Period pain, or dysmenorrhoea, affects around 80% of women. It can range from discomfort to absolute agony. If you fall into the latter camp, you will be nodding along vigorously by now.
Caused by changes in hormone-like compounds called prostaglandins, the pain is known as “spasmodic” dysmenorrhoea, as the uterus is literally contracting in order to push out blood and clots. Charming.
Ok, so we’re pretty much getting over the taboo around periods now. After all, since the advent of period poverty awareness and the rise of menstrual tech; we’ve been talking about periods more than ever. But, there is one aspect of menstruation that we should be talking about more: pain.
A study in 2019 showed that 14% of women with period pain had taken time off from school or work, whilst a staggering 80% had stayed at work but suffered, and were ultimately unproductive. Couple this with findings in 2018 by John Guillebaud, Emeritus Professor of Family Planning and Reproductive Health at UCL.
“This cramping can cause ischemia which is a lack of blood flow in the endometrium, the lining of the womb,” he says, “When you get a lack of blood flow you get pain – actually very similar to the pain of a heart attack in its mechanism. A heart attack is also caused by ischemia.”
Yes, you read that right. Period pain can be as bad as a heart attack.
So far, so scary. But the scary stuff is still to come, because the stats on the amount of pain felt by women are nothing compared to the lack of treatment they receive. Or even; if they are believed by doctors.
Here are some facts likely to inflame your already painful womb…
A 2008 study showed that women are less likely to be given strong painkillers than men- and they wait longer to receive them. A 2014 study in Sweden showed women were dramatically less likely to be classified as an ‘urgent case” and American doctor Esther Chan told a BBC report in 2018 that female pain is often “assumed to be gynaecological” and therefore most doctors “don’t think it needs strong painkillers.” She also said that most women are assumed to be suffering “psychologically” as opposed to physically. Let’s just let that sink in, shall we… ?
In 2001, a groundbreaking US study was undertaken, brilliantly entitled ‘The Girl Who Cried Pain.’ It found that women report more severe levels of pain, more frequent incidences of pain and pain for longer duration- but are treated for it less frequently. Women found they were having to “prove” they were as sick as male patients. It revealed that nothing was really being done to treat or prevent period pain, that it still suffered from habitual underfunding and a total lack of research. The women surveyed said they had the distinct impression that people just didn’t take it seriously at all.
Imogen Walters, 31, has endometriosis; a chronic pain condition caused when the tissue that grows inside your womb lining, begins to grow outside it. Women can experience this mildly or in extreme ways- like Imogen. Many women are so crippled by it, like one if its most famous sufferers, Lena Dunham, that they opt to have their womb removed entirely.
Yet when Imogen first started reporting symptoms, she came across a wall of disbelief from the doctors she met.
“There seemed to be an unconscious assumption that as a woman I couldn’t be trusted to understand my body and my experience;” she said, “Surely I must have been exaggerating or was misinformed.”
She found her pain was quickly dismissed as “her period.”
There is, of course, the underlying fact that we ourselves propagate; that being in pain on your period is just part of being a woman. How many times have we just accepted feeling totally awful as an unjust reality of being a lady? However, this idea that pain is ubiquitous with womanhood – an idea that women have readily bought into – is damaging to the perception of female pain among medical professionals. If we diminish and dismiss our own pain- doctors will too.
“Period pain being dismissed happens a lot,” explains Eleni Mavrides, Consultant Obstetrician and Gynaecologist at The Portland Hospital, “Because you have it all the time- it’s just assumed you will be in pain. Pain is a very subjective thing; it is very individualised; bleeding between your periods is a tangible thing, it is black and white; you know it’s there. But pain is subjective.”
Eleni Mavrides works a lot with women like Imogen, who suffer from endometriosis – a condition which affects 10% of the female population of the UK, but which can take a shocking 7 years to properly diagnose.
“A lot of doctors still don’t totally understand endometriosis,” she says, “It is also hard to diagnose, as it shares symptoms with a lot of other conditions.”
Imogen is now suffering from a variety of chronic pains as a result of her endometriosis surgery, but still feels fearful about her ability to get effective treatment.
“It can feel as if they’re working under the assumption that my body will always experience pain, that this is simply how my body is now,” she explains, “It’s disheartening, and causes quite a bit of fear – will my doctors actively look into the condition and try to treat it, or will it be deemed something I have to live with because they believe it’s insignificant?”
John Guillebaud thinks that – although anyone’s pain is hard to fully comprehend- there is a definite type of sexism at play here.
“Pain is difficult because it’s felt by the person and not the researcher or the doctor, so how do you measure it?” he says, “I speak as a man who is aware, but there are men out there who can be very unsympathetic because they think it’s a “woman’s problem.” This attitude is also there sometimes even among female doctors. Because of the absence of a kind of solid diagnostic process, it’s very easy for a clinician to first of all think it’s all or mainly psychological, which is obviously wrong.”
There is also the fact that precious little money and research goes into “women’s problems.” Because we have our pesky periods monthly- what’s the point, right?
Although she admits some of this is due to the fact medicine is still a “male dominated industry,” Eleni Mavrides tells me that, because it is not life threatening, period pain and endometriosis doesn’t get priority. John Guillebaud also agrees that period pain, “however severe, is not itself a dangerous condition, it’s just horrible.”
Whilst understandable, it doesn’t change the fact that women’s pain is still treated in a fundamentally different way to male pain. The fact that the NHS in 2017 had to have an endometriosis campaign called “Believe Women”- targeted at doctors- is terrifying. As is the fact that studies for erectile dysfunction (another non-life-threatening condition, just FYI) outnumber research for PMS, 5- 1; despite the fact 9/10 women have debilitating symptoms and only 19% of men suffer from this dysfunction.
So, whilst we’re waving our tampons loud and proud and campaigning for accessible period products; lets shout out about pain too. Being in pain is not, and should not be, a reality for every woman. More than that- every woman has the right to be listened to- especially about her own body.