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A study by the Institute for Innovation and Knowledge Management (INGENIO), a joint centre of the Spanish National Research Council (CSIC) and the Universitat Politècnica de València (UPV), the Department of Applied Mathematics of the UPV and the University of Western Australia indicates that 70.9% of women in Spain experience menstrual discomfort every month or almost every month. Despite the high prevalence, 20% of those who experience discomfort monthly report they have never had a gynaecological visit. The study, published in the Frontiers in Public Health journal, combines quantitative and qualitative methods with a sample of 3,490 participants and was carried out through an online questionnaire to women over 14 years of age born or residing in Spain.

The work, led by the INGENIO (CSIC-UPV) researcher Sara Sánchez-López, reveals that menstrual pain (dysmenorrhoea), abdominal bloating, diarrhoea and heavy bleeding are common symptoms in more than 70% of menstruating women. However, only 45% of the respondents state that they visit the gynaecologist at least once a year. 35% say they visit a gynaecologist less than once a year, and 19% say they have never been seen by a gynaecologist.

Sara Sánchez-López explains that "many patients feel neglected or even ignored by healthcare professionals. Factors such as being overweight, having a history of anxiety or simply being a woman negatively affect the credibility of patients in consultation. This inequality, known as the gender pain gap - which describes the tendency of the healthcare system to underestimate or under-treat pain in women - contributes to mistrust in the healthcare system and encourages many women to resort to non-medical solutions or even abandon help-seeking.

"The normalisation of pain distances us from proper diagnosis and treatment. Endometriosis, for example, can take between 4 and 11 years to be diagnosed. We are talking about incapacitating pain and a significant loss in quality of life, as well as the potential worsening of health due to lack of adequate treatment," says Sara Sánchez-López.

The research also includes numerous testimonies about the "standardised" prescription of the contraceptive pill, as well as the lack of alternatives when this treatment is rejected for some reason or does not work, and even cases where pregnancy is recommended as a way of relieving menstrual pain.

The loss of trust in specialists is leading many women not to seek medical care, even when their symptoms are disabling. Furthermore, when they go for a consultation, many report feeling ignored and invalidated, receiving erroneous diagnoses or being treated only with contraceptives, without prior examinations," says Rocío Poveda Bautista, also a researcher at INGENIO (CSIC-UPV) and co-author of the study.

Public and private healthcare

Santiago Moll López, a researcher in the Department of Applied Mathematics at the Universitat Politècnica de València and also co-author of the study, points out that "the type of health system makes an important difference: women who use private health care attend gynaecological consultations more regularly than those who use the public system".

Long waiting times and the difficulty of obtaining referrals in the public system lead many women to delay or avoid consultation". In fact, the data also reveals that 71.4% of postmenopausal women with access to private healthcare go for annual gynaecological check-ups, while only 39.1% do so in the public system. "Given that income level conditions access to the healthcare system, the limitations of the public system could be generating inequalities in access to adequate diagnoses and treatments," the researcher comments.

The research team also includes the participation of Dani Barrington, from the University of Western Australia, an international expert in menstrual health and activism in this field.

This research aims to be a call to action and a starting point for the development of legislative and social measures to ensure adequate and unbiased medical care for those suffering from menstrual pain," concludes Sánchez-López.

This study, a pioneer in the Spanish context, alerts us of the urgent need to transform the way menstrual health is understood and addressed. Among the measures proposed by the authors are gender-sensitive training for health professionals, awareness campaigns to de-normalise menstrual pain, and structural reforms to improve access to gynaecological care in the public system.

Reference

Sánchez-López S, Barrington DJ, Poveda-Bautista R, Moll-López S. A mixed method study of menstrual health in Spain: pain, disorders, and the journey for health. Front Public Health. 2025 Feb 25;13:1517302. doi:10.3389/fpubh.2025.1517302. PMID: 40071118; PMCID: PMC11893987