At the Victorian Women's Trust offices in bustling Melbourne, Australia, the small staff of about 15 employees -- all women except for one -- talk openly about everything, even their menstrual cycles.
The women's advocacy organization in Australia has been offering paid days off for painful periods, called "period leave" or "menstrual leave," to its employees for the past 18 months.
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These days do not count as "sick leave," but they are specifically provided for those monthly occasions when a woman might request to stay home due to having uncomfortable symptoms related to her menstrual cycle.
Now, the organization is encouraging other employers to introduce similar menstrual policies, and it even provides a "menstrual policy template" for employers to download online to integrate into their own organizations.
"The interesting thing, over 18 months, I think the number of days of leave that my staff has claimed is probably about seven or eight across the whole office," said Mary Crooks, executive director of the Victorian Women's Trust.
The menstrual leave policy was introduced after the organization launched a large research project called The Waratah Project, exploring how women collectively think about menstruation and menopause, Crooks said.
That research, which involved an online survey of more than 3,000 women and 22 in-person discussion groups, could be released within the next six months, Crooks said.
"In that context of doing that work, we realized as a women's organization, that we had no menstrual policy," she said. "So the development of the menstrual policy was just an automatic response of, if we want to shift attitudes and behaviors, we have to start right here in our own office."
The policy that was adopted, she said, provides women the option of working from home when they experience discomfort during their periods, or they may access up to 12 days of paid leave a year.
"If you are experiencing discomfort with a period but you are at work and you want to stay at work, then you can certainly feel free to move to somewhere in the office -- maybe stretch out on a couch -- but keep your laptop and keep doing your work," Crooks said.
Yet period leave policies come with controversy.
Some groups, such as the Victorian Women's Trust, argue that providing women paid days off for painful periods can be beneficial to women's health care. But some other people view such policies as a hindrance that might exclude women from the workplace.
"The conversation usually goes in one of two directions. On one side, often a journalist or a colleague will say something like, 'Well, I don't think it's very feminist to medicalize women's bodies,' assuming that symptoms around the onset of menses are somehow completely culturally constructed," said Tory Eisenlohr-Moul, a clinical psychologist, assistant professor of psychiatry and associate director of translational research in the Women's Mental Health Research Program at the University of Illinois at Chicago.
On the other side, everyday women who have severe menstrual cycle changes in their physical or emotional symptoms might argue that there is a need for leave and that there should be more awareness around severe cyclical symptoms, said Eisenlohr-Moul, who is also a member of the clinical advisory board for the International Association for Premenstrual Disorders.
"Sometimes, I feel like the synthesis of those two positions gets lost," she said.
"Most women do not suffer from important changes in emotional and physical health across the cycle, but there is a minority that do and deserve diagnosis, treatment and potentially accommodations at work," she said. "So it's a matter of acknowledging individual differences."
The places where period leave exists
Victorian Women's Trust isn't the first organization to introduce a workplace policy allowing allocated paid leave for women's menstrual cycles.
Across several Asian countries, menstrual leave is offered to working women, said Danielle Keiser, founder of a global women's health organization called the Menstrual Health Hub.
Since 1947, women in Japan have been granted menstrual leave.
In South Korea, female workers have been entitled to a day off each month since 2001, but few employees in male-dominated workplaces are eager to exercise that right, according to the Korea Times.
In 2014, Taiwan moved to grant women menstrual leave. In 2016, China's Anhui province introduced a new rule allowing women who suffer severe menstrual pain to take one to two days off every month, after presenting a doctor's note.
In others parts of the world, menstrual leave policies have emerged more on a company-by-company basis.
For instance, Coexist, a group based in the United Kingdom that hosts community spaces, introduced a period policy last year. The policy allows employees who opt into it to take time off, work from home or consider other options, such as altering their working hours during their periods.
The Victorian Women's Trust in Australia hopes to make a "call to action" in its forthcoming research paper for the country to adopt some type of nationwide menstrual leave policy -- "and to find ways for companies to be incentivized to do that, to be encouraged to do it," Crooks said.
'They weren't reporting their periods because they wanted to fly'
"On the face of it, the option of 'menstrual leave' seems like a great idea. No one who faces cramps and pain should be expected to work and should be able to take the day off," said Inga Winkler, a lecturer in human rights and director of the Working Group on Menstrual Health and Gender Justice at Columbia University in New York.
