The science lesson in which we covered human biology focused primarily on puberty – things would change, we were told in a serious voice: hair would grow in new places, breasts would sprout, shoulders would broaden and voices would break. Girls were informed of the menarche – their first menstrual cycle – one of approximately 500 over the course of a lifetime. We were told to expect "some discomfort", but given no hint that for some this pain would go beyond mild and descend into pretty damn awful.
Period pain is caused by contractions in the uterus. The blood vessels in the muscle wall are compressed by the contractions, which cut off blood supply to the womb, starving it of oxygen and adding to the discomfort.
Dysmenorrhea, as period pain is medically known, generally falls into two camps: secondary dysmenorrhea is caused by a specific underlying condition such as endometriosis (when cells that normally line the uterus are found at other sites in the body – usually the ovaries and fallopian tubes). The more common primary dysmenorrhea, which affects nine out of 10 women, has no specific cause. It is generally worst in the first few years after starting your period, with symptoms tending to improve with age or after childbirth. Yet many women who report having primary dysmenorrhea well into their 20s and 30s say their pain is dismissed.
My request for painful period stories brought a barrage of responses. A colleague said she experienced such agony she collapsed in the street. Two women wrote to tell me their GP had told them they were exaggerating how painful it was ("I get such cramps . . . there's nothing that makes the pain less"), while another with endometriosis had been told by her mother (who also suffered from the condition) that the pain was "normal". I suffered such cramps and other symptoms – vomiting, migraines – that I routinely missed school as a teenager.
Researchers at Oxford University recently found that women with painful periods show increased sensitivity to pain (and lower levels of cortisol, the hormone released by the body in times of stress) throughout their cycles – not just when they are menstruating.
Yet Deborah Mason, from Wellbeing of Women, a charity that has been funding research into all aspects of reproductive health since 1964, says there is little new information in the area – partly because women don't complain. "Too often we don't want to make a fuss and this is one of the reasons why so little research is done in this area," she says. "If period pain is preventing you from continuing your normal activities for more than a few hours, seek medical advice. Just because period pain has been around for millions of years doesn't mean women should suffer in silence."
Marilyn Glenville, a nutritionist specialising in women's health, agrees. "I think women still don't know how much they can ask for," she says."Women should know that they can be referred to a gynaecologist – and not just be fobbed off with painkillers when there may be an underlying cause or something else that could be done to actually treat the problem."
Yet Gabrielle Downey, a consultant gynaecologist, says things are getting better. "GPs are much more aware of quality-of-life issues," she says. "If it's interfering with a woman's life, we need to get that under control." And she says there's a logical progression to follow in treatment. "Mefenamic acid [an anti-inflammatory] is specifically for period pain. If you don't get better with that and/or the pill, you should be investigated to make sure you don't have an underlying condition," she says. "If it's not endometriosis, I'd prescribe the pill for three months and see if that helps. If that doesn't work, the next step is giving something like Implanon – the contraceptive that is progesterone-only – so you don't have periods, or a Mirena coil, which gets rid of the lining of the womb so there's less bleeding and less pain."
And if all this doesn't work? "If you fail to respond to medical treatment, you need a laparoscopy to make sure we're not missing something."
Glenville, meanwhile, suggests that the anti-inflammatory effect of omega-3 fish oils mean they can lessen the cramping. While Helen Knox, a qualified nurse specialist and director of Sexplained, a resource that promotes safer sexual and reproductive health, says women should listen to advice to take the pill. "A lot of women say they don't want to take hormones. You're only taking what your body makes anyway, in a synthetic form, and at a controlled level. The pill has so many non-contraceptive benefits but it doesn't get promoted properly. Spending a little bit of time with someone who's a specialist in that area helps."
