What happens when women suffer from severe period pains? Louise Carroll reports.
The stigma that continues to surround the world of menstruation could be adding to women’s frustration in knowing where to turn when they experience difficulties such as extreme pain.
In many parts of the world, women are still seen as being ‘unclean’ during menstruation and are often segregated from the rest of the community.
Around three quarters of young women and up to a quarter to a half of adult women are thought to be affected by cramping pains in their abdomen during menstruation.
According to the HSE, for one in five women, this pain is so severe it prevents them from carrying out everyday tasks.
Fighting For Answers
Aoife Hamill first went to her GP with difficult periods and “depressive blocks.” She was told that her periods and her depressive spells were not related.
“Every time I spoke to the doctor they would tell me the same thing—eat healthy, exercise more, be more positive,” says Aoife.
“My periods were still awful and the depression was getting worse every time it flared up.”
She felt there was more to her symptoms as her periods were extremely irregular.
“I was doing a ski season and exercising every day, I don’t eat unhealthy food and I was acting so upbeat and positive that I actually ran out of steam and crashed.”
Aoife was also admitted to hospital due to the severity of her condition. She was becoming increasingly distraught over what seemed to be an unsolvable case.
“It was seven years of chasing people who were supposed to be helping me,” says Aoife.
While visiting a dermatologist, she was told her acne was likely related to ovarian issues and her reproductive system.
“The dermatologist recommended I go and have an ultrasound, a pelvic examination and a hormone test,” says Aoife.
“I had the hormone test and had very high levels of prolactin. None of my doctors had done any tests on my hormones until now…lots of blood tests but never hormones,” explains Aoife.
Prolactin is a hormone responsible for the production of milk. It is also responsible for over 300 bodily functions including reproductive, metabolic and behavioural functions.
After eight years and approximately ten different doctors—it is only now Aoife feels she is beginning to get some answers.
Her diagnosis of PCOS (Polycystic ovarian syndrome) came from a private endocrinologist and she is currently undergoing further examinations and taking steps to find out what the next move should be.
“You can’t be sure that this is the answer to my problems but it’s more suited to my symptoms. It just suddenly all made sense,” says Aoife.
Dealing With Chronic Pain
Laura* (24) also experienced debilitating period pains.
“I’m definitely one of the lucky ones in the sense that my pain only occurred on the first day of my period each month, but it was absolute agony,” says Laura.
“It would come on gradually throughout the morning and would get to the point where I would need to roll up into a ball to help ease the pain.”
“There was one instance where the pain was so bad I actually called my mum asking her to rush home because I honestly thought the pain was going to kill me,” says Laura.
It really is beyond me why people are still so wincy & fey about menstruation. Half the world bleeds, your mam did. Your gran did. #periods
— Joolz Denby (@JoolzDenby) March 5, 2017
For the most part—and by chance—she wasn’t scheduled to work when she was in such pain and could stay at home to rest.
She explained that there were about two occasions where she wasn’t as fortunate and would end up having to leave early.
“There would really be no other option—it’s either stay there unable to concentrate, feeling like you’re going to pass out or just go home. My manager who by the way was female—she just didn’t get it,” says Laura.
“If I didn’t suffer from something this painful—I probably wouldn’t understand either. Now that I do though—I really wish more people did,” she explains.
Laura did go to her doctor and was prescribed a painkiller called ponstin which she says “did absolutely nothing” to ease her pain.
“Every time I went back [to the GP], I got the sense my pain just wasn’t being taken as seriously as I wanted it to be or as much as I thought it should be,” she says.
Laura changed her GP and managed to find one who she says listened and took more time with her to talk about it.
She finally found relief after being advised to go on the contraceptive pill. After a few months, her severe pain was under control.
“Now that it’s been three years and I’ve thought about it more, it does worry me that I’m taking something that’s known to increase risk of breast cancer,” she says.
“I also never found out what was causing the pain. I was told it was either just how I’m made or it could be endometriosis—but if that’s what it is then I’m looking at surgery,” says Laura, “and there would be nothing other than the pill to stop it from coming back as far as I’m aware.”
