Period Pain
Period pain
Menstrual pain
Dysmenorrhea
A Prevalent yet underrecognized condition
Dysmenorrhea, menstrual pain or period pain, affects a significant proportion of menstruating individuals. Despite its prevalence, it remains underdiagnosed and inadequately treated. Period pain is normalized in society, often due to societal stigmas that tell women that pain is just part of being a woman and to deal with it. This systemic denial of women’s pain makes it much harder to tell when the pain threshold has crossed the line from “normal” to something much more severe. This normalization leads to delays in appropriate medical care and contributes to underestimating the condition's impact on quality of life, education, and work productivity.
Here are some helpful resources on periods and period pain.
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Understanding the Basics
Period pain, or dysmenorrhea, affects around 7 in 10 people who menstruate. It can range from mild discomfort to severe, debilitating cramps. Dysmenorrhea is classified into two types: primary and secondary. Primary dysmenorrhea refers to common menstrual cramps without an underlying medical condition, often beginning in adolescence. Secondary dysmenorrhea is typically associated with underlying gynecological conditions such as endometriosis, adenomyosis, fibroids, or pelvic inflammatory disease. The prevalence of primary dysmenorrhea is as high as 80.9%, with most individuals describing their menstrual pain as moderate to severe, significantly affecting their daily activities. The main driver is a group of hormone-like substances called prostaglandins.
What prostaglandins do?
Prostaglandins naturally rise in the uterus before menstruation. Their job is to trigger contractions so the uterus can shed its inner lining if pregnancy hasn’t occurred. When prostaglandin levels are too high, contractions become stronger and more frequent, leading to cramping, throbbing abdominal pain, lower back or hip pain, and sometimes discomfort radiating down the legs.
Role of prostaglandins beyond the uterus
These compounds are produced by many cell types throughout the body, especially immune cells and the linings of blood vessels. They act as “danger signals” in response to injury or infection, drawing in more immune cells and activating nerve endings that send pain signals to the brain.
Why is menstruation painful for some?
During menstruation, large amounts of prostaglandins are released to cause inflammation and support uterine contraction to shed the endometrium, resulting in massive tissue destruction and bleeding. While some inflammation is normal and even necessary for tissue repair, excessive or imbalanced prostaglandin production can cause severe period pain.
This link has been recognised since the 1960s, with later studies confirming higher prostaglandin levels in women experiencing dysmenorrhea. In effect, those with severe menstrual pain are thought to be experiencing an intense local inflammatory response in the uterus.
Period Pain is Not Normal
While mild discomfort during menstruation can be expected, pain that interferes with daily life is not normal and should not be dismissed. Pain is highly subjective, and tolerance can vary from individual to individual. However, around 20% of menstruating people do not feel pain or describe their period pain as mild.
This means periods without pain are normal and a real possibility. Normalizing severe pain contributes to diagnostic delays and emotional distress. It's crucial to recognize that severe menstrual pain may indicate underlying health issues that require urgent medical attention.
Emoji-based Visual Analog Scale (Source: JAMA Network)
