The Texas House and Senate are considering excused absences for students who suffer from menstrual disorders, but poor and uninsured students may not receive the level of medical care necessary to qualify. Under the proposals, the Texas Education Code would require schools to grant excused absences to students suffering from menstrual-related health conditions, with a doctor’s note, and ensure they receive all necessary support without academic penalties. 

Background

Menstrual disorders encompass a wide range of medical conditions that disrupt an individual’s menstrual cycle. These disorders can lead to both physical and emotional distress. Common menstrual disorders include: 

•  Dysmenorrhea: Severe menstrual cramping
•  Endometriosis: A condition where tissue grows outside the uterus, typically causing severe cramping
•  Menorrhagia: Heavy menstrual bleeding

 Polycystic Ovary Syndrome (PCOS): A hormonal disorder that can cause a range of symptoms, typically irregular periods and other health complications 

Menstrual disorders can result in extreme cramping, abdominal bleeding, headaches, bloating and more. Studies have found that symptoms of menstrual disorders are associated with decreased academic performance. Adolescents with menstrual disorders might have trouble with attendance, concentrating on tasks and participating in classroom activities. Individuals who endure heavy or prolonged bleeding on average miss 1-7 days of school a year, and many of the studies found that social interactions are also negatively impacted, leading to increased stress and a lower quality of life. “I did miss school for symptoms, often my cramps would be so bad I would throw up. Everything hurt like it would hurt to move anywhere, it was crazy,” said Hayden, a recent high school graduate with PCOS, she asked to only wanted to use her first name for privacy reasons. 

Legislation

House Bill 161, filed on Nov. 12, 2024, by Rep. Donna Howard, D-Austin, and its companion bill, Senate Bill 774, introduced by Sen. Sarah Eckhardt, D-Austin, proposes amendments to Section 25.087 of the Texas Education Code. The key provisions include: 

• Excused absences: Texas school districts would be required to excuse up to 10 days of absences per academic year for students with diagnosed menstrual disorders. 
• Medical documentation: To qualify for these excused absences, students must provide a valid doctor’s note confirming their condition and necessity. 
• Implementation timeline: If passed, the legislation would take effect starting from the 2025-2026 school year. 

House Bill 161:

Senate Bill 774:

Socioeconomic barriers  

While the bills aim to help students manage their health without academic repercussions,  the legislation doesn’t address the socioeconomic disparities that hinder access to the medical care necessary for such diagnoses.​

At the end of last year, the U.S. Census Bureau reported that 4.4 million children in the U.S. were uninsured in 2023, and since April 2023, around 5.5 million children have been unenrolled from Medicaid. Texas accounts for 23% of uninsured children in the U.S.

And out of all children in Texas, 11.9% of them are uninsured.

Obtaining a medical diagnosis for a menstrual disorder often requires consultations with specialists, diagnostic tests and follow-up appointments–all of which can be expensive even with insurance. Accessibility could pose a significant barrier for students trying to obtain the documentation House Bill 161 and Senate Bill 774 require. By requiring doctor’s notes these bills might unintentionally favor students with better healthcare. 

Although Hayden was insured throughout the long process of being diagnosed with PCOS, “I have been showing symptoms like insulin resistance, weight gain in the belly area, super awful periods and increased hair growth for a lot of my life, but they waited until I was older and more mature to give me a set-in-stone diagnosis. I had a ton of bloodwork done and between my endocrinologist and my gynecologist they confirmed my PCOS.” 

Social barriers  

In addition to the insurance barrier, this bill faces another challenge: the stigma surrounding menstruation. Although efforts have been made to decrease the stigma, it remains prevalent. Students could be unlikely to miss school, even if necessary, due to the fear of being perceived as abnormal.

“Women who signaled their menstrual status by dropping a tampon in front of others were ranked less competent and less likable than someone who dropped an object perceived as neutral, such as a hairpin,” a study examining stigma surrounding menstruation, found. “Teasing and bullying because of menstruation are significant problems for girls’ educational experiences and outcomes.”

These stigmas could prevent students from seeking medical care and contribute to added roadblocks in their ability to perform well at school. "I feel like the stigma I hear the most is ‘it can’t be that bad,’” Hayden said. “My cramps are brutal and I feel like not a lot of other people truly understand how awful it is.”