SPEAKER PROGRAM SCRIPT

Precious Olpos Opening

Prayer

Khatreen Opening
Sieras Remarks

Nezza Lisondra Introduction of Good morning. Welcome to Symposium on

Speaker 1 Dysmenorrhea 2023. I am Nezza Lisondra, and I am the
moderator for today. I am pleased to be with everyone and
to have the chance to introduce our presenters. Since the
theme of our symposium is on menstruation, specifically
on cases of dysmenorrhea, our speakers are professional
gynecologists hailing from different hospitals in the world.

Our first speaker obtained her Doctor of Medicine degree

from Cebu Doctor’s University specializing in Pediatric
and Adolescent Gynecology. She is currently situated in
St. Vincent’s Hospital Melbourne, and it is a great honor
that she accepted our invitation and is here with us today
to share her expertise on our topic. Speaking to us on
Primary Dysmenorrhea, please welcome Dr. Rei
Bomediano.

Rei Bomediano SPEAKER 1 Research shows that women have higher pain tolerances
than men. Childbirth is just an example of a struggle
women face. But monthly some women deal with
dysmenorrhea.

Dysmenorrhea is the medical term for pain with your

period or menstrual cramps. There are two types of
dysmenorrhea: primary and secondary. Primary
dysmenorrhea is the name for common menstrual cramps
that come back over and over again and aren't due to
other diseases. Pain can range from mild to severe and
can last 12 to 72 hours. Common menstrual cramps may
become less painful as you get older and may stop
entirely if you have a baby.

Primary dysmenorrhea is thought to be caused by

excessive levels of prostaglandins, hormones that make
your uterus contract during menstruation and childbirth.
The pain results from the release of these hormones when
the lining is sloughing off during your menstrual period.
This leads to uterus contraction and decreased blood flow
to the uterus.

Factors such as a tilted uterus, longer menstrual periods,

lack of exercise, psychological or social stress, smoking,
drinking alcohol, being overweight, and starting
menstruating before age 12 can make primary
dysmenorrhea worse.

Symptoms and Complications

Dysmenorrhea is a symptom of menstruation that causes

pain in the lower abdomen, hips, lower back, and thighs.
Other symptoms may include nausea, vomiting, diarrhea,
lightheadedness, headache, or fatigue. Pain usually starts
before or at the beginning of the menstrual period,
peaking 24 hours after the start of bleeding, and subsiding
after 2 to 3 days.

Dysmenorrhea pain can be spasmodic or congestive, and

secondary dysmenorrhea usually starts earlier and lasts
longer. In 5% to 15% of women with primary
dysmenorrhea, the pain is severe enough to disrupt daily
activities and result in missed work or school.

there are several treatment options available for primary

dysmenorrhea, and I’d like to discuss a few of them with
you today.

Firstly, nonsteroidal anti-inflammatory drugs such as

ibuprofen or naproxen can effectively reduce menstrual
pain by blocking the production of prostaglandins, which
are hormones responsible for causing menstrual cramps.

Secondly, hormonal contraceptives such as birth control

pills, patches, or injections by regulating estrogen and
progesterone levels, which can reduce the severity and
frequency of menstrual cramps.

In addition to medication, there are also a number of

non-pharmacological treatments that can help relieve
menstrual pain. These include:

- Heat therapy: Applying a heating pad or hot water bottle

to the lower abdomen or lower back can help to relax the
muscles and relieve pain.

- Exercise: Regular exercise, particularly aerobic exercise,

can help to reduce menstrual pain by increasing blood
flow and releasing endorphins, which are natural
painkillers.
 - Relaxation techniques: Practicing relaxation techniques
such as deep breathing, yoga, or meditation can help to
reduce stress and tension, which can exacerbate
menstrual pain.

It is important to note that if your symptoms are severe

and impacting your quality of life, it is recommended that
you consult with your healthcare provider, who can
determine the best treatment option for you.

Nezza Lisondra Thank you very much Dr. Bomediano for giving us a
concise talk on this term that I believe is familiar to most
women. Before we proceed to our next speaker, I will give
this opportunity to Dr. Dorene Yee, a Women’s Health
Advocate and a member of the Center for Reproductive
Health to ask questions if there are any for our first
speaker.

Dorene Yee Q&A

1. As mentioned in your presentation,
dysmenorrhea is the result of high levels of
prostaglandins. Food is often used as a
way of regulating hormones, is there a way
for women to regulate their prostaglandin
levels by altering their diets?

ANSWER:
First of all, It is worth noting that individual responses
to dietary changes can vary, and the effectiveness of
altering the diet in regulating prostaglandin levels
specifically for dysmenorrhea may vary among
individuals. Consulting a healthcare provider or a
registered dietitian can provide personalized
guidance on dietary strategies to manage
dysmenorrhea symptoms and optimize overall health.
You may include foods rich in omega-3 fatty acids,
calcium, vitamin D, and magnesium, as well as
maintain a balanced diet with anti-inflammatory
foods, which may have a positive impact on
menstrual health.

