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.
All video credits belong to the NHS, a national health authority in the United Kingdom.
Understanding the Basics
Period pain affects 7 in 10 menstruating people. It can range from mild discomfort to severe and debilitating pain. The main culprit for period pain is prostaglandins. These hormone-like substances naturally rise sharply in the uterus right before menstruation to tell your uterus to contract and shed its inner lining when you are not pregnant. But when the concentration of prostaglandins is out of balance, the contractions can become too intense, leading to period pain. These contractions can lead to throbbing or aching in the abdomen, pain in the lower back and hips and discomfort radiating down the legs.
Prostaglandins can be secreted by many cell types throughout the body and play a role in regulating normal tissue functions. Especially cells lining blood vessels and immune cells can secrete high amounts of prostaglandins, which serve as danger signals when there is an injury or infection. Prostaglandins attract more immune cells to the injury site and nerve endings can sense prostaglandins to convey the information of tissue injury to the brain – in the form of pain.
In the uterus, prostaglandins are important regulators of contraction, birth, and fertility. At the end of the menstrual cycle, during menstruation, the uterus sheds its inner lining (the endometrium). This results in massive tissue destruction and bleeding. No wonder that lots of prostaglandins are released as “tissue injury signals", causing significant inflammation and contraction of the uterus. While some inflammation is healthy and important for tissue regeneration, many people experience severe pain caused by an overproduction or imbalance of prostaglandins. This was recognized already in the 1960s. Subsequent studies confirmed higher levels of specific prostaglandins in women experiencing menstrual pain. So, people with severe dysmenorrhea can be thought to be suffering from a particularly severe uterine inflammation during menstruation.
Primary vs. Secondary Dysmenorrhea
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 caused by an underlying reproductive health issue, such as endometriosis or fibroids. 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.
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)
Tips on how to speak to your healthcare provider
Bringing up period pain in a clinical setting can feel uncomfortable, but being prepared can help you advocate for yourself effectively. Start by tracking your symptoms over a few cycles—note the intensity of pain, how long it lasts, and how it affects your daily life. This information helps your physician better understand the impact and pattern of your experience. Use clear, descriptive language when speaking about your pain, and avoid minimizing it with phrases like “It’s probably normal.” If your symptoms are interfering with work, school, sleep, or relationships, say so plainly. Remember, your lived experience is a critical part of the diagnostic process. If you feel dismissed or not taken seriously, consider seeking a second opinion—your health and well-being are worth it.
Quick Tips to Prepare:
🗓️ Track your cycle – log timing, pain intensity, and related symptoms
🔍 Use a pain scale (e.g. 1–10) to describe severity
📉 Explain impact – how it affects your daily activities or mental health
🗣️ Be specific and honest – avoid downplaying your experience
🧾 Bring data – a symptom diary or app tracker helps give context
✊ Advocate for yourself – your pain is real, and you deserve care