I have a confession to make: I don’t mind my period. It's that welcome monthly confirmation that I’ve dodged the pregnancy bullet. And after spending years on the pill, I definitely prefer the natural regularity of my period turning up each month, unfettered by synthetic hormones. For many, however, periods mark the coming of all evil, the crumbling of time and space, of everything that is good in this world. Darkness falls and the days of reckoning come in the form of a gradual drop in progesterone and oestrogen resulting in the expulsion of your uterus lining.
I am lucky enough not to experience the worst of it (s/o to my reproductive organs). Saying that, there is one element that can fuck right off - and that's the pain. I've had the joy of late night wakeups from my uterus, and it’s one of the most painful things I’ve ever experienced. This is no exaggeration - John Guillebaud, Emeritus Professor of Family Planning and Reproductive Health at UCL, told me period pains were 'very similar to the pain of a heart attack.' Dysmenorrhea, the medical term given to period pain is an area with little known research, even though a report in the American Family Physician stated that 'Dysmenorrhea...may be severe enough to interfere with daily activities in up to 20 percent of women.' Research from the University of Bath even puts the percentage of women who struggle with it as high as 40%.
That’s up to two fifths of women affected by painful cramps, that have barely any where to go for help - little research into the area means that not only are there few treatments, but they’re hard to get prescribed. Visiting a GP in the UK is rarely any help. The reality is usually an old man who will sincerely ask you whether you’ve tried ibuprofen yet, as if, after 4 hours of pain, you’d just forgotten about this magic household substance called “pain killers.” The official NHS treatment for dysmenorrhea (other than pain killers) seems to be contraceptive - not an uncontroversial referral, considering the Debrief’s recent investigation into the overlooked side effects of the Pill.
Because of the pernicious ties between our ovaries making us all emoshunal, pain associated with the womb is often seen as an insignificant ailment. Just silly women ovary stuff, rather than a literal physical pain. As a result, seminal studies like The Girl Who Cried Pain have reported that men suffering from the same level of pain are treated on average quicker than women - despite the fact women report more experiences of severe pain. The study concludes that women are 'more likely to be treated less aggressively in their initial encounters with the health-care system until they ‘prove that they are as sick as male patients.' Ugh.
Why do we feel period pain?
You may have a decent idea of why the whole period thing happens, but the reason we feel pain is a little more complicated. 'The common cause of spasmodic dysmenorrhea is prostaglandins, which are the substances that are released when women have a period,' explain Dr John Guillebaud 'They’re needed because the uterus has got to contract to push out the blood and clots. The problem for some women is that their wombs produce more than they should. This cramping can cause ischemia, which is a lack of blood flow in the lining of the womb. When you get a lack of blood flow you get pain - actually very similar to the pain of a heart attack in its mechanism.'
Yup, that’s right, a heart attack. Please feel free to quote this to any sceptical men when they tell you to stop making such a fuss.
How much period pain is too much pain?
Speaking to various medical professionals, it’s clear that pain is not always a good indicator of a problem. However, there are ways to quantify even our subjective understanding of pain - such as using a sliding scale. 'In medicine, severity of pain does not necessarily correlate to the dangerousness of your condition. Certain spasmodic dysmenorrhea, however severe, is not itself a dangerous condition, it’s just horrible,' explains Guillebaud.
Using a scale from 0 to 10, 0 being no pain at all and ten being so bad you’d punch a puppy to make it stop, there are ways we can quantify it. "Too much pain is what the patient feels is intolerable, which is normally marked by the patient on her line at 7,8,9, or 10 on the scale. A lot of people for bad dysmenorrhea will put nines.”
What treatment is there for period pain?
One of the biggest issues I’ve found is having a doctor trust your pain enough to prescribe anything other than ibuprophen, but accoding to Guillebaud, this often comes down to the fact that when you’re presenting to a doctor, you’re most likely not in the most pain. 'Not many doctors see you on the worst day of your month. Which makes it difficult for the doctor to appreciate how hard it is.' Either way, Guillebaud explains that there are steps to be taken. 'My first choice would be to prescribe ibuprofen or naproxen (or another anti-prostaglandin), and if that wasn’t enough, then I would go straight to the pill, regardless of contraception.'
There are a lot of reasons dysmenorrhea isn’t dealt with as seriously as we’d like
Other than the fact that pain isn’t always a good indicator, sexism (shock horror) definitely comes into it. 'There are men out there who can be very unsympathetic, because they think it’s a “woman’s problem”: there is a kind of sexism out there, sometimes even among male doctors,' explains Guillebaud
We also don’t know as much as we would like about dysmenorrhea, and if we do, it’s often not applied. 'I agree with you that there hasn’t been enough research as there should have been, but I do think there’s probably more been done than [most people] know about,' he adds.
This doesn’t mean it should be ignored
It’s hard to know the norm when we have no idea what other women are experiencing, and having a national health service that doesn’t take it seriously isn’t helping anything. You don't have to pin your blood stained pants to the fridge with a note that says, 'is this weird guys?' but we shouldn’t feel embarrassed about talking about our pain, especially when it could lead to a better culture of diagnosis.
'Ten percent of women are incapacitated on the worst day of their periods, and that’s a lot. It’s a big problem,' says Guillebaud. 'Why should anybody suffer like this?'
So take your medicine, tell your friends, and don’t be embarrassed to take time off work or bring it up. Respecting our bodies - especially when they’re in pain - is the best step to creating a culture that has structures to help. Talk about it with siblings (boys inc.), partners (yes, boys inc.) or friends (even boys!!) to eradicate that stigma. Do like Aretha Franklin, and demand some respect for all the painful uteri across the world.
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This article originally appeared on The Debrief.