If painful periods aren’t normal, why do so many people have them?

[Jay27]

I keep seeing doctors on social media saying that painful periods aren’t normal and you should get them checked out. I’m going for another opinion soon, but most of my doctors have said “everyone feels like that” when I talk about my cramps. My friends who have periods also get bad cramps that make them throw up or feel dizzy and they have to miss school to rest in bed. If it isn’t normal, why is it so common?

[Latha]

Hi there, Jay27!

Here's how I understand it: having some degree of pain/cramping (along with other symptoms like nausea and fatigue) during one's period is normal and common- experiencing those things doesn't necessarily mean that anything is wrong. That said, these symptoms can still be difficult and disruptive. The fact that they are normal and common ('everyone feels like that') does not mean that people don't need accommodations and support during their periods- it can often help to take pain medication, rest, use a heating pad, or do some light exercise/stretching.

However, it is possible, to have a degree of pain that is severe and abnormal due to conditions like endometriosis. These conditions often go undiagnosed because both patients and doctors believe that everyone has painful periods. So if you experience painful periods, and none of the usual solutions give you any significant relief, it is a good idea to get checked out.

[Heather]

I'm happy to talk a bit about the more theoretical part of your question -- why is menstrual pain so widespread? -- if you want, Jay, just let me know!

[Jay27]

Yeah, I’d like to know why it’s so common. I feel like I might have endometriosis since my cramps are especially bad but I don’t know why people who don’t have anything “wrong” with them are also having severe pain?

I’m going to the doctor in a few days because I can barely function after taking pain meds and using a heating pad and stretching.

[Heather]

I'm not a big fan of the word "normal" in nearly any context, because it can be pretty misleading. In this case, what's meant when people say that isn't actually about whether painful periods are common, so much as that there's not really an anatomical reason for them to be painful most of the time unless something else is going on. After all, uterine contractions -- which is what those cramps are -- are also a part of orgasm, and don't usually cause people pain when they happen in that context. And to the best of my knowledge, medical research bears out that menstrual pain still isn't something that happens to most people, over a lifetime, who have periods and who don't have other health conditions that interact with periods or the whole of the menstrual cycle.

But yes, I'd agree with you that it can certainly seem common. This is always going to be especially true in groups of people where most folks in the group have only been having regular periods for around five years: pain with periods is far more common when people just start having them, and often tends to chill out after those first five years or so. Too, we always have to keep in mind people's different pain thresholds and how much even talking about our experiences with periods has changed. Up until about thirty years ago, even talking about your period at all, including to other people with periods, let alone to medical professionals, was typically considered unacceptable, so only in more recent times are we even casually hearing about people experiencing pain or even just discomfort. Some people report pain when it is more like discomfort. Others, like you, clearly, are experiencing severe and very life-interrupting pain.

What typically causes pain with periods are prostaglandins, which are lipids that act like hormones that can cause inflammation in the body when there are too many of them. One thing we know is that a lot of people's lives involve things that can tend to create excess prostaglandin, or make that hormone skew to creating pain instead of helping with pain, which they can also do.

Those are things like diet, especially a typical Western diet which lacks some essential nutrients when it comes to this -- like omega-3s, magnesium and potassium -- and tends to have a lot of dairy, sugar and processed foods, as well as caffeine and alcohol; being too sedentary, chronic stress, and poor sleep. All of these things have become more and more prevalent, especially in North America and Europe, over the last few decades.

It may simply also be that coincidentally, you and your friends have the same or a similar medical issue with your periods. For example, it may be that you all have endometriosis or PCOS (which has becoming more prevalent in these same decades), who knows? It's certainly possible.

Does that fill you in some more on this?

I do very much agree that the level of pain you are reporting, even when you do things that should help, is something you should see a healthcare provider about.

[Jay27]

Thank you for all the information! I wonder if health issues are the common thing in my friend group that makes periods worse. Most of us are under an extreme amount of stress and have clinical anxiety and depression and trauma, and don’t get enough sleep. I think people with those problems tend to cluster together. I also have at least three other close friends with vaginismus which can’t be that common, right? We’re all around 20-24 so periods have been regular for a while (except for mine which have always been off). My cramps have actually been getting way worse since I turned 20. I’m 21 now, almost 22. Aren’t a lot of people with PCOS, endometriosis, adenomyosis etc. undiagnosed too?

No doctors have ever taken me seriously before but I’m getting another opinion soon. I also have a super low pain threshold according to my therapist. She thinks it might be because I’m neurodivergent. I can barely handle a tiny injection that most people wouldn’t feel.