Nezza Lisondra Introduction of Our next speaker graduated from University of Oslo,
Speaker 2 Norway in 2013 obtaining a degree in Physical Therapy.
He then proceeded to the Medicine Department of the
same university to become a gynecologist specializing in
 Reproductive Surgery. He obtained his MD degree in
2018 and is now working at Oslo University Hospital.
Once again, it is a great honor to be graced with his
presence here today to share his expertise on the
Importance of Early Detection and Treatment for
Secondary Dysmenorrhea. Please help me welcome Dr.
Jakob Gimena.

SPEAKER 2 Picture this: as you navigate through your day, a sudden

“Shedding light onslaught of agonizing period pain strikes, rendering your
on the usual activities nearly impossible to bear. It's a harsh
reality faced by numerous women grappling with
importance of
secondary dysmenorrhea – a condition where the
Proper medical relentless pain is rooted in an underlying health concern.
attention and Today, I step forward to illuminate the shadows cast upon
promoting this frequently misunderstood condition, underscoring the
early detection critical significance of seeking rightful medical
of secondary intervention.
dysmenorrhea Secondary dysmenorrhea refers to menstrual pain that is
caused by an underlying health condition affecting the
a.”
female reproductive organs. It differs from common
menstrual cramps as it starts earlier in the menstrual
cycle, lasts longer, and lacks accompanying symptoms
like nausea or fatigue. In adolescents, endometriosis is a
common cause of secondary dysmenorrhea. Identifying
endometriosis in adolescents can be challenging due to
variations in lesion appearance. Untreated endometriosis
can progress and impact fertility. Treatment aims to
alleviate symptoms, halt disease progression, and
consider individual factors such as contraception,
hormone use, and potential side effects.
Obstetrician-gynecologists play a crucial role in discussing
treatment options with adolescents and their families.

Evaluation of Suspected Secondary Dysmenorrhea

In most cases, adolescents with dysmenorrhea have

primary dysmenorrhea, which can be effectively treated
with nonsteroidal anti-inflammatory drugs (NSAIDs),
hormonal suppression, or a combination of both.

Figure 1 illustrates the need for additional assessment in

such cases. a comprehensive evaluation should be
conducted to investigate potential causes of chronic pelvic
pain, including gastrointestinal, urological,
musculoskeletal, and psychosocial factors.

The examination may reveal findings indicating various

causes of secondary dysmenorrhea, such as
 endometriosis, reproductive tract anomalies, uterine
abnormalities, pelvic inflammatory disease, ovarian cysts,
vaginismus, or pelvic floor disorders.
In the evaluation of secondary dysmenorrhea, pelvic
imaging using ultrasonography is also recommended,
regardless of the findings from the pelvic examination.

Magnetic resonance imaging (MRI) may be required to

further assess müllerian anomalies, but it is not
cost-effective, not effective in determining the extent of
endometriosis. It's important to note that a normal pelvic
examination or ultrasonography does not rule out the
possibility of endometriosis.

Nezza Lisondra Dr. Yee, you may now ask any questions to our speaker if
there are any.

Dorene Yee Q&A

1. As you’ve mentioned in your presentation,
identifying endometriosis in adolescents is
challenging due to the variation of lesions
making comprehensive evaluations a must
in diagnosis. How can you encourage
adolescents to get examined and regularly
checked up? Not to mention the taboo
surrounding women’s reproductive health.
ANSWER:
Encouraging adolescents to prioritize their
reproductive health involves personal and relatable
strategies such as education, open conversations,
empowerment, breaking stigma, support networks,
inclusive healthcare settings, and collaboration with
schools and community organizations. These
approaches aim to empower adolescents to take
control of their reproductive well-being, seek regular
check-ups, and detect and manage conditions like
endometriosis at an early stage.

Nezza Lisondra
In this portion, we will be having a 5-minute break before
we hear again from our last speaker for today.

5 MINUTE BREAK
Nezza Lisondra Introduction of Let us now head on to our last speaker. She is a
Speaker 3 gynecologist at St. Luke’s Medical Center with a
specialization on Menopausal and Geriatric Gynecology. A
topnotcher on the 2015 nursing licensure examination,
she graduated from the University of the Philippines
wherein she also obtained her Doctor of Medicine.
Sharing to us on the issue of dysmenorrhea in the
workplace, let us welcome Dr. Ahva Devivar for her talk on
Menstrual Leave in the Philippines.

Speaker 3 What exactly is Period Leave? Is there a policy that allows

Period leave in the PH? Are employers required to provide
it? Is there a way to make a case for implementation?

Well, way back Aug 10,2004 under senate bill number

1687

But things have changed now,

On February 28,2023

Philippines proposes 2-day monthly menstruation leave

A new bill seeking to provide female employees with up to

two days of menstruation leave every month has been
filed in the Philippines.

