya- provincial-board-passes-menstrual-privilege-ordinance/1902677
  26. Domingo, L. C. (2023, July 28). NVizcaya board okays menstrual privilege ordinance, first in           PH.      The      Manila Times.
  27. Dysmenorrhea - StatPearls - NCBI bookshelf. (2022, July 18). National Center for Biotechnology    Information. https://www.ncbi.nlm.nih.gov/books/NBK560834/
  28. Dysmenorrhea   (Menstrual       cramps).          (2024,  May     1).        Cleveland   Clinic. https://my.clevelandclinic.org/health/diseases/4148-dysmenorrhea
  29. Escudero, C. (2023, March 27). Proposed menstrual leave in PH draws mixed reactions online. RAPPLER. https://www.rappler.com/nation/filipinos-online-reactions- proposed-menstrual-leave-gabriela-party-list-philippines/
  30. Eshetu, N., Abebe, H., Fikadu, E., Getaye, S., Jemal, S., Geze, S., Mesfin, Y., Abebe, S., Tsega, D., Tefera, B., & Tesfaye, W. (2022). Premenstrual syndrome, coping mechanisms and associated factors among Wolkite university female regular students, Ethiopia, 2021. BMC Women S Health, 22(1). https://doi.org/10.1186/s12905-022-01658-5
  31. Ezbarami, S. M., Esfarjani, F., & Mirzaei, B. (2014). Comparison the prevalence and severity of dysmenorrhea among athletes and non-athletes and its relation with body composition. Arak Medical University Journal, 16(80), 8.
  32. Fehring, R., Schneider, M., & Raviele, K. (2006). Variability in the Phases of the Menstrual Cycle. Journal of Obstetric, Gynecologic & Neonatal Nursing,, 376-384. https://doi.org/10.1111/j.1552-6909.2006.00051.x
  33. Ghani, H. M., Shafi, G. N., Wardhana, D. F., Maulani, I., & Oktorina, S. (2023). A review Articel : The relationship between nutritional status and menstrual patterns with the incidence of anemia in adolescent girls. Proceedings of International Conference on Halal Food and Health Nutrition, 1(1), 129-136. https://doi.org/10.29080/ichafohn.v1i1.1148
  34. Grzegorz Mrugacz, Piotr Pietrewicz, Igor Bołkun, Mirosław Grusza, Cezary Grygoruk, & Piotr Sieczyński. (2013, March 17). Etiopathogenesis of dysmenorrhea. PubMed.
  35. Gul Nawaz; Alan D. Rogol. (2023). Amenorrhea - StatPearls - NCBI bookshelf. National Center  for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK482168/
  36. Hardy, C., & Hunter, M. S. (2021). Premenstrual symptoms and work: Exploring female staff experiences and recommendations for workplaces. International Journal of Environmental Research and Public Health, 18(7), 3647. https://doi.org/10.3390/ijerph18073647
  37. Hennegan, J. (2020). Interventions to improve menstrual health in low- and middle- income countries: Do we know what works? The Palgrave Handbook of Critical Menstruation Studies, 637-652. https://doi.org/10.1007/978-981-15-0614- 7_47
  38. Hennegan, J., Bukenya, J. N., Makumbi, F. E., Nakamya, P., Exum, N., Schwab, K. J., & Kibira, S. P. (2021). Menstrual health challenges in the workplace and consequences for women’s work and wellbeing: A cross-sectional survey in Mukono, Uganda. https://doi.org/10.31235/osf.io/rb9wq
  39. Herndon, J. (2024, March 11). When should I worry about Mastalgia (Breast pain)? Verywell Health. https://www.verywellhealth.com/mastalgia-medical- definition
  40. Hirschfeld, R. M. (2001). Clinical importance of long-term antidepressant treatment. British Journal of Psychiatry, 179(S42), s4-s8. https://doi.org/10.1192/bjp.179.42.s4
  41. Hofmeister, S., & Bodden, S. (2016, August 1). Premenstrual syndrome and premenstrual dysphoric disorder. American Academy of Family Physicians | AAFP.https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html#afp201 60801p236-b10
  42. House passes bill strengthening anti-discrimination law for women workers. (2022, November          29). Philstar.com. https://www.philstar.com/headlines/2022/11/29/2227276/house-passes- bill-strengthening-anti-discrimination-law-women-workers
