An image of protest placards stuck against a wall. The placards are pained onto cardboard with slogans in red paint. Some are decorated with images of blood drops, toilet paper or with period pads stuck to them. Slogans on the signs read "smash the stigma glass ceilings bleed" "end the shame" "period empowerment" "end period shame" "one flow at a time" "periods slay" "you can flow your own way" and "period pride"

There can be no disability justice without menstrual justice

There can be no disability justice without menstrual justice: make the welfare system fair, safe and equitable for all of us

The UK Labour government have proposed catastrophic changes to disability benefits [1]. These changes would be devastating for disabled people, with in excess of three million disabled people and their families at risk of having their income cut, and forcing hundreds of thousands of people further into poverty [2]. We add to criticisms from disabled activists and advocacy groups of the Government’s proposals [3] by highlighting the impact this would have on disabled people who menstruate [4]. These proposals would further entrench the longstanding failures of the UK disability benefits system to recognise the ways in which symptoms, challenges, and support needs can fluctuate throughout the menstrual cycle or be intrinsically linked to menstrual and gynaecological health [5] – ultimately risking discrimination on the basis of the protected characteristic of ‘sex’.

In order to create a safe, supportive and non-discriminatory welfare system, we call on the Government to:

Immediately reverse the proposed welfare cuts.
Engage meaningfully with disabled people to consider how the disability benefits system can appropriately meet the needs of disabled people who menstruate, and better account for experiences of conditions and disabilities which fluctuate.
Adapt the questions and assessment processes to explicitly recognise managing menstruation as an activity of daily living.

Signatures

This letter was prepared by Hat Porter on behalf of the Irise International Youth Board, the Empower Period Committee with support from the following: 4M, AbleOT, All Yours Period Box CIC, Cysters, The Guidance Suite, In Kind Direct, Menstrual Health Project, Nisaba, NSUN, The Period Equity Alliance, Period Power, Annalise Weckesser and Gemma Williams, Birmingham City University, .

Please contact Hat (they/them) at hatporter1@gmail.com for matters related to this letter.

Introduction

The UK Labour Government have proposed changes which would impact a number of disability benefits including freezing the health element of Universal Credit; withholding this from those aged under 22; and making changes to Employment and Support Allowance [6]. In addition, the proposals include a dramatic tightening of the eligibility criteria for access to PIP, requiring applicants to score higher in individual assessment areas of the ‘Daily Living’ element, rather than through a cumulative score across the ten categories of daily activities [6]. This could see in excess of a million PIP recipients lose their eligibility to financial support, or have their benefits slashed [7].

The Government’s own Impact Assessment – despite understating the true impact [8] – acknowledges the severe harm these changes would inflict, pushing disabled people and their families further into poverty [9]. If the government proceed, these changes would inflict further avoidable deaths [10, 11] and exacerbate existing racialised injustices within the benefits systems, causing harm to disabled people of colour [12].

Disability, menstruation and menopause

Many disabled people who menstruate experience cyclical fluctuations in their symptoms through the menstrual cycle, experiencing worsening or unique symptoms at different cycle points. Additionally, during perimenopause, disabled people may experience a worsening or progression of their symptoms. Disabilities may also pertain specifically to the menstrual cycle and reproductive organs, including conditions such as adenomyosis, endometriosis, fibroids, polycystic ovary syndrome (PCOS), and premenstrual dysphoric disorder (PMDD). These conditions often cause cyclical pain, with symptoms that fluctuate across the menstrual cycle.

Despite the debilitating impact gynaecological conditions have, patients face having their concerns repeatedly dismissed with it often taking years to access a diagnosis or appropriate treatment [13]. Compounded by experiences of medical racism, some gynaecological conditions differ in prevalence by ethnicity, for example fibroids are most prevalent amongst Black women [14].