What’s the difference between discomfort and pain? I don’t get it. A few times, doctors have asked me whether I have pain during sex and I can’t really tell? Sometimes I get overstimulated and it feels off, and sometimes my back cramps after an orgasm, but idk if that’s pain?

[Sofi]

Yep - many people are undiagnosed and might never even know they have something like endo because they think everyone experiences that much pain during their period, or are just reluctant to bring it up to a healthcare professional and/or would rather just "tough it out". The truth is, as Heather explained, it's not actually true that everyone goes through such painful cramps.

I am also neurodivergent and have endo. My pain tolerance is super low, so I also wasn't taken seriously at first, until I saw a young doctor who also had endo and she was great. I'm sorry you've been through it too, but thankfully there are doctors out there that are on our side. Personally, I have better experiences with women or nonbinary healthcare professionals.

Pain and discomfort can certainly be perceived very similarly, I know personally I often say something hurts when it's really just discomfort, because it can be hard for my brain to tell the difference in the moment (and because in many situations the terminology doesn't really matter). Typically, pain will derail whatever you're doing, you won't be able to focus on anything else (likely what you described you go through during your period). Discomfort is milder and while it feels unpleasent and is distracting, you can usually still do things through the discomfort. Pain can be a cause of discomfort, but not all discomfort involves pain necessarily. This is more of a literal difference between them, though, but in practice they're used interchangeably. Does that help it make some more sense?

[Jay27]

Yeah, I think that makes more sense! It’s hard for me to understand things without a lot of details because of my autism. I’m a very literal thinker. I used to have a female gynecologist who kept telling me my severe cramps were no big deal and refused to test me. The one I’m seeing next week was recommended by my mom’s doctor friend and she’s a black woman. I’m not black, but I’m hoping she’ll be better about believing patients since women of color face a lot of medical discrimination.

So with those definitions, I think I have pain during my period but just discomfort during sex. My period cramps feel like I’ve just run a marathon with a 100 pound backpack on, super sore and I just wanna sleep all day but I can’t because it hurts too bad. Sometimes I get really mild cramps after sex. But during, I get uncomfortable if we go for too long or if the touch isn’t gentle enough. Nothing has ever hurt though.

[Heather]

I totally get it, I take things very literally myself. (Which is why almost everyone close to me at least once has been the recipient of me saying, "Words have specific meanings!" )

I hear what you're saying about having some more hope with a Black practitioner. I really hope this goes better for you this time. I think it's fair and accurate to tell that doctor that your menstrual pain is severe.

With sex, it doesn't sound to me like anything is happening that's unusual, just based on what you told me. Pretty much everyone will experience discomfort or even pain if certain activities go on for too long, or if the way it's going on is too rough. The cramps are the only things I'd be concerned about, unless they are happening with sex where you haven't experienced orgasm: in that situation, it's common to have some mild cramps. If cramping is happening outside that scenario, then I'd go ahead and mention these cramps to that doctor, too. Better to give more information than needed than not enough.

[Jay27]

Thank you! I care a lot about wording things properly so that I get taken seriously. I’m glad my experiences with discomfort during sex are common. My partner hasn’t really experienced it before but her body is much less sensitive than mine overall. I’ve had some back pain after most sex even if I don’t come but that might also have to do with positions and stuff, right?

I’m also anxious about being judged for my sex life when I go to the doctor. I’m already atypical because I’m a lesbian, and I’ve never had PIV and never want to. And I’m 21 but I had zero experience until a few months ago.

Doctors started asking me whether I was telling the truth about not being sexually active when I was around 18. The nurse I saw in my college health center was suspicious when I said I started having sex at 21. I actually wish I had waited longer lol but it is what it is. I just want to be believed and respected!

[Latha]

Hi Jay27,

You should be believed and respected- I'm sorry it hasn't been that way! Doctors and nurses really have no business judging you for such things, though it happens all too often. Fingers crossed that it will go better with the new doctor!

Yes, back pain could be due to things like position. If you don't mind me asking, where exactly is the pain in your back? Have you noticed pain after being in certain positions?

[Jay27]

It’s lower back pain. It starts afterward so I can’t really tell in the moment whether it’s associated with certain positions. Sometimes things can get uncomfortable because she’s almost a foot shorter than me lol but we’ve figured out how to work with that.

