Period Pain: A Public Health Issue No One Talks About

Menstrual cramps. Primary dysmenorrhea. Pain associated with menses. That time of the month. Whatever you want to call it… it’s this weird thing that we can’t talk about. It makes many women feel weak and vulnerable — like they are being controlled by their bodies. When we talk about it, it’s perceived as petulant whining.

The truth is, some people have seriously terrible menstrual cramps. What’s happening inside a woman’s body during her period is intense. In many women it manifests as physical or mental pain in many women.

A Look Behind My Curtain

Recently, I was blasted out of sleep with cringing stomach pain. I spent 3 hours in the bathroom, nauseous as all hell, and spewing out of both ends. I was lightheaded. The stomach and back pain was so severe that tears were streaming down my face.

This was not right. It was not your average period cramps. I had had a miscarriage about a month prior, but didn’t see the connection here. This pain was worse. My husband called the Kaiser nurse hotline to try to figure out what the hell to do. I couldn’t even speak on the phone, my voice was quivering so much. My body was literally shaking. He described my symptoms to the nurse and she suggested I first take out my tampon immediately, then go to the ER.

I followed her advice and we rushed to the hospital — I was curled in a ball in the front seat. Again, the tears streaming down my face from the intense pain.

We check into the hospital, I’m in the gown, and I’m asked to do a urine sample while they await some test results. I go into the bathroom and have a “holy shit” moment — there was a 2nd tampon in there. I was very sure I had Toxic Shock Syndrome, because what else could it possibly be? This was bad, very bad.

The nurse asks me to describe my pain on a scale from 1 to 10 (10 being the worst pain you’ve ever felt). I think about it for a second, and say “9”. She says, “really?!” I’m first annoyed, feeling like she was demoting my pain. I think about it a little longer — I’ve never had a broken bone, so I felt like it’s hard for me to answer the question honestly. Still, I try not to discount my own pain. I adjust my number ever so slightly and say “8–9”. She gets an IV in, and gets a morphine drip started.

Then there was the initial shock of the morphine. I didn’t realize that was a thing, but it’s apparently fairly common. What happens to many people, immediately when the drug hits the bloodstream, is this overwhelming sensation of panic. It’s best described as the the early signs of a panic attack, and lasts for about 60 seconds. The best way I can describe it is the feeling that you’re slowly suffocating in quicksand. Then the initial morphine shock passes and I felt warmth, and numb relaxation pass over me. Finally the pain went away — I felt nothing.

After 2 ultrasounds (external and vaginal) it was determined that I had “free fluid” in my pelvic cavity. It isn’t dangerous, but it’s incredibly painful. That was all the information they had to share with me, so they sent me home with a diagnosis of “acute unidentifiable pain.”

Essentially, the ER doctor told me that it was period cramps. (Primary dysmenorrhea is the medical term for period cramps.) He said there was a slight possibility of Endometriosis (though unlikely given I’m over 30 years old). Not Toxic Shock Syndrome. He didn’t even think the doubled tampon had caused any impact.

He gave me this sad look that made me shrink down further into the hospital bed. Maybe I was imagining it, but I swear his eyes said, “What a wimp. Period cramps? Suck it up, lady.”

To be honest, I was mortified. I couldn’t believe I had put everyone through so much trouble just because of my monthly menses.

I went home from the ER and slept for 4 hours. I woke up and, though sluggish, I honestly felt fine. I was glad to be feeling better, but then the reality of what he had said started to hit me: What if that pain was actually just period cramps. It didn’t mean the pain wasn’t real. Could it be that I will have recurring, debilitating pain every month? After every ovulation that doesn’t result in a healthy pregnancy, I will shed my superficial endometrium producing pain that invokes vomit and tears? Every. Single. Month?!

Yet another reason why being a woman can be really tough.

(To dive deeper into the mechanics of periods, listen to Suzanne Sadedin, Ph.D in evolutionary biology from Monash University on “How and Why Women Evolve Periods”.)

The (Lack of) Research

There are a few fabulous pieces written about how period pain can be as painful as a heart attack, but how a pathetically tiny amount of research is done on it. It affects many (but not all) of women and it happens monthly. Richard Legro, M.D., of Penn State College of Medicine stated:

“I think the bottom line is that nobody thinks menstrual cramps is an important public health issue.”

Doctors are unclear about the triggers, best possible treatments, and why it affects some women but not others. Andrew S. Coco M.D. from Lancaster General Hospital wrote about it in the American Family Physician:

Primary dysmenorrhea is by far the most common gynecologic problem in menstruating women. It is so common that many women fail to report it in medical interviews, even when their daily activities are restricted. Reported prevalence rates are as high as 90 percent.1
A recent prospective study of college students, based on diaries kept for one year, found that 72 percent of monitored periods were painful, most commonly during the first day of menses.
Sixty percent of the women studied reported at least one episode of severe pain.2

The Call To Action: Break the Silence

What can we do to help fun research around this issue? How can we elevate primary dysmenorrhea to be viewed as a public health issue? How can we make this hotly researched and discussed within the medical community?

We can start by not being ashamed of our pain. It’s not uncommon to have terrible period pain. And that doesn’t make it less important. It makes it MORE important.

Primary dysmenorrhea is a public health issue.

Let’s give it the attention it deserves.