Paid leave for severe menstrual cramps

In 2023, Spain became the first country in Europe to introduce special paid leave for people with severe, so-called incapacitating menstruation. This is not “extra vacation time,” but a specific type of temporary sick leave, under which income replacement is paid directly by the state Social Security system (Seguridad Social). The aim is to acknowledge that, with certain gynecological diagnoses, menstrual cramps can completely prevent a person from functioning—and a standard “painkiller” simply isn’t enough.

At the same time, the measure is meant to help destigmatize menstruation in the workplace. Until now, many women dealt with extreme pain by taking vacation days, unpaid leave, or simply suffering through it at work; the new system allows them to stay home without financial loss. In practice, however, it is not a tool used on a mass scale—rather, it serves as a “safety net” for a relatively small group of people with serious health problems.

How paid menstrual leave was introduced in Spain

The legal basis for menstrual leave is found in Ley Orgánica 1/2023, which from 1 June 2023 regulates sexual and reproductive health and also amends older legislation on abortion. The package also created a new category of temporary incapacity: “incapacidad temporal por menstruación incapacitante secundaria” — temporary incapacity due to secondary incapacitating menstruation.

This category sits alongside other “special situations” of temporary incapacity, such as complications during pregnancy or a health condition following an abortion. In doing so, the state explicitly recognizes that menstrual health is part of overall health and can legitimately prevent someone from working. It also simplifies administration: it is standard sick leave (IT – incapacidad temporal), just with specific rules on funding and entitlement.

Who is entitled to paid leave for menstrual pain

An important point: Spain’s paid leave does not apply to every period that is “uncomfortable” or mildly painful. The law refers to so-called secondary incapacitating menstruation (menstruación incapacitante secundaria). This is a condition where pain and accompanying symptoms are so severe that the person is unable to work, and they are linked to a previously diagnosed gynecological pathology—for example endometriosis, fibroids, pelvic inflammatory disease, adenomyosis, or polycystic ovary syndrome.

In practice, this means a person must have a confirmed diagnosis from a specialist and then, in a specific cycle when the pain is extreme, their primary care doctor (or gynecologist) issues a certificate of temporary incapacity. So this is not an automatic entitlement to “x days per month for everyone,” but a medically assessed situation that must be documented. This is meant to reduce the risk of abuse, but it also places an obligation on the patient to repeatedly engage with the healthcare system.

How many days of paid leave can be taken

The law itself does not set an exact maximum number of days off per month, because it is based on medical assessment—it is temporary sick leave that can last as long as medically justified. Media reports often mention a framework of 3 days per month, extendable to 5 in more severe cases, but the legal text does not establish one universal number; the actual duration is at the doctor’s discretion.

For recurring pain, a doctor may issue a certificate valid for a longer period (for example, up to a year), but even then each individual absence from work is assessed separately, and the length of previous episodes is not taken into account. That means there is no “used-up limit” after which a person would lose entitlement to further menstrual sick leave, as long as their health condition still objectively prevents them from working.

Who pays for menstrual leave, and how much

The key difference compared with standard sick leave lies in the funding. With ordinary temporary incapacity in Spain, employers often cover the first days and only afterward does Social Security step in. With incapacitating menstruation, however, the state Social Security system (Seguridad Social) pays from day one of the incapacity.

The benefit amount is tied to the so-called regulatory base (base reguladora). For menstrual leave, 100% of this amount is paid, which is more generous than for ordinary illness, where the percentages tend to be lower. If an employee had, for example, a monthly regulatory base of €1,500, one day of menstrual sick leave corresponds to roughly one-thirtieth of the monthly amount. For three days off, Social Security therefore reimburses an amount that can make up a significant part of weekly earnings—without the employer bearing the wage cost of the absence.

Another advantage for employees is that this special sick leave does not require a prior minimum period of contributions, which is otherwise a condition for standard illness benefits. Lawmakers thus acknowledged that this health condition can significantly affect younger women or workers with a shorter employment history.

How the process works—step by step

In practice, taking menstrual leave looks similar to standard sick leave, just with a few specifics. First, the patient must have the cause of painful menstruation diagnosed—for example endometriosis or another gynecological condition. With this finding, she then visits her primary care doctor or gynecologist, who assesses whether the current condition truly prevents her from working.

If the doctor agrees that it is incapacitating menstruation, they issue a certificate of temporary incapacity—electronically sent to Social Security and the employer. In most cases, for each cycle in which the patient wants to take menstrual leave, she must contact the doctor again. This means more administrative burden, but it also acts as a control mechanism to prevent abuse. The employer then treats this sick leave the same as any other illness or injury when planning shifts and workloads.

The difference between menstrual leave and standard sick leave

Formally, menstrual leave is a special type of temporary incapacity due to so-called common (non-work-related) contingencies. The difference is mainly that, with ordinary illness, the insured person must have paid contributions for a certain period and the income replacement rate is lower, especially during the first days. With incapacitating menstruation, these contribution conditions do not apply and the benefit is set at 100% of the regulatory base from the start.

Compared to standard “vacation” (paid time off for rest), the key difference is that menstrual leave is tied to a medical condition and must be certified by a doctor. It is not a perk an employee can plan in advance, but a tool activated in a crisis situation—similar to a migraine, an acute infection, or another health complication.

How often women use menstrual leave

Although some critics feared a “wave” of absences, the data so far do not support that. According to statistics published by the Spanish ministry and cited by multiple media outlets, from June 2023 to spring 2024 menstrual leave was used on average only a few times per day across all of Spain, with the average length of each sick leave being around three days.