Managing the practical tasks associated with menstruation, such as purchasing, using, and disposing of or washing menstrual products, can present additional challenges for disabled people. These tasks may be complicated by mobility, dexterity, sensory, psychological, or energy-related difficulties, many of which can be exacerbated during menstruation. This context is compounded by the lack of choice of period products and technologies which meet the needs and preferences of disabled people [15] and the (often prohibitive) costs of period products, with disabled people being more likely to experience period poverty [16]. Disabled people may require additional assistance and adaptations to manage menstruation or to complete other daily living activities during this period. Yet there is too often insufficient support from health and social care professionals with menstruation-related needs unmet, overlooked and denied, compromising the dignity of disabled people.

Excluding menstruation and menopause: a critical oversight

Despite the intertwining of menstruation and disability, the current processes for assessing disability benefits are not designed with recognition of these experiences – reflecting the broader societal disregard and silencing of menstruation and menopause.

People with conditions which are associated with the menstrual cycle repeatedly report distressing and traumatic experiences of applying for disability benefits and being denied accessing the vital financial support they are entitled to [17, 18], often having claims rejected [19] or having to endure lengthy and distressing appeals processes [20]. Although symptoms are often persistent and disabling, the ways in which these can fluctuate throughout the menstrual cycle can be challenging to evidence in a system which falsely assumes consistent and predictable experiences [17, 18]. PIP assessments require that symptoms are present on more than 50% of days to be considered [21], however, this appears to assume a binary of days with, or without, symptoms, rather than as usually present but sometimes heightened and intensified.

Disability benefits assessors often lack knowledge about conditions such as PMDD and endometriosis, dismissing debilitating experiences as ‘just a period’ or disbelieving that these conditions constitute disabilities [17, 18]. This results in wide inconsistencies in the assessment process, where a lack of knowledge – or bias and prejudice – about conditions can impact the assessor’s perception of the applicant’s condition. These challenges are further exacerbated by barriers to receiving appropriate diagnoses and accessing the required medical evidence.

Indeed, DWP data reflects substantially lower than the average 51.63% ‘success’ rates for applicants where their primary condition is designated as a gynaecological condition [22]:

Diseases of the ovary, uterus, cervix, vagina, or vulva (type not known): 33.15%
Endometriosis: 32.22%
Fibroids: 26.64%
Ovarian cysts: 35.67%
Uterine prolapse: 31.50%

There is no evidence that the Government have considered how the proposed changes may impact disabled people who menstruate [9, 23]. However, it is likely that the change in eligibility criteria for PIP will only exacerbate and enhance the existing challenges, barriers and discrimination faced by applicants who menstruate.

The impact of managing periods

The PIP Daily Living component is assessed through ten activity areas, including elements such as "washing and bathing", "managing toilet needs or incontinence", and "dressing and undressing" [24]. However, none of these categories make explicit reference, in the question or scoring, to activities related to managing menstruation. A note from the 2011 drafting of the assessment questions presents an unsubstantiated claim that: “the activities required to manage menstruation are similar to those required to manage toilet needs or incontinence. Therefore, this activity is not explicitly included in the definition above”[25]. Despite disabled people arguing that ‘managing toilet needs’ must explicitly include consideration of menstruation this has never been addressed [26, 27]. Similarly, the assessment form for Disability Living Allowance – which can be claimed by under 16s – does not contain explicit reference to activities related to menstruation [33].

PIP assessment scoring for the question about ‘managing toilet needs and incontinence [24]’. Under the new proposals, applicants would be required to score 4 or above from a single question in order to receive the Daily Living Component.

Without explicit questions related to menstruation, it is unclear how these needs are factored into assessments if raised by the applicant, further contributing to inconsistencies in the assessment process. By failing to recognise this activity of daily living, the PIP assessment process systematically overlooks the needs of disabled people who menstruate, risking assessment outcomes and financial awards being unjust and unfairly reflecting the applicant’s experiences.

It is important to recognise that disability benefits processes are traumatic, invasive and undignified. Whilst menstruation should not be stigmatised, the reality is that societal shame and taboo persist and people may find it exposing to be asked about their experiences of menstruation. Whilst individuals must not be required to share intimate details they feel uncomfortable discussing, space must be created to recognise the experiences of disabled people who menstruate to not further contribute to the silencing and invisibilising of these experiences.

