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This is how much work women miss because of their periods

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As period pain and other menstrual symptoms cause a "great deal" of lost productivity at work and school for women, most still hide the real reason why they're calling in sick, a new study has found.

Cramps and heavy bleeding were linked to almost nine days of lost productivity for a woman every year, researchers reported Thursday in the journal BMJ Open.

That lost time came in the form of "presenteeism," or still showing up in the office or in class, but accomplishing less than normal.

When it came to actually taking time off from work or school, a woman missed about 1.3 days a year on average. When calling out sick because of their periods, only 20% of women told their bosses the real reason why they were feeling unwell — almost half just mentioned a symptom like cramps and the rest either gave no reason or made something up.

The findings are based on a survey of almost 33,000 women in the Netherlands who were 15-45 years old — the largest study so far to analyse how periods affect work and school productivity, the authors said.

Dr. Theodoor Nieboer, the lead author and a gynecologist at the Radboud University Medical Center in the Netherlands, called the results "more or less universal."

"In my opinion, women hide the reason because they don't want to be treated as someone with a disease," Nieboer told TODAY.

They may also be more reluctant to talk about their menstrual complaints with male bosses or in an environment where few other women experience symptoms, he added.

The findings are likely applicable to women in the U.S., said Dr. Christine C. Greves, an OB-GYN at the Center for Obstetrics and Gynecology at Orlando Health in Florida, who wasn't involved in the study.

Women may not feel comfortable sharing that they need time off due to period pain because their workplace is not as open about women's concerns or the subject is still somewhat off-limits in some settings, she said.

"One of my soap boxes is to stamp out any shame of any problems," Greves told TODAY.

"It's possible there could be a taboo still. It's sad that there is because… if women are in such pain that it's affecting their quality of life, their work, their livelihood, it's important they mention it to someone so they can see a doctor and get help."

Indeed, the study suggests there's a taboo for women when it comes to discussing menstrual pain — or dysmenorrhea in medical terms — with their employers. More than half of women experience such pain, according to the American College of Obstetricians and Gynecologists.

Primary dysmenorrhea is caused by natural chemicals in the body, while secondary dysmenorrhea is caused by a disorder such as endometriosis or fibroids. About 9% of women in the survey reported having such a disorder.

Women under 21 were more likely to report they took time off, perhaps because period pain that doesn't have a specific cause is most common among younger women.

About 80% of women reported being less productive at work or at school during their periods, a finding that didn't surprise Greves.

"If you're in pain or experiencing mood changes, then that is distracting," she said. "[You're] not going to run as efficiently."

When should women see a doctor?

If period pain affects your personal or work life, make an appointment to be evaluated by your OB-GYN, Greves advised.

Menstrual pain that's not caused by a disorder can be managed with the help of birth control pills combined with nonsteroidal anti-inflammatory drugs in up to 75% of cases, she said.

For routine symptoms that may not require a doctor's visit, track your pain and cycle in a calendar. Two days before your period is supposed to begin, start taking nonsteroidal anti-inflammatory drugs like ibuprofen (as long as you don't have any adverse effects to them) every six to eight hours, and keep taking them during your period to help with physical symptoms, Greves said. A heating pad can also bring relief.

To feel better emotionally, try exercise. "I know it seems counter-intuitive, but exercise can increase your endorphins," Greves noted.