  43. Huda, F., Afrin, S., Sarker, B., Mahmood, H., & Alam, A. (2017). Introduction and approval of menstrual regulation with medication in Bangladesh: A stakeholder analysis. https://doi.org/10.31899/rh4.1030
  44. Huo, L., Straub, R. E., Roca, C., Schmidt, P. J., Shi, K., Vakkalanka, R., Weinberger, D. R., & Rubinow, D. R. (2007). Risk for premenstrual dysphoric disorder is associated with genetic variation in ESR1, the estrogen receptor Alpha gene. Biological Psych
  45. Iacovides S, Avidon I, Baker FC: What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015;21(6):762–78. 10.1093/humupd/dmv039
  46. Jahanfar, S., Lye, M., & Krishnarajah, I. S. (2011). The heritability of premenstrual syndrome. Twin Research and Human Genetics, 14(5), 433-436. https://doi.org/10.1375/twin.14.5.433
  47. Janoowalla, H., Keppler, H., Asanti, D., Xie, X., Negassa, A., Benfield, N., Rulisa, S., & Nathan,L. M. (2019). The impact of menstrual hygiene management on adolescent health: The effect of go! pads on rate of urinary tract infection in adolescent females in Kibogora, Rwanda. International Journal of Gynecology & Obstetrics, 148(1), 87-95. https://doi.org/10.1002/ijgo.12983
  48. Jardim, N. (2021, July 29). Menstrual cycle phases: Each stage of your cycle, explained | mindbodygreen. mindbodygreen: well-rounded well-being for a life well lived. https://www.mindbodygreen.com/articles/menstrual-cycle-phases
  49. Jiang, W., Hua, X., Hu, C., Li, F., Huang, K., & Zhang, X. (2018). The prevalence and risk factors of menstrual pain of married women in Anhui province, China. European Journal of Obstetrics & Gynecology and Reproductive Biology, 229, 190-194. https://doi.org/10.1016/j.ejogrb.2018.09.002
  50. Jukic, A. M., Weinberg, C. R., Baird, D. D., & Wilcox, A. J. (2007). Lifestyle and reproductive factors associated with follicular phase length. Journal of Women’s Health, 16(9), 1340-1347. https://doi.org/10.1089/jwh.2007.0354
  51. Karjula, S., Morin-Papunen, L., Auvinen, J., Ruokonen, A., Puukka, K., Franks, S., Järvelin, M., Tapanainen, J. S., Jokelainen, J., Miettunen, J., & Piltonen, T. T. (2017). Psychological distress is more prevalent in Fertile age and Premenopausal women with PCOS symptoms: 15-Year follow-up. The Journal of Clinical Endocrinology    &          Metabolism,     102(6), 1861-1869.
  52. Karlsson, T. S., Marions, L. B., & Edlund, M. G. (2013). Heavy menstrual bleeding significantly affects quality of life. Acta Obstetricia et Gynecologica Scandinavica, 93(1), 52-57. https://doi.org/10.1111/aogs.12292
  53. Karout, S., Soubra, L., Rahme, D., Karout, L., Khojah, H. M., & Itani, R. (2021). Prevalence, risk factors, and management practices of primary dysmenorrhea among young females. BMC Women’s Health, 21(1). https://doi.org/10.1186/s12905-021- 01532-w
  54. Kay, C. (2019, November 19). Bloated or pregnant: How to tell. Medical and health information         | MedicalNewsToday. https://www.medicalnewstoday.com/articles/327043
  55. Kessel, B. (2001). Premenstrual Syndrome: Advances in Diagnosis and Treatment. ScienceDirect. https://doi.org/10.1016/S0889-8545(05)70160-1
  56. Lee, Y., & Im, E. (2015). Stress and premenstrual symptoms in reproductive-aged women. Health Care for Women International, 37(6), 646-670. https://doi.org/10.1080/07399332.2015.1049352
  57. Lena, P. (2022). WFH on ‘red days’ to benefit 100 municipal workers in Aklan. Philippine News Agency.
  58. Levitt, R. B., & Barnack-Tavlaris, J. L. (2020). Addressing Menstruation in the Workplace: The Menstrual Leave Debate. In Springer eBooks (pp. 561–575). https://doi.org/10.1007/978-981-15-0614-7_43
  59. Luteal phase of the menstrual cycle: Symptoms & length. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/24417-luteal-phase
  60. Manoj, K., Narayan, J., Singh, N., & Saxena, I. (2010). Indian J Physiol Pharmacolo. Variation in response to experimental pain across the menstrual cycle in women compared with one month response in men., 54, 57-62.