Talking to these women there seems to be a recurring theme of dissatisfaction—whether that be with the advice received, having few satisfactory options or feeling like many people don’t understand.
It seems common that women don’t understand the causes of their pain or how it is being managed through medication.
“I do think education and awareness is extremely important because there are women who might be living with their symptoms and thinking this is normal,” says Dr Sorca O’Brien, UCD Obstetrics and Gynaecology.
Dr O’Brien explained that if severe period pain is affecting a woman’s daily routine or relationships, action needs to be taken.
“The majority of the time there’s nothing going on—it is simply period pain with no pathology and that can be managed by using pain killers and trying to target when the pain might be worse in the month,” she says.
Dr O’Brien pointed out that period pain—and in particular severe period pain—may have causes and effects which need to be investigated, diagnosed and hopefully treated.
“I would advise anyone suffering from painful periods or pain in the month at any stage to record a pain diary.”
“For six months, record what days you get pain, when in the day it is happening, how long it lasts, what kind of pain it is and on a scale of one to ten how bad you would say it is—one being a tickle and ten being the worst pain you’ve ever felt,” advises Dr O’Brien.
This will be helpful when visiting the GP as “we can see if it’s cyclical and if it’s a gynaecological pain.”
“If a trial of medication hasn’t worked for the patient or they’re not keen on taking it and we’ve ruled out infection—then we move into the realm of further investigation,” explains Dr O’Brien.
“One of the things we can do very easily is an ultrasound of the pelvis—it would help us see if a patient has a cyst on an ovary, if they have fibroids, or if they have large deposits of endometriosis in and around the ovaries.”
An ultrasound will not be helpful if doctors do not find anything in specific but options from there would include a diagnostic laparoscopy.
This is invasive or keyhole surgery that allows doctors to check for cysts, fibroids and infection by looking inside of the pelvis.
“We wouldn’t advocate CT or MRI scans because of risks with radiation and because an ultrasound tends to give us a better view of the uterus and the ovaries,” says Dr O’Brien.
“The difficulty for us and for patients is that you don’t just have a uterus and ovaries—you have a bowel, a bladder—and there’s a lot of crossover between the organs and pain felt in the area,” she says. “It’s not always one or the other—it could actually be a mix of everything.”
“The most common condition we would discuss is probably something like endometriosis where you have small deposits of the lining of the womb in the pelvis—so they’re outside the uterus,” she says.
“They might make their way to the ovaries or tubes and can be found in other parts of the body,” Dr O’Brien explains.
“When you get your period those deposits also bleed and break down—you get local inflammation in the pelvis causing pain and it can cause scar tissue leading to infertility problems later in life.”
There are many discussions and forums online advocating a change in diet or other alternative remedies.
“We don’t have to treat things in the sense that they’re not life threatening—they can certainly be life-impacting however,” said Dr O’Brien.
“Things I’ve read in the literature that have been promoted would be acupuncture and Chinese herbal medicine,” she says.
“The difficulty for me to say whether some people should have that is due to the research looking into it—it’s not one hundred per cent great research in the sense that it’s not conducted properly in a scientific manner.”
“The problem with a lot of alternative therapies is not that they don’t necessarily work—it’s that we don’t know how they work—or if the benefit is applicable to everyone,” says Dr O’ Brien.
“For most conditions, there are certain aspects of alternative therapy that doctors would recommend.”
Dr O’Brien also indicated that inflammation or irritable gut problems can be factors leading to increased pain in the pelvic area.
“Your bowel sits right behind your uterus so people can have a crossover of pain symptoms—if you can reduce inflammation that will reduce your pain,” she says.
“If people feel that alternative or nutritional therapies help their symptoms—well that’s the main aim,” says Dr O’Brien.
Here we’ve focused on two case studies of women in their twenties suffering from chronic period pain.
It is important that women are encouraged to express their concerns and never shy away from issues regarding their health.
Women may have to seek referral for specialist investigations where pain is severe. Conversation can help to reduce stigma and that might help to improve women’s health.
*Name has been changed to protect identity of interviewee