As we mark the end of Women’s History Month and endometriosis awareness month, this is a good time to address a persistent, common, and misguided belief about menstrual pain. Whether you menstruate or not, popular culture and medical culture continue to perpetuate the message that periods are supposed to hurt, that we are expected to “suck up” and settle for over-the-counter medications like advil, nurofen or ibuprofen when necessary. If periods are part of being female, then so are menstrual pain and cramps. How did we get here?
Throughout human history, we have been programmed to equate being female with pain. We have been conditioned to believe that women’s bodies naturally experience pain during periods, sex and childbirth. This belief has served to reinforce the idea that women are the weaker, inferior sex. Women are supposed to experience pain, that’s just nature. Why have we blindly accepted rather than challenge this notion?
Alongside period stigma is the historical legacy of how women’s bodies and menstruation came to be viewed more as pathological and deviational rather than normal. Beginning in ancient Greece, women’s body problems were thought to be rooted in hysteria, the Greek word for womb. Male bodies were revered as athletic, beautiful, perfect and erotic. The male form was worshiped.
In today’s world, commercial messaging may worship the female body for its beauty while female hormones are still portrayed more as a curse, as the cause of depression, instability, infertility, and sexual dysfunction.
Period and body shaming converge in a toxic cocktail which hurts and discriminates against all who menstruate. While body and period shaming may be more pronounced in places like Africa, India and the Middle East, misogynist ideas about periods and period pain persist in western, “developed” countries as well.
Our culture views periods as negative, embarrassing, private, taboo and stigmatic; a nuisance at best. This means that young girls, their mothers, and women in general are reluctant to speak out about their period experiences, including those with pain and disability.
If menstrual pain is synonymous with being female, then we accept this idea as self-evident. We learn from a young age to hide our periods, then later to hide pads and tampons, and everything associated with them.
An entire language of slang has developed around this so the word “period” is never uttered. Yet when we normalize period pain we are basically internalizing another message, that our bodies are not only problematic but defective. No wonder that so many girls and women develop poor self-image and self-esteem around their bodies and sexuality.
Take, for example, the early development of American gynecology, which was based on crude medical experiments performed on black female slaves without anesthesia because it was believed that black women were less sensitive to pain than white women. This bias and attitude still pervades today, as most white physicians continue to underestimate the levels of pain experienced by people of color.
Menstruation and menopause are two ends on the biological spectrum, viewed through a lens of potential illness rather than one of health and normalcy. Both hormonal transitions are viewed in a negative light.
The biomedical model breaks the body down into separate parts and generally does not recognize the body-mind connection. It tends to assume that pain issues experienced by women are rooted in the emotional, the psychological or “in their heads.”
For decades, women’s symptoms and complaints about period, pelvic, chest and heart pain have been typically dismissed and ignored, often seen as the result of emotional stress, while men’s symptoms and complaints typically lead to immediate referral for diagnostic testing.
When it comes to period pain, known in medical jargon as “dysmenorrhea” this generic symptom is often trivialized if not outright dismissed as “non-medical” and non-urgent by most gynecologists.
How many females have been told “I’ve examined you and there’s nothing wrong with you,” when what they really mean and cannot say is, “I examined you and I don’t know what’s wrong with you.” From the perspective of the physician and western culture in general, period pain is mostly a personal and social nuisance, which can easily be treated with anti-inflammatory pain relievers or with contraceptive hormones.
If your period really hurts, physicians have no problem recommending continuous birth control, which eliminates the menstrual cycle altogether. This approach doesn’t solve the underlying problem, it only hides it.
When gynecologists are only educated to see periods through a very narrow pathological lens, they lose sight of the fact that normal periods, including ovulation and balanced reproductive hormones are actually necessary and important for overall health. The best resource to date on this is Lara Briden’s Period Repair Manual. Her book belongs in every home. Listen to her recent podcast about pain and endometriosis.
As more and more of us learn to listen to our bodies, we realize that pain is the body’s way of communicating that something is wrong.
Natural medicine approaches like naturopathy, acupuncture, herbal medicine, dietary and lifestyle changes, pelvic massage, nutritional supplements and body-mind healing are gaining popularity, but for the most part, they are not recognized by conventional medicine or covered by health insurance.
Prostaglandins are hormone-like fatty acids secreted in the uterus that cause the uterine lining to contract and shed. They are thought to be the main cause of menstrual pain. The leading recommendations for alleviating period pain are:
Regardless of the treatment you choose, continuing for at least two to three months is essential for achieving results.
Endometriosis is an inflammatory disorder where endometrial tissue grows outside of the uterus in the pelvic area. It usually presents as very painful periods and chronic pelvic pain, though not for everyone.
Endometriosis can cause bladder problems, abdominal and digestive problems, nausea, infertility, and sexual pain. Endometriosis affects approximately 10-15% of females of reproductive age. It takes an average of ten years to diagnose endometriosis. That should be the clearest sign that conventional medical knowledge and education are trailing behind. For many who train in conventional medicine, disabling pelvic pain is just a more extreme version of period pain on the spectrum of women’s pains. The lack of research and knowledge about the causes of endometriosis are just another example of how period pain is not taken seriously. And the current situation begs for us to look at why we, as women, families and society, normalize period pain.
Another common cause of menstrual and pelvic pain are uterine fibroids, non-cancerous growths in and around the uterus. Not only do they cause pelvic pain but also heavy bleeding and anemia, pain during sex, urinary tract infections, miscarriages and infertility. They can be easily diagnosed and as patients, we need to stand up for ourselves and make sure we are getting the diagnostic and treatment care we deserve.
There is much we can do to shift the paradigm and improve health awareness, diagnosis and care:
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