  61. Maqbool, R., Maqbool, M., Zehravi, M., & Ara, I. (2021). Menstrual distress in females of reproductive age: A literature review. International Journal of Adolescent Medicine and Health, 34(2), 11-17. https://doi.org/10.1515/ijamh-2021-0081
  62. Marshburn, P. B., & Hurst, B. S. (2014). Overview: Disorders of menstruation. Disorders of Menstruation, 1-9. https://doi.org/10.1002/9781444391824.ch1
  63. Masuda, H., & Okada, S. (2023). Menstruation-related symptoms are associated with physical activity and midpoint of sleep: a pilot study. Frontiers in Global Women S Health, 4. https://doi.org/10.3389/fgwh.2023.1260645
  64. Matsumoto, T., Egawa, M., Kimura, T., & Hayashi, T. (2019). A potential relation between premenstrual symptoms and subjective perception of health and stress among college students: a cross-sectional study. BioPsychoSocial Medicine, 13(1). https://doi.org/10.1186/s13030-019-0167-y
  65. Matthew T Bernstein Lesley A Graff , Lisa Avery, Carrie Palatnick, Katie Parnerowski & Laura E. (2014, January 22). Just a moment... Just a moment... https://www.researchgate.net/publication/7080221_Variability_in_the_Phase s_of_the_Menstrual_Cycle
  66. Mbongo, E. N., Miranda, H., & Haikera, H. (2023). A narrative inquiry into women’s experiences of menstruation at the workplace in Namibia. Journal of Public Health in Africa, 14(8), 5. https://doi.org/10.4081/jphia.2023.2587
  67. Mendoza, G. (2023, August 3). Why the menstrual leave bill faces an arduous path to legislation. Philippine Collegian. https://phkule.org/article/845/why-the- menstrual-leave-bill-faces-an-arduous-path-to-legislation
  68. Messinis, I. E., Messini, C. I., & Dafopoulos, K. (2014). Novel aspects of the endocrinology of the menstrual cycle. Reproductive BioMedicine Online, 28(6), 714-722. https://doi.org/10.1016/j.rbmo.2014.02.003
  69. Midilli, T. S., Yasar, E., & Baysal, E. (2015). Dysmenorrhea characteristics of female students of health school and affecting factors and their knowledge and use of complementary and alternative medicine methods. Holistic Nursing Practice, 29(4), 194-204. https://doi.org/10.1097/hnp.0000000000000091
  70. Mike Armour, Caroline A. Smith, Kylie A. Steel & Freya Macmillan. (2019, January 17). The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: A systematic review and meta-analysis. BioMed Central. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s 12906-019-2433-8
  71. Mizuta, R., Maeda, N., Komiya, M., Suzuki, Y., Tashiro, T., Kaneda, K., Tsutsumi, S., Ishihara, H., Kuroda, S., & Urabe, Y. (2022). The relationship between the severity of perimenstrual symptoms and a regular exercise habit in Japanese young women: a cross-sectional online survey. BMC Women S Health, 22(1). https://doi.org/10.1186/s12905-022-01720-2
  72. Mutha’alimah, H., Marijo, M., Trisetiyono, Y., & Wiyati, P. S. (2021). The effect of Zumba on dysmenorrhea in students of the Faculty of Medicine, Diponegoro University. Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal), 10(3), 172–176. https://doi.org/10.14710/dmj.v10i3.29949
  73. Najmabadi, S., Schliep, K. C., Simonsen, S. E., Porucznik, C. A., Egger, M. J., & Stanford, J. B. (2020). Menstrual bleeding, cycle length, and follicular and luteal phase lengths in women without known subfertility: A pooled analysis of three cohorts. Paediatric    and    Perinatal    Epidemiology,    34(3),    318-327.
  74. Nall, R. (2019, November 15). Period poop: How does your period affect bowel movements? Medical and health information | MedicalNewsToday. https://www.medicalnewstoday.com/articles/327009
  75. Naraoka, Y., Hosokawa, M., Minato-Inokawa, S., & Sato, Y. (2023). Severity of menstrual pain is associated with nutritional intake and lifestyle habits. Healthcare, 11(9), 1289. https://doi.org/10.3390/healthcare11091289
  76. Natalie Brown Daniel Martin Mark Waldron Georgie Bruinvels Lucy Farrant Ruth Fairchild. (2023, September 23). Nutritional practices to manage menstrual cycle   related symptoms:       A          systematic       review. Cambridge      Core. https://www.cambridge.org/core/journals/nutrition-research- reviews/article/nutritional-practices-to-manage-menstrual-cycle-related- symptoms-a-systematic-review/
  77. Negi, P., Mishra, A., & Lakhera, P. (2018). Menstrual abnormalities and their association with lifestyle pattern in adolescent girls of Garhwal, India. Journal of Family Medicine and      Primary            Care,   7(4),     804.
