I have never had what most women would call an “easy” period. I can remember countless occasions when menstruation pain left me feeling delirious and desperate. In one vivid memory, I am curled up in my bed, sobbing helplessly as one wave of excruciating pain after another washes over me. In another, I am crawling on all fours to the bathroom, about to be physically sick during a sleepover.
Every month, I was terrified by the pain my period would bring, knowing I would be powerless to stop it. I never questioned whether my period pain was abnormal. In fact, I grew up believing that when girls and women were hit with their monthly “cramps,” they were experiencing the same debilitating pain that I was. Not only did I think intense period pain was normal, I thought it was universal.
Many other young women are brought up believing that period pain is simply an unfortunate part of being a woman. In many health classes, teachers skim over the gory details of the menstrual cycle, using the vague “cramps” as a catchall term for all kinds of period pain. In films and TV shows, we are presented with images of women curled up in bed with a hot bottle as the butt of a joke. Rarely do we see an accurate depiction of the nuances of period pain.
The normalization of period pain
We spoke to Dr. Stello Bullo, a linguistics professor who is researching how language is used to describe endometriosis pain. According to Dr. Bullo, we as a society are failing to give women the information they need to understand what constitutes normal period pain. “It’s very, very important that women are educated about the difference between normal pain and abnormal pain,” she says. “If you’re lying on the floor in a fetal position every time you have your period, that’s not normal.”
The misconceptions about period pain, Dr. Bullo explains, stem from what we learn in school, what we are told by our families, what we hear in our friendship circles, and what we see on TV. Bullo has encountered numerous women who were told by their own mothers that they had a low pain threshold because they themselves were never taught that cramps could be debilitating. Dr. Bullo has also worked with countless women who were told by doctors that their pain was simply part and parcel of being a woman. “Pain gets normalized as part of the female condition,” she says.
The consequences of misinformation
These misconceptions about period pain can have serious consequences. Severe pain can often be a sign of a condition like endometriosis, a condition that results in tissue like that found in the womb’s lining growing in other parts of the reproductive system, or polycystic ovary syndrome (PCOS), which can cause hormonal abnormalities and ovarian cysts. When women and doctors aren’t aware of the difference between what “normal” and “severe” pain feels like, it can take years for a woman to seek help and then years for doctors to reach a diagnosis.
A 2017 study of women with PCOS from around the world showed that 33.6 percent of women have to wait more than 2 years for a diagnosis and 47.1% see more than 3 doctors. A 2020 study found that almost all women experienced delays getting an endometriosis diagnosis–37.7 percent 27.0 percent and 35.3 percent had short, intermediate and long delays respectively.
Emma, 29, has period pain that ended up being a symptom of both PCOS and endometriosis—but because of gaps in her health education, she didn’t initially realize the link.
“My ‘normal’ periods are easily described as hell on earth,” she says. “I take strong painkillers, live with a heat pack and I have pain throughout my body making it hard for me to be mobile.”
From the age of 11, Emma lived with these debilitating periods, thinking they were normal. When she was 20, she had her second child. “My symptoms really took a turn for the worse, which made me research periods and related conditions,” she says. She finally realized that her education surrounding period pain had made her believe her period was normal.
Eventually, she received her diagnosis and is also currently under investigation for Adenomyosis. For Emma, a lack of information and education meant that she had to wait nine years before getting her first diagnosis. “If there was better education around periods I definitely would have done something about my suffering sooner as it is far from normal to live this way,” she says. “Too many girls go through years of suffering and are passed off as hypochondriacs.”
Now, Emma runs I’m Fine Attire, a clothing company designed for women with chronic conditions.
While it takes some women years and years to readjust their understanding of what “normal” pain levels are, other women realize that their pain is abnormal from the beginning. However, when they seek medical help, they are denied tests and told that their pain is simply a normal side effect of having a period.
This is exactly what happened to Gemma. Gemma, 29, has always had extremely painful periods. “While at school there were many occasions when I would need to go to the nurse’s office and be sent home. There were many sleepless nights writhing in pain and even passing out on the bathroom floor,” she says. This experience didn’t line up with what she was taught as a child. “My understanding from an education point of view was that women would experience some very mild cramping each month,” she says.
When she was young, Gemma managed her periods with a mixture of ibuprofen and paracetamol along with a hot water bottle. When ibuprofen began to irritate her stomach and led to gastritis, she switched to co-codamol.
Gemma has sought help from her doctor multiple times. “I was tested for PCOS a few times, each time it came back negative–the doctors refused to test me for endometriosis,” she says. “In fact, a female doctor told me that the pain would get better after I had a baby and should try that first.”
Instead of testing Gemma for endometriosis or another condition that may cause her abnormal pain, her doctors suggested she try a variety of contraceptives to ease her pain. “Nothing has helped,” she says.
Gracie, 21, had a similar problem when it came to seeking help. She started her period relatively late. When it finally came, she was ill for a week and had to take time off school. “My mum told the school I had food poisoning because she was worried they wouldn’t authorize that much time off sick if they knew it was for my period,” she says. “Painkillers don’t help soothe my pain and I normally vomit on the first two days of my period.” She continues to suffer from extreme pain each month to this day.
She realized early on that her period pain wasn’t the same as that of her friends. “I realized it isn’t something I should simply put up with,” she says. Nevertheless, getting help hasn’t been easy. “Despite visiting the doctor several times throughout my teenage years, I’ve never been tested for any conditions—instead I was placed on several different forms of contraception, all with more negative side effects than positive,” she says. “This summer I’m planning to go private [rather than going through the UK’s public healthcare system] to receive treatment after nearly six years of suffering the monthly pain.”
So, how can we better understand what our period pain is telling us?
Women are struggling to receive the tests and treatment they need for conditions that cause abnormal period pain. Many have been raised to believe that pain of all severities is a burden that women must simply put up with. Others are met with disbelief and resistance from medical professionals.
I ask Dr. Bullo why doctors often fail to understand why women’s pain needs to be taken seriously. In her opinion, doctors don’t always have the education they need either. “I’ve spoken to doctors that didn’t necessarily know about the many different types of endometriosis and the different manifestations of pain,” she says. “If doctors don’t have a full overview of possible ways in which pain can be manifested, then how are they expected to understand each woman’s unique symptoms?”
Because doctors can’t always be trusted to understand the nuances of period pain, the burden falls on women to educate themselves on the line between normal and abnormal pain.
I eventually learned that my own period pain was out of the ordinary when I began to research and discuss the nuances of period pain for myself. Unfortunately, many education systems, parental “talks,” and media portrayals are bound to let us down—if we don’t arm ourselves with knowledge, who will?