[Michaela]

Hi Jay27,

Like Latha said it is possible that positions during sex might cause some back pain after the fact. I thought I would pop in a couple of suggestions for making different positions a little more comfortable that maybe you have or haven’t tried. Things to think about would be trying positions where the natural curve of your back is maintained, avoiding excessive arching / bending of the back, or adding a pillow for support.

Incorporating some of these and being aware of what might or might not be putting strain on your back may help to ease some of the discomfort that you are feeling. But, it is definitely a game of trying something out and then listening and learning from your body to see what will work for you.

I’m hoping that everything goes well at your upcoming doctor’s appointment as well! After catching up with your thread it seems like you’re feeling more confident to talk about the pain you are experiencing. Is there other support that would be helpful in preparation for the appointment?

[Jay27]

My psychologist wanted me to call the gynecologist office ahead of time and tell them I have anxiety and ASD but I’m scared to. I’m also supposed to ask my psychiatrist to increase my Ativan just for the appointment but I haven’t yet because I don’t want him to think I’m taking advantage or something.

[Heather]

Can you perhaps circle back to your psychologist and a) tell them about that fear and get help getting through that to make that call, and b) ask them to just contact your psychiatrist to order the Ativan?

[Jay27]

I already have a script that she gave me but I’ve been anxious about calling. I didn’t think about her calling the psychiatrist instead of me but maybe I could try that.

[Heather]

What do you think might help you make that call? Do you want to talk through what’s making you anxious about it?

[Jay27]

I don’t know what it is, but I hate phone calls and emails. I even struggle to make a haircut appointment even though I know exactly what to say.

[Carly]

Hmmm... well, I don't think you're in the minority here. I know a lot of people who are very anxious about phone calls and emails. But! It sounds like there's something about phone calls and emails that we haven't quite hit on yet that might give us some insight on a bigger issue you're struggling with. Maybe worrying an interaction wont follow a script? You say you know exactly what you need to say, but it could it be fearing that you don't know exactly what another person might say? Or perhaps there's something about expressing yourself in general that feels vulnerable and uncomfortable.

Any of this resonating with you?

[Jay27]

Yeah I’m uncomfortable with expressing my needs. I’m also still kind of in denial about my mental health issues. Idk if that’s dumb because I’ve had severe anxiety symptoms since I was a toddler and I’ve had depressive episodes since middle school but I still feel like maybe I can be normal if I try hard enough.

[Sam W]

Hi Jay27,

I hear you on that feeling that if you just tried hard enough to be "normal", maybe the mental health issues would go away. One thing I find helpful when dealing with those thoughts is that, if just willing yourself into not having depression or anxiety worked, way fewer people would have those things. The fact that many of us still struggle with them suggests that they really are things that need specific kinds of tools and supports to manage.

When it comes to things like making calls and scheduling appointments, something that can help is to remind yourself that, for the person on the other end of the line, this is their job. They've probably gotten all kinds of questions and helped with all kinds of scenarios, so even if you're not sure what to say or how to go about getting the appointment scheduled, part of why they're there is to help you do those exact things. Even if it's awkward or difficult, it's not really a conversation you can get wrong (unless you're rude or cruel to the other person, but that doesn't strike me as something you're going to be). Does that make sense?

[Jay27]

Yes. I actually just had the appointment. I didn’t call the office beforehand to mention my sensory issues or mental health. I told my doctor about those during the appointment and said I’d had painful pelvic exams. The pap smear she gave me hurt pretty bad, like scratching and stabbing pain, and I still feel kind of crampy. But at least she was able to get the speculum in even though it hurt too much to fully open. I had no pain from her fingers, just that awful speculum (which was the extra small size!)
I think my double dose of Ativan worked well cause the last time, I was so tense that they couldn’t even put the swab in by itself. Now i have to get a sonogram in a few days and start some supplements and exercises. I’m overwhelmed.

[Sam W]

I'm glad you were able to get to the appointment, and communicate to your healthcare provider about your concerns and needs. It's crummy that there was still pain and discomfort, although it sounds at the very least like you've learned at least one strategy--the Ativan--that you can use in future appointments.

It does sound like you're getting a lot of stuff assigned or scheduled for your healthcare all at once, which can absolutely be overwhelming. I do want to give you kudos for keeping going even when it's stressful; that's an excellent step in terms of taking care of yourself.

[Jay27]

Thank you! I really hope things will get better. I feel like my gyno took me seriously and she was surprised that no doctors had tried to address my pain before.

[Sofi]

Just want to jump back in and say I'm so glad to hear this update! You deserve to be taken seriously by your gyno, so that's awesome, and I hope she'll be someone you can keep working with