Under House Bill 6728, the "Menstruation Leave Act"

states that every female employee, except pregnant and
menopausal women, who have rendered at least six
months of service shall be entitled to a monthly
menstruation leave of up to two days.

The leave will cover private and public sector staff,

regardless of the nature of their employment, according to
the bill.

While on leave, these employees would also continue to

earn at least 50% of their compensation for the day.

"The enactment of this bill will allow women to attend to

the hormonal and physiological difficulties that they have
to endure at least on a monthly basis," said
Congresswoman Samantha Taliño Santos in the
proposal's explanatory note.

"By pursuing this bill, we are not only acknowledging and

protecting women's health but also, we are raising
 awareness to avoid stigmatization and ensure that
individuals receive the right support.”

What this means for employers

If the bill gets enacted, non-compliant employers may

receive a fine not exceeding P50,000 or imprisonment of
not less than 30 days nor more than six months.
The bill also seeks to protect the benefit's potential impact
on the employability of women.

"No employer whether in the public or private sector shall

discriminate against the employment of women in order to
avoid the benefits provided for in this act," the proposal
said.

As of December 2022, the Philippines' labour force

participation rate among women was 56%, while
employment rate among women was at 95.1%, according
to the Philippine Statistics Authority.

Similar menstruation leave measures

Similar measures to support women in the workforce have

been in place or are underway in the Philippines as of
late. In the provincial government of La Union, female
employees have been granted a "Menstrual Privilege"
policy where they may choose to work remotely on days
they have their period.
In the municipality of Tangalan in Aklan, female
employees of the local government unit are also recently
given the option to work from home for up to two days
monthly during their period, GMA News reported.

Meanwhile, Senator Ramon Revilla, Jr. last year also

revived in the Senate a bill pushing for a one-day monthly
leave for female employees during their period, while still
receiving 100% of their daily remuneration.

Across the world, Spain recently became the first

European country to grant women menstruation leave. In
the United Kingdom, however, ministers there recently
rejected a pilot "menstruation leave" policy in the public
sector.

Nezza Lisondra
Dr. Yee, do you have any questions for our speaker?
Dorene Yee Q&A 1. To this day, women are still fighting for
equal pay and for representation in the
workforce. How does the proposed bill
address concerns about potential
discrimination against women in the
workplace?
ANSWER:
The proposed "Menstruation Leave Act" in the
Philippines aims to address concerns about possible
discrimination against women in the workplace by
explicitly stating that no employer, whether in the
public or private sector, shall discriminate against the
employment of women to avoid the benefits provided
by the act. This provision ensures that female
employees cannot be mistreated or subjected to
adverse actions based on their entitlement to
menstruation leave. By including this provision, the
bill emphasizes the importance of gender equality
and the protection of women's rights in the
workplace. It seeks to create a level playing field and
promote a work environment that values and
supports female employees, ensuring they have
equal opportunities and protections.

Nezza Lisondra We have now heard from all our speakers on their
knowledge and opinions on our topic for today. To
synthesize and conclude our symposium on
dysmenorrhea, let us hear from Dr. Yee.

Dorene Yee Synthesis In recent years, there has been a growing recognition of
the importance of addressing women's health concerns,
particularly those related to menstruation. The
presentations today all highlighted various aspects of
Dysmenorrhea that aim to promote women’s overall
health and fight against gender-based discrimination. We
can clearly see their expertise on their respective topics.
The first two speakers were able to effectively
characterize and differentiate primary and secondary
dysmenorrhea. Wherein the main discerning factor
between the two is that primary dysmenorrhea is caused
by excessive levels of prostaglandins, which are
hormones that cause the uterus to contract during
menstruation and secondary dysmenorrhea is caused by
underlying conditions such as endometriosis. However,
both speakers could have cited specific statistics or
research data to emphasize the credibility of their
presentations. Additional input on the potential limitations
or side effects of the treatment options for dysmenorrhea
 would have offered a more comprehensive overview. The
last speaker was able to emphasize that the proposed
"Menstruation Leave Act" in the Philippines aims to
provide female employees with up to two days of
menstruation leave every month. It covers both private
and public sector staff and ensures that women receive at
least 50% of their compensation during their leave.
However, if they provided more context on the existing
labor laws and policies in the Philippines related to
women's health and well-being it would have enhanced
the understanding of the proposed bill. Including any
potential opposition or concerns raised about the bill
would have also provided a balanced perspective on the
topic. Overall, all three speakers were able to concretize
our understanding of dysmenorrhea and its implications
for women in the workforce and in their daily lives.

Nezza Lisondra Open Forum I am now opening the floor for questions from the
audience. Please raise your hand to be recognized.

CLOSING

Now I would like to close this symposium by thanking all of our presenters for
their time and contribution to the discussions in our symposium today. I would
also like to thank our organizers for hosting this event and opening an
opportunity to talk about Dysmenorrhea with a highlight on how it affects
women in the workplace. I hope the audience learned from the insights of our
speakers. Thank you and good day.