Of every ten elementary and high school students who menstruate, six report experiencing severe or moderate cramps that disrupt their school routine and require medication. About four in ten female students (37.1%) miss classes every month due to period pain.

The data can be found in a survey conducted by the Alana Institute in partnership with the Equidade.info Institute and was released for International Menstrual Hygiene Day, celebrated on Thursday (May 28). The date aims to promote discussion and combat stigma and period poverty.

The study was conducted in February this year with 2,551 students – 770 of them menstruating – 303 teachers, and 181 school administrators from public and private schools across Brazil.

Menstrual symptoms

The unprecedented survey reveals that the main menstrual symptom preventing female students from attending classes is cramps, cited by 57.7 percent of respondents. Other menstruation-related issues mentioned are:

• fatigue and body aches (30.1% of respondents);
• headaches (28%);
• stomach pain (20.1%);
• embarrassment and fear of leakage (19.3%);
• lack of restrooms or hygiene products (8.2%).

Absences and tardiness

The figures reveal that menstrual symptoms can lead to approximately two days of absence per month.

Sofia Reinach, one of the leaders at the Alana Institute, explains that absenteeism on days when girls experience pain can affect learning, their connection to school, and educational opportunities, and therefore should be taken seriously.

“Nearly 40 percent of girls in Brazil miss at least one day of school per month due to menstrual pain. This is a substantial portion of the population that needs to be cared for so this does not result in underperformance and a chronic disadvantage in learning.”

The institute underscores the need to recognize pain as a collective problem and suggests adopting protocols for excused absences and providing guidance to teachers. These changes are expected to make students more comfortable and improve the tracking of such cases.

Racial inequality in menstruation

The study also highlights racial disparities. Even though black girls report experiencing fewer severe cramps, they miss more school days.

In this racial breakdown, they miss up to 1.5 times more school days (two to five per month) than white students – 14.5 percent of black students miss two to five days per month due to menstrual issues. Among white students, the rate drops to 9.6 percent.

When examining the experience of pain during menstruation, there is also no consistency across racial groups. White girls report experiencing more intense pain. Among white respondents, 37.5 percent describe their cramps as severe. Among black girls and adolescents, this rate is lower (25.9%). At the same time, 16 percent of black girls say they do not experience menstrual cramps, compared to 8.5 percent of white girls who report feeling no pain at all.

Sofia Reinach concludes that, in reality, the indicator of severe pain underestimates the problem among black female students – they are more likely to normalize their pain because they are culturally taught to believe that pain should not require treatment.

“Black girls are less likely to describe their pain as severe. Apparently they have a higher pain threshold, so they’re less likely to recognize it as debilitating. In reality, though, the impact of the pain keeps them from their activities and from school,” she said.

The expert argues that professionals in the fields of education and health “must unlearn this outdated bias that black bodies feel less pain” or that they are more resilient.

“This perception needs to change. Black girls are in pain – but they talk less about it. Professionals need to be more attentive. Schools must be part of a care network,” she argued.

To ensure that black girls receive proper support and that the impacts of pain are minimized, the specialist in menstrual health and pelvic pain highlights the need for teachers to recognize their students’ pain, for school administrators to ask about it, and for families to get involved.

A project to combat period poverty

In Brasília, advertising major Ana Clara Maimoni rallied her neighbors and acquaintances to collect sanitary pads.

“I’ve always found it preposterous that health clinics give out free condoms but not sanitary pads, and wondered how that affects our lives,” she noted.

Maimoni managed to collect about 1,000 sanitary pads and donate them to a school where students did not have full access to them. The supply was enough to serve the girls for six months.

Her project against period poverty also included a lecture by health professionals to educate the students in Vila Planalto, an economically disadvantaged area in Brazil’s federal capital. “The girls loved it and seemed really excited to participate. They asked lots of questions,” said Maimoni.

According to Maimoni, school is a strategic space to address this issue, and it is precisely education that these girls end up being deprived of when they lack access to the bare minimum needed for menstrual dignity.

“They often don’t talk about it because it’s still considered a taboo in many places,” she pointed out.

Menstrual health education

Many students experience their first period without any guidance on the menstrual cycle, which is why the Alana Institute stresses the importance of discussing menstrual health before a girl’s first period.

“We need to bring discussions about menstrual health in schools forward to elementary school. And we need to take a careful approach and expand care strategies for this age group, especially so that girls experiencing severe pain with early menarche receive closer monitoring,” Reinach said.

Women in education

Brazilian schools suffer doubly from absences, both among female students and teachers. Among the survey’s respondents, 28.3 percent of school administrators reported experiencing severe menstrual cramps, and 16.9 percent of those interviewed had missed work due to menstrual issues.

In the classroom, 15.8 percent of teachers reported experiencing severe cramps, and one in ten teachers (12.1%) missed work at least once in the past year due to menstrual issues.

Considering that 37.1 percent of female students miss school monthly due to menstruation and 64 percent reported moderate or severe cramps, the study suggests that the lower percentage among education professionals, compared to students, may partly reflect greater access to diagnosis, monitoring, and pain management among professionals, as well as the responsibilities of adulthood.

“Women teachers are absent less often than students. At every stage of life when responsibilities increase and professionals see their work threatened by pain, female teachers make a greater effort to cope with this pain in their professional environment,” the study notes.

Sofia Reinach advocates for the adoption of menstrual health policies in schools that include both students and staff, with appropriate protocols for each group. “We need to understand that menstrual pain takes girls and women out of their daily school routine and makes this a cumulative problem. Schools are suffering twice over from these absences, both from students and teachers.”

Lack of knowledge among boys

Menstruation is still poorly understood as a collective issue within schools. The data show that 36.8 percent of male students say they do not think much about the topic – nearly double the percentage among girls (19.7%).

The difference is also evident in perceptions of the menstrual cycle’s impact on daily life – about a quarter of boys and adolescents (23.7%) believe that menstruation can interfere with school or sports, while 41.2 percent of female students acknowledge this negative effect.

“The topic of menstruation needs to cease being taboo. And to achieve that, we need to bring boys into everyday conversations. Menstruation can no longer be a subject limited to girls and women in their private lives,” the expert argued.

The idea is for boys and young men to stop being passive spectators or sources of embarrassment and instead become part of a support network for girls and young women.

*Intern Alice Rodrigues from Rio de Janeiro contributed to this article.