  78. Nishikitani, M., Nakao, M., Tsurugano, S., Inoure, M., & Yano, E. (2017). Relationship between menstruation status and work conditions in Japan. BioPsychoSocial Medicine, 11(1). https://doi.org/10.1186/s13030-017-0112-x
  79. Nuranna, L., Abdullah, I., Pratama, G., & Kayika, I. P. (2018). The association between menstrual disorder and work disturbance among employees. Indonesian Journal of Obstetrics and Gynecology, 10. https://doi.org/10.32771/inajog.v6i1.751
  80. Odongo, E., Byamugisha, J., Ajeani, J., & Mukisa, J. (2023). Prevalence and effects of menstrual disorders on quality of life of female undergraduate students in Makerere University College of health sciences, a cross sectional survey. BMC Women’s Health, 23(1). https://doi.org/10.1186/s12905-023-02290-7
  81. Pearlstein, T., Yonkers, K. A., Fayyad, R., & Gillespie, J. A. (2005). Pretreatment pattern of symptom expression in premenstrual dysphoric disorder. Journal of Affective Disorders, 85(3), 275-282. https://doi.org/10.1016/j.jad.2004.10.004
  82. Phases of menstrual cycle. (n.d.). Menstrupedia. https://menstrupedia.com/articles/physiology/cycle-phases
  83. Pincus, H. A., Pechura, C. M., Elinson, L., & Pettit, A. R. (2001). Depression in primary care: Linking clinical and systems strategies. General Hospital Psychiatry, 23(6), 311-318. https://doi.org/10.1016/s0163-8343(01)00165-7
  84. Quaglia, C., Nettore, I. C., Palatucci, G., Franchini, F., Ungaro, P., Colao, A., & Macchia, P.E. (2023). Association between Dietary Habits and Severity of Symptoms in Premenstrual Syndrome. International Journal of Environmental Research and Public Health, 20(3), 1717. https://doi.org/10.3390/ijerph20031717
  85. Ramnani, S. (2024). Exploring The Relationship Between Menstrual Distress Symptoms and their Impact on Overall Wellbeing in Female Young Adults. International Journal of Interdisciplinary Approaches in Psychology (IJIAP), 2(5).
  86. Rita Champaneria, & Pallavi Manish Latthe. (2011, February 21). Dysmenorrhea. ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275141/
  87. Roberts, T., Goldenberg, J. L., Power, C., & Pyszczynski, T. (2002). “Feminine protection”: The effects of menstruation on attitudes towards women. Psychology of Women Quarterly, 26(2), 131-139. https://doi.org/10.1111/1471-6402.00051
  88. Rodrigo, A. (2022, April 28). Is menstrual pain normal? Remedies to relieve period pain. inviTRA. https://www.invitra.com/en/painful-menstrual-periods/
  89. Safarzadeh, A., Zare, S., Arbabisarjou, A., & Ghoreishinia, G. (2016). The relationship between Exercise and premenstrual syndrome. International Journal of Medical Research & Health Sciences, 5(183), 9.
  90. Sammon, C. J., Nazareth, I., & Petersen, I. (2016). Recording and treatment of premenstrual syndrome in UK general practice: A retrospective cohort study. BMJ Open, 6(3), e010244. https://doi.org/10.1136/bmjopen-2015-010244
  91. Santer, M., Warner, P., & Wyke, S. (2005). A Scottish postal survey suggested that the prevailing clinical preoccupation with heavy periods does not reflect the epidemiology of reported symptoms and problems. Journal of Clinical Epidemiology,    58(11), 1206-1210.