Gender based discrimination in disability benefits

The failure of the disability benefits system to account for gynaecological conditions, as well as experiences of menstruation, menarche, and menopause, constitutes a gender equality issue. Women are more likely than men to be disabled [28]; disability is an intersectional experience, with prevalence varying across ethnic groups [29] and shaped by broader systems including gender, racial, age-based, and class-based discrimination. Therefore, systematic failure to adequately account for the experiences of disabled people who menstruate may risk discrimination under the 2010 Equality Act, which protects against discrimination against individuals on the basis of nine protected characteristics, including sex, age, ethnicity and disability [30].

The proposed PIP reforms would disproportionately impact women; under the proposed changes, it is estimated that 32% of male claimants would receive an award, compared to just 25% of female claimants, a dramatic widening of the existing 0.7% gender gap between applicants [31]. Furthermore, currently, 52% of female PIP claimants, compared to 39% of male claimants were awarded less than 4 points across each daily living category assessed – under the proposed changes, these people may be at risk of losing this element of PIP [31].

The persistent failure to recognise disabled people’s experiences of menstruation and menopause may contribute further to gender-based disparities in PIP assessments and awards under the Government's proposed changes.

An alternative approach

We urge the Government to reconsider these cruel and reckless proposals. Instead, the Government must engage with disabled people to create changes to the disability benefits systems which focus on creating more flexibility within the process to recognise the fluctuating nature of disabilities and rectifying exclusionary and discriminatory processes which have disproportionate impacts for disabled applicants in relation to ‘protected characteristics’ and compound injustices against disabled migrants and refugees [32]. Explicit consideration of managing menstruation as an activity of daily living should be incorporated into assessment processes, for those for whom this is relevant.

Whilst there is no doubt that major reform is needed to address the harmful and discriminatory welfare system, the proposed changes would only serve to further the harms of an already punitive, discriminatory and flawed system, risking causing further hardship, isolation and preventable deaths.

References

[1] For clarity and consistency with the terminology used in the relevant legislation, in this letter we use the term ‘disability benefits’. However, we acknowledge that this term is problematic and can imply these payments are generous gifts or ‘handouts’, rather than provision of resources that disabled people both entitled to and require to manage the high costs of meeting fundamental needs.

[2] https://www.citizensadvice.org.uk/policy/publications/pathways-to-poverty-how-planned-cuts-to-disability-benefits-will-impact-the/

[3] e.g.https://dpac.uk.net/ and https://takingthepip.co.uk/#letter

[4] We use the term ‘people who menstruate’ to emphasise that not all women menstruate, for example those who have experienced menopause. This also recognises that not all people who menstruate identify as women or girls.

[5] We recognise the limitations of describing conditions as ‘gynaecological’ where these have systemic impacts. While many experiences of ill-health are filed under menstrual and gynaecological health, people's associated symptoms, challenges and support needs are much broader than this label suggests.

[6] https://www.scope.org.uk/the-disability-benefits-green-paper-what-you-need-to-know

[7] https://www.disabilityrightsuk.org/news/90-pip-standard-daily-living-component-recipients-would-fail-new-green-paper-test?srsltid=AfmBOoqqv39y-SVXhA_EGQ5thc8atXJxfghE9G-B-PBHxHhafaiqHuhP

[8] https://neweconomics.org/2025/03/the-true-scale-and-impact-of-benefit-cuts-for-ill-and-disabled-people

[9] https://www.benefitsandwork.co.uk/news/dwp-green-paper-impact-assessment

[10] https://www.disabilitynewsservice.com/pip-cuts-will-cause-further-deaths-say-disabled-relatives-of-claimants-who-died-due-to-previous-dwp-reforms/

[11] https://www.plutobooks.com/9780745349893/the-department/

[12] https://irr.org.uk/article/connecting-the-cuts-disability-borders-and-race/

[13] e.g. https://www.independent.co.uk/news/health/women-health-diagnosis-delay-treatment-b2280080.html

[14] https://www.wellbeingofwomen.org.uk/news/fibroids-awareness-month-2024/

[15] https://www.citytosea.org.uk/periods-and-disability-impairments-and-conditions/

[16] https://www.irise.org.uk/theredreport

[17] https://zenodo.org/records/14644134