Are my period pains normal?

Periods can be very painful.

“Come on, it can’t be THAT bad”, “pain is normal, don’t overreact, just get out of bed”, or “don’t rely on painkillers, this is something we have to bear” are frustrating things menstruators have probably heard again and again. Sadly, it’s common for people to have their very real pain and discomfort downplayed, or to not be believed.

Although cramps are a common period-related side effect (especially on the dreaded first 1–3 days), it is important to be in tune with our bodies and realise when a doctor’s advice may be needed.

We completely empathize with your pain, and are here to help and support you.

Why do we experience period pain?

You may have come across the term “dysmenorrhea” before – although it sounds scary and serious, it’s just a fancy word for “period pain”. Primary dysmenorrhea is what we know as menstrual cramps. It fluctuates, so it can feel worse on some days and more bearable on others. Abdominal pain and discomfort are normal to have on your period, especially on the first two or three days.

Let’s understand why period pain or primary dysmenorrhea happens.

• The muscles of the uterus begin to contract vigorously during menstruation.

• Pain chemicals called prostaglandins are released when the body prepares to shed the lining of the uterus. The uterine lining is what comes out as menstrual blood.

• Prostaglandins are thought to make the blood vessels and muscles of the uterus squeeze or contract, which is what we experience as painful cramps.

Pain can start up to two days before your period. You may even experience pain during ovulation, roughly 14 days before the first day of your period.

It’s important to remember that everyone is different. Some people naturally don’t experience pain or are able to manage it using common pain relief methods like ibuprofen or a hot water bag. You may also have pain and spasms in the lower back and upper thighs as well as the abdomen. The level of pain can vary and be duller some months and more severe on others.

Severe pain that doesn’t go away even with pain medication or occurs with other symptoms like a heavy flow (having to replace your pad or tampon every 2 to 3 hours, for example), long periods (longer than the typical range of 2 to 7 days), or nausea may signal an underlying health issue. This should be investigated by a doctor. Examples of these possible health issues are endometriosis, pelvic inflammatory disease, or fibroids (source). This kind of pain that is caused by an underlying reproductive health condition is called secondary dysmenorrhea.

We know this sounds scary, but it’s important that you approach a doctor and address the problem as early as possible. Remember that support is always available.

We are together in this - Prevalence Data

Studies have shown that up to 90% of people with uteruses experience some amount of menstrual pain, and that up to 30% have severe pain that hampers their ability to go about their daily lives (source).

In India, it is estimated that 50–87.8% of people have painful periods (source). Unfortunately, it is possible that this statistic is actually higher, as it is believed that menstrual pain tends to go under-reported. These researchers found that 40.7% of people experienced pain for 1–2 days of their period. Those with moderate to severe pain also tended to miss an average of 2.5 days of school or college, showing that the pain was affecting their productivity and quality of life.

Similarly, another Indian study found that over half of their study participants were unable to go about their usual daily activities and had to rest due to pain (source).

A study from 2018 found that menstrual pain tends to be overlooked and seen as just a “part of life” or something that women just have to go through (source). This can be a dangerous way to think as pain that goes unreported can lead to delays in identifying and treating conditions that need medical attention.

How to manage our symptoms - a simple to-do

Some common fixes for period pain (source):

• Heat - a hot water bag can be a comforting and effective way to relieve abdominal or back pain. Make sure not to directly expose your skin to the heat for too long though.

• Light exercise - although exercise is usually the last thing on your mind during a painful period, light activity like a short walk or yoga can be relaxing and help ease pain. Here are some yoga poses that have been shown to help with period pains!

• Medication - Painkillers like paracetamol (also called acetaminophen) and mefanamic acid help by stopping your body from making the pain chemicals that cause cramps. You can get these painkillers over-the-counter at pharmacies.

You can also measure your pain using this scale that’s been developed by menstrual health researchers to score period pain:

(source)

Score yourself on each column (working ability, location, intensity, and days of pain) on a scale of 0 to 3; then, calculate the total score by adding each of the individual scores.

• 0 indicates no period pain

• 1–4 indicates mild pain

• 5–7 indicates moderate pain

• 8–12 indicates severe pain

If you're experiencing severe period pain that doesn't improve despite trying various remedies, it's important to seek medical advice. Consulting with a doctor early on can help identify any underlying health conditions and ensure you receive the necessary support and treatment. Taking proactive steps towards managing your periods can make your overall menstrual experience more comfortable and manageable.

Some doctors may suggest going on hormonal birth control or contraceptives to regulate periods and control pain. Currently, many hormonal birth control options exist, such as the pill, subcutaneous implant, or intrauterine devices (IUDs). Make sure to speak to a gynaecologist if this seems like the right path for you.

- Team Cranberry

Sources:

https://www.nhs.uk/conditions/period-pain/ Accessed: June 13, 2023

https://www.healthline.com/health/fitness/yoga-poses-for-period-cramps#poses-to-try Accessed: June 13, 2023

Ju, H., Jones, M. and Mishra, G., 2014. The prevalence and risk factors of dysmenorrhea. Epidemiologic reviews, 36(1), pp.104-113. https://pubmed.ncbi.nlm.nih.gov/24284871/ Accessed on: July 5, 2023

Teherán, A.A., Piñeros, L.G., Pulido, F. and Mejía Guatibonza, M.C., 2018. WalIDD score, a new tool to diagnose dysmenorrhea and predict medical leave in university students. International journal of women's health, pp.35-45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775738/ Accessed: June 18, 2023

Omidvar, S., Bakouei, F., Amiri, F.N. and Begum, K., 2016. Primary dysmenorrhea and menstrual symptoms in Indian female students: prevalence, impact and management. Global journal of health science, 8(8), p.135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016343/ Accessed: June 13, 2023

Chen, C.X., Draucker, C.B. and Carpenter, J.S., 2018. What women say about their dysmenorrhea: A qualitative thematic analysis. BMC women's health, 18, pp.1-8. https://pubmed.ncbi.nlm.nih.gov/29499683/ Accessed: June 13, 2023

Patel, V., Tanksale, V., Sahasrabhojanee, M., Gupte, S. and Nevrekar, P., 2006. The burden and determinants of dysmenorrhoea: a population‐based survey of 2262 women in Goa, India. BJOG: An International Journal of Obstetrics & Gynaecology, 113(4), pp.453-463. https://pubmed.ncbi.nlm.nih.gov/16489934/ Accessed: July 5, 2023