Population surveys measure health and wellbeing but overlook menstrual cycle status and symptom burden, a blind spot affecting nearly half the population. Drawing on a survey review and qualitative research, Jule Becker and Billie de Haas discuss what is missing, why it matters for gender-sensitive research, and how two simple questions could begin to change this.
For nearly half the population, health and wellbeing fluctuates across the menstrual cycle, but their cyclical health experience remains absent from the surveys we use to understand population health. As a result, what we know about gender differences in health and wellbeing may be incomplete and misunderstood.
Menstrual health: measured but missed
Menstrual cycles affect mood, energy, pain, and daily functioning for a substantial share of the population across several decades of their life course. Around 38% of menstruating women report being unable to perform all their regular daily activities during menstruation, with consequences extending to work productivity, academic performance, and social participation (Schoep et al., 2019; Leon-Larios et al., 2024). Menstrual irregularity is also associated with longer-term health conditions including cardiovascular disease and metabolic disorders (Attia et al., 2023), making the menstrual cycle not just a reproductive marker but a crucial health indicator (Vollmar et al., 2025).
In early 2026, we conducted small-scale exploratory qualitative research in the Netherlands to inform and interpret the findings of the survey review, including an in-person focus group discussion with three participants aged 24 who currently menstruated, and an online in-depth interview with one participant aged 49 with perimenopausal experience. Both interviews were conducted in English and lasted approximately 60 minutes. Participants were recruited through personal networks.
Although our sample is small and not representative, its results seem clear: menstrual cycles matter for women, but are ignored, or at least underplayed, by society as a whole. As a 49-year-old participant in our research described: “I even tried at some point to start moving important appointments to a date that would not fall within my PMS (premenstrual syndrome) phase, because I just thought if I have an important meeting, right then, it will just mess it up”. Another, aged 24, put it simply: “I cry more before my period and then I don’t know why I’m that sad if I don’t look at my tracker. And then when I get my period I’m like, that’s why I was sad”.
These are not marginal experiences. They are widespread, consequential, and entirely invisible in the data we use to understand population health.
What surveys currently capture and what they miss
A review of major population health and demographic surveys, including the European Social Survey, the Generations and Gender Survey, the WHO World Health Survey Plus, the Socio- Economic Panel and the Demographic and Health Survey reveals a consistent pattern. All include single-item measures of self-rated health and life satisfaction. None capture menstrual cycle phase, cycle regularity, or symptom burden as health-relevant variables.Where menstruation does appear in these surveys, it is framed as a reproductive marker, e.g. age at first menstruation, menopause onset, or contraceptive use to prevent pregnancy. The health dimension of menstruation, how it shapes daily functioning, mood, and energy across the cycle is not present.
This matters because these health measures are collected at a single moment in time. For women who menstruate that moment is not neutral. As one participant in our research reflected: “When you get those questionnaires and they ask, ‘how are you?’, I find it sometimes difficult to answer because it’s so cyclical. In one week, I would feel super energetic and like the old me, and if I would have to answer that questionnaire in a week that it’s not going well, then it really would be quite low”.
Cyclical health variation is one factor that could contribute to observed gender gaps in self-reported health in ways that have not been examined. Without knowing where a woman is in her cycle or how much menstrual symptoms affect her daily life, a health rating captured on a high-symptom day may say more about the timing of the survey than about her general health. This may help explain why women report poorer self-rated health on average than men, though this gap narrows when health covariates are controlled (Zajacova et al., 2017). This suggests that unmeasured factors may be contributing to what looks like a stable gender difference. It should be noted, however, that gender differences in self-rated health persist beyond menopause, suggesting that menstrual cycle variation is one contributing factor among several, rather than a complete explanation of the gender health gap.
A small addition with significant potential
The good news is that this is a solvable problem. Menstrual cycle characteristics can be captured through brief, accessible self-reported items in large-scale studies. Women can and do report their cycle status, symptom frequency and the impact of symptoms on daily activities and these reports are both feasible and informative at population scale (Ali et al., 2026; Dhonnabháin & Wallace, 2025).
Two brief items, one asking where a respondent places themselves in their menstrual cycle at the moment of interview and one asking how often menstrual symptoms have affected their daily activities in the past month, would be enough to begin addressing this concern. They require no medical diagnosis, no clinical knowledge, and minimal survey time.
When asked about the idea, participants in our research were unambiguous: “This is such an easy thing to include, it’s one question and then you would be able to adjust for it as a variable. That does not seem scientific, to exclude half the population”.
The policy relevance is also clear. Spain became the first European country to introduce statutory menstrual sick leave in 2023, and similar provisions exist in several countries across Asia and Africa (Boletí, 2023). Evaluating whether such policies reduce symptom burden and improve daily functioning requires population-level data that current surveys simply cannot provide.
Menstrual health has long been treated as a topic solely for women’s health, studied separately in specific research, outside the mainstream of population science. But cyclical health variation does not exist in isolation. It intersects with work, education, relationships, and social participation in ways that only become visible when measured alongside the full range of variables that general population surveys capture. Growing policy attention, like Spain’s introduction of menstrual sick leave in 2023, reflects a broader recognition that this is a population-level issue. A few simple questions could make a previously invisible health experience finally countable and comparable.
References
Ali, Z. E., Wainwright, E., Murugesu, S., Moraru, S., Lawrie, L., Getreu, N., & O’Neill, H. C. (2026) How well do women understand their menstrual cycles? Insights from 383,085 UK based women. Reproductive Health.
Attia, G. M., Alharbi, O. A., & Aljohani, R. M. (2023). The impact of irregular menstruation on health: a review of the literature. Cureus, 15(11).
Boletín Oficial del Estado. Ley Orgánica 1/2023, de 28 de febrero, por la que se modifica la Ley Orgánica 2/2010, de 3 de marzo, de salud sexual y reproductiva y de la interrupción voluntaria del embarazo. España, núm. 51, 1 de marzo de 2023. https://www.boe.es/buscar/act.php?id=BOE-A-2023-5364
Dhonnabháin, B. N., & Wallace, H. (2025). Exploring the role of menstrual perceptions on health, well- being, and daily functioning. Women’s Health, 21, 17455057251399893.
Leon-Larios, F., Silva-Reus, I., Puente Martínez, M. J., Renuncio Roba, A., Ibeas Martínez, E., Lahoz Pascual, I., … & Quílez Conde, J. C. (2024). Influence of menstrual pain and symptoms on activities of daily living and work absenteeism: a cross-sectional study. Reproductive Health, 21(1), 25.
Schoep, M. E., Nieboer, T. E., van der Zanden, M., Braat, D. D., & Nap, A. W. (2019). The impact of menstrual symptoms on everyday life: a survey among 42,879 women. American journal of obstetrics and gynecology, 220(6), 569-e1.
Vollmar, A. K. R., Mahalingaiah, S., & Jukic, A. M. Z. (2025). The menstrual cycle: a vital sign across the lifespan. The Lancet Obstetrics, Gynaecology, & Women’s Health, 1(2), e141-e145.
Zajacova, A., Huzurbazar, S., & Todd, M. (2017). Gender and the structure of self-rated health across the adult life span. Social Science & Medicine, 187, 58-66.