"The reason the concept of 'menstrual leave' is controversial is the broader context of the society we live in -- a society characterized by huge gender inequalities, where women earn less, are perceived as less capable and, in particular when menstruating, are seen as 'hysterical,' not trustworthy and unfit for decision-making," Winkler said.
"So while these policies may be well-intentioned, they risk playing right into stereotypes of labeling women as needing extra protection and extra time off, which in turn might reinforce biases in hiring, promotion and compensation," she said. "What we really need to work on is challenging these prejudices, but we shouldn't expect the women who are confident enough to take menstrual leave to challenge these perceptions on their own."
Over the years, there has been a shift in thinking around women's menstrual cycles and the work force, said Sharra Vostral, an associate professor of history at Purdue University in Indiana and author of the book "Under Wraps: A History of Menstrual Hygiene Technology."
Women who operated planes during World War II as part of the Women's Auxiliary Ferrying Squadron, or WAFS, were forbidden from working during their menstrual cycles, Vostral said, specifically "from one day before the beginning of the menstrual period until two days after it."
In 1943, the WAFS and Women's Flying Training Detachment merged into the Women Airforce Service Pilots, or WASP. After that happened, women still had to report their periods, even though a document called the " 'Medical Considerations of WASPS' determined that menstruation was 'not a handicap to flying and there was no relationship to accidents,' " Vostral said.
"Some of the reports from the physician came back, tongue-in-cheek, saying this was the most interesting group of women he'd ever encountered because they weren't having their periods," she said. "They weren't reporting their periods because they wanted to fly."
Crooks said she sees modern-day menstrual leave policies as a step forward and not a step back.
"In an era of competitiveness and trying to hold and retain skilled and talented people, most employers are going to want to create workplaces that work for people," she said.
"The bottom line is that productivity and loyalty and respect in a workplace is going to come from both employees and employers trying to do the right thing by one another," she said. "I don't accept the premise that this is a backwards step for women. I don't accept the premise that it will mitigate negatively against women."
Dysmenorrhea, or pain associated with menstruation, is the most commonly reported menstrual disorder, and more than half of women who menstruate have some pain for one or two days each month, according to The American College of Obstetricians and Gynecologists.
'You can't categorize all women as the same'
Women in Indonesia are given a monthly two-day menstruation leave by law, but workers rarely take up this offer, according to research.
A study published in the Indonesian Journals of Obstetrics and Gynecology in January found that among 150 working women, menstrual disorders were reported to have a mild impact on work and did not interfere with activity for 49% of them.
However, 47% of the women reported feeling a moderate impact but continued to work despite being disturbed, and 4% reported a severe work disturbance, according to the study.
The study, conducted last year at Dr. Cipto Mangunkusumo National General Hospital in Jakarta, was based on questionnaires and diary forms completed by the women.
That small percentage of women in the study who reported severe disturbances might represent a group affected by what's called premenstrual dysphoric disorder, or PMDD.
"On the one hand, most women have no important changes in their mood or functioning across the cycle. That's been shown again and again," Eisenlohr-Moul said.
On the other hand, about 5% of women of childbearing age experience recurring emotional and physical symptoms severe enough to meet criteria for PMDD, she said.
The condition, which follows a similar pattern to premenstrual syndrome or PMS, has been found to cause more severe emotional symptoms, including severe irritability, depression and anxiety.
"PMDD is characterized by the cyclical recurrence of emotional and physical symptoms in the 14 days before the onset of menstrual flow, and in these individuals, the symptoms are severe enough to cause impairment at work, at home, in relationships, and they really require treatment," said Eisenlohr-Moul, who led the development of a standardized protocol for diagnosing PMDD, published in the American Journal of Psychiatry in 2016.
"The main point is that that's only about 5% of women that have this disorder that's severe enough to really warrant diagnosis, treatment, and, I would say, potentially even time off work," she said.
In general, it's important to focus on individual differences and not paint all women as having uniform experiences, Vostral said.
"The thing is, women experience their periods very differently. Some women do have debilitating cramps and are laid out for days, and other people barely even know they have their period," she said. "So you can't categorize all women as the same."
Additionally, conversations about such differences and menstrual leave policies can open the door for discussions around menstruation stigmas and societal change, Winkler said.
"I think having the debate might be more important than having the actual policies. Proposals on menstrual leave garner attention, and they force us to have a broader discussion about menstruation, to speak more openly about our periods," she said.
"I also hope that the discussion on menstrual leave can lead to broader change around social norms and gender stereotypes in the workplace -- that affect everyone, not only menstruating women."