Cramping up? This is why your period is so painful

Funny, no, that it took a man comparing period pain to the sensation of having a heart attack for society to sit up and listen? When John Guillebaud, professor of reproductive health at University College London, described the pain felt during some episodes of menstrual cramping as “almost as bad as having a heart attack” to  Quartz , it caused quite a stir, going viral in March and prompting a resulting Twitter storm that generally reflected a “well, duh” sentiment.

Since then, I’ve attended the book launch of the new women’s health bible, The Wonder Down Under , which I keep harping on about because it's just so bloody brilliant (literally) and I’m on the campaign path to get it on a syllabus, somewhere, stat. Its authors, doctors Nina Brochmann and Ellen Støkken Dahl, also had period pain high on their agenda, similarly reflecting Guillebaud’s collation of menstrual cramps and heart attacks, explaining that the contractions felt during period cramps can be likened to the hypoxic pain associated with a heart attack. The muscles of the uterus squeeze, blood vessels are constricted, as they are during a heart attack, they become deprived of oxygen and the result in both cases is pain, either of the chest or period variety.

Clearly the two cannot be conflated across the board, and you’re not likely to die from menstrual cramps, but many posit that the pain you experience during your period can in fact be more intense than that of experiencing a heart attack, and the fact that said pain has largely been ignored by throughout history speaks volumes of how seriously women’s pain is taken by researchers and doctors in general. As an example, and staying on the topic of heart attacks, The New England Journal of Medicine  has found that women are seven times more likely than men to be misdiagnosed and discharged in the middle of having a heart attack. Brochmann and Støkken Dahl mused that this is partly down to the fact that women tend to have heart attacks “more quietly”. Possibly because we’re accustomed to putting up with such searing pain as labour, and for one in six women, excruciating menstrual cramps, known as dysmenorrhoea. It’s time to shout about those severe menstrual spasms, because the average woman spends 6.25 years of her life on her period, and as Brochmann and Støkken Dahl neatly summarise, if men were menstruating, many period related issues would be first priority in terms of medical research:

“Imagine if one in ten men had to take a week off work each month because of excruciating pain in his balls. It would be a national issue, covered on the curriculum in every school.”

While you’re busy lobbying the education secretary, here’s your pocket guide to period pain, why we need more research on the subject and what you can do for now to put out at least some of fire associated with those evil cramps.

Why you’re getting period pain

If you’re one of the unlucky 20 per cent, and have ruled out other possible causes such as endometriosis ,  fibroids  or an ectopic pregnancy , studies indicate that a possible trigger of painful menstrual cramps could be a surplus of production of prostaglandins, a group of lipids that cause your uterus to contract. Incidentally, prostaglandins are sometimes prescribed to pregnant women to bring on childbirth, i.e, contractions, i.e, pain. It’s not known why some women produce more prostaglandins than others, so if that could be worked on soon, cool.

What happens during menstrual cramps

Ahh, your old friend hypoxic pain. You can feel period pain in your lower belly, across your lower back and at the top of your thighs, but intense spasms occur when your womb contracts strongly to expel period blood. As we’ve mentioned, the blood supply to your womb cuts oxygen supply, and your body reacts by releasing pain-triggering chemicals. Basically, a small labour, and in their book Brochmann and Støkken Dahl reassure you that your menstrual discomfort isn’t down to a pathetically low pain threshold- pain pressure of severe dysmenorrhoea has been proven to exceed that of uterine contractions during labour. If your GP/ boss/ partner/ inner critic isn’t taking you seriously, bring that harrowing fact along to the conversation.

What you can do to ease the pain

First off, give yourself a break. Onto the immediate SOS relief:

Painkillers: Anti-inflammatory painkillers such as ibuprofen and aspirin have been shown to be more effective when it comes to relieving the pain of menstrual cramps, but Brochmann and Støkken Dahl stress that, if painful menstrual cramps tend to come along for the ride with every single period, you should take pain relief as directed the day before your period starts, or at the very first sign that an agonising contraction could be on its way, in order to make it as effective as possible.

Hormonal contraceptives: Make an appointment with your GP to discuss your period pain, and if you’ve eliminated other potential triggers you may be recommended hormonal contraception to thin the womb lining, reducing the amount of prostaglandin that your body produces, resulting in less frequent, and less severe, cramps. The combined contraceptive pill, the contraceptive impact or injection and the Mirena coil are thought to be most effective when it comes to reducing period pain, but not all contraception has this effect. The copper or plastic IUD is known to cause both heavy periods and more painful menstrual cramps, so if you have it and are in agony, discuss other options with your GP, sharpish. Whatever your situation, if hormonal contraceptives haven’t reduced your period pain after three months, ask to be referred to a specialist for further tests.

A workout: The prospect is probably hideous if you’re mid menstrual cramp attack, but studies suggest that gentle exercise can act as mild pain relief. If you can move, try swimming  or walking and see how you go. A paper published by scientists in Taiwan in 2016  also concluded that a short-term course of yoga (two 50 minute sessions twice a week for 12 weeks) resulted in a reduction of menstrual pain and physical premenstrual symptoms. More research is needed, but if you can get through a few sun salutations and a savasana, it should at least help to lower your stress levels. Combine with breathing techniques  to aid relaxation and aromatherapy if you’re into it- clary sage is particularly therapeutic for period paid according to aromatherapy expert  Michelle Roques O’Neil .

Localised heat: i.e, the hot water bottle method. Seems crude, but until we have better treatment options, it can help, as can heat pads and localised massage. Or just book a full body massage and file it under “giving yourself a break”.

That’s pretty much it. Stopping smoking is another suggestion, but otherwise, that’s essentially your lot. Which is why it’s all the more vital to speak up and not suffer in silence. While research into whether certain drugs (viagra for one) can help to reduce dysmenorrhoea is in its early stages, scientists reported to Quartz that there’s still a reticence to fund studies and provide grants for further research, with one doctor commenting that “the bottom line is that nobody thinks menstrual cramps is an important public health issue.”

We (and he in that case) would clearly beg to differ. While the topic is more widely discussed than previously, and with new NICE guidelines issued last month with the aim of improving the diagnosis of conditions such as endometriosis and PCOS, menstrual issues such as heavy bleeding  are hitting the headlines, but we need to be taken seriously from the get-go. While some UK companies offer menstrual leave, and it’s a national policy in many countries, such as China, Japan and Taiwan, it’s a controversial scheme that risks women being further marginalised in the workplace, and while a duvet day certainly provides a more comfortable environment if you experience extreme nausea and cramping, it rather hides the matter away at home and doesn’t get us any closer to identifying a root cause or establishing effective treatment. We need to step up the studies as well as end the stigma- given that women represent 49.6 per cent of the current world population, and 39 per cent of the global workforce according to The World Bank , we can’t afford not to. In the meantime, namaste, and pass the Nurofen.

The tests that could improve quality of life for women with heavy periods

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