A similar picture emerges from regional data from the Basque Country: in the two years since the measure was introduced, the entire autonomous community recorded only a few dozen cases of incapacitating menstruation per month. This suggests it is an exceptional tool for people with serious diagnoses rather than mass “extra time off” for a large share of the population.

Benefits and concerns: what supporters and critics say

Supporters of Spain’s approach emphasize that it is an important step toward recognizing women’s lived reality in the workplace. Menstrual pain—especially with conditions such as endometriosis—can be comparable to other conditions for which sick leave is entirely normal. The law also removes the financial barrier: people no longer have to choose between their health and their paycheck, because the leave is fully covered by the public system.

On the other hand, critics warn that employers may become even more cautious about hiring women of reproductive age, which in an extreme scenario could deepen gender discrimination in the labor market. Questions also arise about how to verify health status in a sensitive yet fair way—menstrual pain is subjective and not always visible in tests. Some feminist groups fear that emphasizing “weakness” during menstruation could reinforce stereotypes that women are less reliable workers; others see it as a finally fair naming of reality.

What Spain’s experience could bring to other countries

Spain is still the only country in Europe to have introduced a national legal framework for menstrual leave, although outside Europe similar regimes exist, for example, in Japan, Indonesia, and in some African countries. Spain’s version is specific in that it is paid sick leave funded by the state, not merely protection against dismissal during unpaid leave.

For other countries, including Slovakia, Spain’s data are interesting precisely because they show low use of the entitlement. In practice, the fear that most women would go home every cycle has not been confirmed; rather, it provides relief for those who were already spending days in emergency rooms or taking strong analgesics while still trying to function at work. The debate over whether to adopt a similar system will therefore likely be framed not only in terms of equality and health, but also in terms of economic impact and administrative burden.

A practical example: what a month with severe cramps can look like for an employee in Spain

Imagine an employee, Lucía, who works in an office and has diagnosed endometriosis. Most months she manages her period with standard painkillers and doesn’t leave work, even though a day or two are uncomfortable. In some months, however, the pain spikes to such intensity that even walking or focusing on simple tasks becomes difficult.

In such a “critical” month, Lucía visits her doctor, who confirms that it is incapacitating menstruation related to her diagnosis and issues temporary sick leave for three days. Lucía stays home, takes medication, rests, and doesn’t have to worry about losing part of her wages—Social Security reimburses 100% of her regulatory base for those days. The employer does have to reorganize the team’s work, but does not bear the wage cost of her absence. A month later, if the pain is milder, she goes to work; if it worsens again, the process repeats. In this way, Lucía has systemic support while still deciding herself when leave is truly necessary.

Video: How the world reacted to menstrual leave in Spain

A short news clip explains why Spain’s measure is considered a historic step and what arguments are heard from supporters and critics alike.

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Conclusion: paid menstrual leave as recognition of the realities of women’s health

Paid leave for severe menstrual cramps in Spain is not a “luxury perk,” but an attempt to adapt labor law to a reality in which some people are objectively unable to work during menstruation. At the same time, it is not an empty gesture—the system is state-funded, medically controlled, and designed to truly help those who need it most.

Spain’s experience shows that initial fears of widespread abuse have not materialized, and menstrual leave is used by a relatively small number of people. The debate is therefore gradually shifting from “will this collapse the labor market?” to “how can we set up a system that is fair and sensitive, respects health, and still protects equality in the workplace?” Regardless of whether other countries introduce a similar arrangement, the Spanish model already provides valuable data and arguments for further discussion about menstrual health and labor law.

Sources

1. Spain introduces menstrual leave [updated] – a detailed overview of the new legislation and funding by Social Security
   https://global.lockton.com/us/en/news-insights/spain-introduces-menstrual-leave (Lockton)
2. Las nuevas situaciones especiales de incapacidad temporal para proteger la salud y el empleo de las mujeres – an explanation of the category “menstruación incapacitante secundaria” and related legal concepts
   https://www.bbvamijubilacion.es/blog/las-nuevas-situaciones-especiales-de-incapacidad-temporal-para-proteger-la-salud-y-el-empleo-de-las-mujeres-baja-por-menstruacion-incapacitante-interrupcion-embarazo-y-39-semana-de-embarazo/ (Mi jubilacion BBVA)
3. Nuevas situaciones especiales de incapacidad temporal por contingencias comunes – information on funding and contribution conditions for menstrual leave
   https://www.mutualia.eus/es/nuevas-situaciones-especiales-de-incapacidad-temporal-por-contingencias-comunes/(Mutualia)
4. Baja por menstruación: qué dice la ley y cómo solicitarla – a practical guide for employees who want to apply for menstrual leave
   https://enterminoslegales.es/baja-por-menstruacion-que-dice-la-ley-y-como-solicitarla/ (En términos legales)
5. A year on, Spain’s ‘historic’ menstrual leave law has hardly been used – an article on usage statistics and the ministry’s position
   https://www.theguardian.com/world/article/2024/jun/04/spain-historic-menstrual-leave-law-hardly-used-period-pain-endometriosis (The Guardian)
6. Menstrual leave – Spain section – an overview of menstrual leave in an international context
   https://en.wikipedia.org/wiki/Menstrual_leave (Wikipedia)
7. Al mes se tramitan de media 3 bajas por dolores menstruales incapacitantes en Euskadi – regional data from the Basque Country on the number of approved menstrual sick leaves
   https://cadenaser.com/euskadi/2025/03/23/al-mes-se-tramitan-de-media-3-bajas-por-dolores-menstruales-incapacitantes-en-euskadi-radio-bilbao/ (Cadena SER)