  92. Sarah Bence. (2023, September 5). Why do I have diarrhea on my period? Verywell Health. https://www.verywellhealth.com/why-do-i-have-diarrhea-on-my- period-
  93. Sarita Y, Richa G and Minakshi S*. (2024, January 1). Menstrual Distress and Its Impact on Quality of Life of Adolescents and Middle-Aged Women. Clinical Case Reports International.    https://www.clinicalcasereportsint.com/open- access/menstrual-distress-and-its-impact-on-quality-of-life-of-9797.pdf
  94. SarSang, K., Remnant, J., Calvard, T., & Myhill, K. (2021). Blood work: Managing menstruation, menopause and gynaecological health conditions in the workplace. International Journal of Environmental Research and Public Health, 18(4), 1951. https://doi.org/10.3390/ijerph18041951
  95. Schoep, M. E., Adang, E. M., Maas, J. W., De Bie, B., Aarts, J. W., & Nieboer, T. E. (2019). Productivity loss due to menstruation-related symptoms: A nationwide cross- sectional survey among 32 748 women. BMJ Open, 9(6), e026186. https://doi.org/10.1136/bmjopen-2018-026186
  96. Shahraki, Z., Tanha, F. D., & Ghajarzadeh, M. (2018). Depression, sexual dysfunction and sexual quality of life in women with infertility. BMC Women’s Health, 18(1). https://doi.org/10.1186/s12905-018-0584-2
  97. Shajeea Arshad Ali,corresponding author1 Mariam Baloch, Lubna Riaz,Ayman Iqbal, Ramsha Riaz, Bushra Perveen, Maham Siddiqui, and Asadullah Arshad Ali. (2020, August 20). Perceptions, practices, and challenges regarding menstrual hygiene among women in Karachi, Pakistan: A comparison between general population and healthcare workers. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502414/
  98. Shi, Y., Shi, M., Liu, C., Sui, L., Zhao, Y., & Fan, X. (2023). Associations with physical activity, sedentary behavior, and premenstrual syndrome among Chinese female college students. BMC Women S Health, 23(1). https://doi.org/10.1186/s12905-023-02262-x
  99. Shim, J., Han, S., & Baek, J. (2024). Factors influencing menstrual regularity among female workers: a cross-sectional analysis study. BMC Women S Health, 24(1). https://doi.org/10.1186/s12905-024-03142-8
  100. Shimamoto, K., Hirano, M., Wada-Hiraike, O., Goto, R., & Osuga, Y. (2021). Examining the association between menstrual symptoms and health-related quality of life among working women in Japan using the EQ-5D. BMC Women S Health, 21(1). https://doi.org/10.1186/s12905-021-01462-7
  101. Should                women get       paid     menstrual        leave? (2017,  June    14).   CBC. https://www.cbc.ca/radio/thecurrent/the-current-for-june-14-2017- 1.4158414/should-women-get-paid-menstrual-leave-1.4158421
  102. Simon, V., Peigné, M., & Dewailly, D. (2023). The psychosocial impact of polycystic ovary syndrome.            Reproductive Medicine, 4(1), 57-64.https://doi.org/10.3390/reprodmed4010007
  103. Sommer, B. (1978). Stress and menstrual distress. Journal of Human Stress, 4(3), 5-47. https://doi.org/10.1080/0097840x.1978.9934989
  104. Strine, T. W., Chapman, D. P., & Ahluwalia, I. B. (2005). Menstrual-related problems and psychological distress among women in the United States. Journal of Women’s Health, 14(4), 316-323. https://doi.org/10.1089/jwh.2005.14.316
  105. Sumpter, C., & Torondel, B. (2013). A systematic review of the health and social effects of menstrual hygiene management. PLoS ONE, 8(4), e62004. https://doi.org/10.1371/journal.pone.0062004
  106. Swaay.
  107. Tabassum Khan, N. (2020). Prevalence of menstrual distress among young undergraduate females in Quetta Balochistan. Epidemiology International Journal, 4(1). https://doi.org/10.23880/eij-16000136
  108. Taleb, R., Tannir, M. E., Akoum, G., Sakr, R., Koleilat, R., Barakat, Z., & Daaboul, R. (2023). Knowledge and attitude towards dysmenorrhea among health professions students: A cross-sectional study from Lebanon. Universal Journal of Public Health, 11(4), 430-440. https://doi.org/10.13189/ujph.2023.110407
  109. Tan, B., Philipp, M., Hill, S., Muhamed, A. M. C., & Mündel, T. (2020). Pain across the menstrual cycle: Considerations of hydration. Frontiers in Physiology, 11. https://doi.org/10.3389/fphys.2020.585667
  110. Thiyagarajan, D. K., Basit, H., & Jeanmonod, R. (2024). Physiology, Menstrual Cycle. National   Library of         Medicine. https://www.ncbi.nlm.nih.gov/books/NBK500020/
  111. Tilo, D. (2023, February 27). Philippines proposes 2-day monthly menstruation leave. HR News for USA HR Professionals | HRD America. https://www.hcamag.com/asia/specialisation/benefits/philippines-proposes- 2-day-monthly-menstruation-leave/437681
  112. Walansky, A. (2020, February 5). Women at work: How periods affect our productivity.
  113. Xu Y, Zhao W, Li T, Bu H, Zhao Z, Zhao Y, Song S. Effects of acupoint-stimulation for the treatment of primary dysmenorrhoea compared with NSAIDs: a systematic review and meta-analysis of 19 RCTs. BMC Complement Altern Med. 2017;17:436–436. doi: 10.1186/s12906-017-1924-8