Bloody pain: Menses are normal, period agony is not

Menstrual pains have been described by experts in some patients to be “almost as bad as a heart attack”. Some patients have likened their pains to the second stage of labor or as severe as a slipped disc. 

The menstrual cycle is a regular part of life for a woman, but the pain that can comes with it is anything but regular. The condition is often downplayed or ignored, yet it is the most common gynaecological complaints: Up to 20 per cent of women suffer from menstrual cramps that are severe enough to interfere with their daily activities. 

Dysmenorrhea, the technical term for period pain, causes poor quality of life, lousy moods, poor sleep quality and recurrent absenteeism from school for young girls, yet the pain is often normalised, met with cynicism, downplayed and ignored. 

The high prevalence of menstrual cramps perhaps explains the near indifference to the debilitating condition as demonstrated by a 2011 report by the Institute of Medicine which discovered that when women report their pain, they were most likely to be dismissed than men. Gendered stereotypes that cast women as more “sensitive” and “dramatic” causes their pain to be taken less seriously. 

The result is that period pain is not treated with the gravity that it ought to be, whether at medical facilities or in the larger society. The culture of period-related issues being taboo and women's pain being characterised as hysterical has led to institutionalised stigma around this, particularly in Africa.

The uterus has a strong muscular layer which contracts and relaxes. Whereas this happens throughout the menstrual cycle, during the period it happens more strongly. 

Typically, these contractions are as a result of prostaglandins, a group of active lipid compounds that increase just before a woman gets her period and decrease towards the end of menstruation. This is one of the reasons why discomfort eases towards the end of the period.

Types of pain

There are two types of dysmenorrhea: primary and secondary, depending on whether the pain is just due to the period itself or another cause. 

Primary dysmenorrhea is simply painful menses with no certain medical explanation, that tends to affect women as soon as they start their period. 

Secondary dysmenorrhea is caused by a disorder in the reproductive organs such as endometriosis, adenomyosis or fibroids, congenital anomalies of the pelvic reproductive organs or by pelvic inflammatory disease resulting commonly from sexually transmitted infections. The pain tends to get worse over time and it often lasts longer than normal menstrual cramps. 

The distinction between the two is not clear-cut, as many women suffering dysmenorrhea may have undiagnosed endometriosis which often takes long to diagnose, particularly in resource-constrained health systems like Kenya's.

Treatment for primary dysmenorrhea is generally effective, and thus, it hasn’t changed in decades. First-line therapy continues to be non-steroidal anti-inflammatory drugs, which are effective in relieving daytime and night-time pain. 

Dysmenorrhea has also been found to respond favourably to ovulation inhibition with the synthetic hormones in the oral contraceptives or hormonal intrauterine devices commonly referred to as the coil. These work by suppressing ovulation and lessening the endometrial lining of the uterus, ultimately resulting in reduced menstrual pain. 

Physical exercise can also be used as a preventive or therapeutic approach to control dysmenorrhea and other menstrual disorders. 

Periods are one of the most basic facts of life. Any squeamishness around the subject is both ridiculous and harmful, because too many women are suffering in silence, grimacing through the agony they experience with their periods. 

The pain that accompanies period cramps is very real for those who suffer them. We cannot keep ignoring its significance just because it is a regular, monthly occurrence. 
In fact it is for this exact reason, that it is so common and recurring, that we should address this issue and deal with it as the societal burden it is. 

For the women who suffer from this affliction, our sisters, colleagues and daughters, I sympathise with you and wish you to know that periods are normal but the agony that comes with it is not. 

You have a right to deal with your pain. You deserve better attention from those around you and moreso from your health care provider. If nothing else, you deserve medication that will rapidly ease your suffering and give you back control over your life. 

You deserve to be happy and productive without the burden of bloody pain.