Period Pain. Yes, it’s common. No, that doesn’t make it “normal”. And nope, it definitely does not mean that you have to suffer through it month after month, time and time again. 

Now read that again. 

Answers are out there for you, and Hazel is here to help guide you through it. 

PSA: Just Because Period Pain is Common, That Doesn’t Mean it’s Normal 

The warm twang of pain spreading deeply across your lower abdomen is often one of the first signs that your great Aunt Flo is coming to town (along with the tell-tale signs of tender breasts, mood swings, and insatiable appetites – ah, the pure joys of menstruation). For the lucky few who fortunately don’t experience period pain, the extent of discomfort they experience whilst menstruating both begins and ends here. 

However, for the 41% of menstruators aged 26 and younger, this is only the very beginning of the next few days of excruciating pain. Despite many of us experiencing pain equivalent to that of a heart attack every time we menstruate, the sad reality is that many of us have just had to learn to deal with it. 

Why? 

We’ve all paid a visit to the school nurse only to be given a lukewarm wheat bag, a pat on the shoulder, and a half-hearted promise that “you’ll be right, love”. 

93% of menstruating teenagers can relate to being practically bedridden with period pain before school but still being hurried out the door (because God forbid you miss roll call) with a forced smile and a couple of painkillers haphazardly shoved into our blazer pockets.

It’s normal. It’s all part of having your period. Everyone goes through it. 

For as long as we’ve been menstruating, our pain hasn’t been taken seriously.

With the highest rates of dysmenorrhea reported in adolescents, we’re wrongfully teaching our youth that severe period pain is an accepted and normal aspect of the menstrual cycle, and therefore, must be tolerated. 

It’s a serious systemic issue that stems from the ideology that menstruators should just deal with period pain. The issue is so harmful that those who menstruate are gaslighted into believing that this is what life is like for everyone, so therefore we must remain silent. That there is no escaping this painful reality. That to speak about any pain pertaining to periods is shameful and weak. 

Well, allow us to be the first to tell you that speaking up about any pain is far from shameful, and it’s the furthest thing from weak. If your period is causing you pain, it’s your right to speak about it and seek help. 

For those of you who are still convinced that the sheer amount of suffering and pain you endure every 28 days is normal, allow us to introduce you to dysmenorrhea. 

What is Dysmenorrhea? 

Dysmenorrhea occurs when the muscles of the uterus contract or tighten before or during menstruation in order to help shed the lining of the uterus. Dysmenorrhea pain is described as feeling like cramping, tightness or heaviness in the lower abdomen, legs or back that typically makes an appearance when your period does. This common condition is experienced by many menstruating folk, with the severity and symptoms varying widely from person to person. 

There are two main kinds of dysmenorrhea: 

1. Primary Dysmenorrhea 
2. Secondary Dysmenorrhea 

Primary Dysmenorrhea 

Primary Dysmenorrhea refers to recurring period pain that has no obvious cause or association with any other pelvic conditions. Studies have shown that primary dysmenorrhea tends to present itself as soon as a person begins menstruating. 

Secondary Dysmenorrhea

Secondary dysmenorrhea refers to period pain that is caused by certain reproductive disorders. These include: 

• Endometriosis. 
• Adenomyosis. 
• Fibroids. 

Studies have shown that secondary dysmenorrhea is more prevalent in those aged 20 and above. The pain associated with secondary dysmenorrhea often begins earlier in the menstrual cycle and can continue until long after menstruation ends. Talk about fighting the hard fight. 

So if dysmenorrhea is considered to be the most common symptom of period pain, and is more prevalent among women and those assigned female at birth (AFAB) than dyspareunia and chronic pelvic pain, why aren’t we talking about it more?

Well, let’s just say we have the Gender Pain Gap to thank for that. To put it simply, we’re pretty certain that if men had to endure gruelling abdominal pain once a month, they’d all receive medals for their bravery and a national public holiday in their honour. 

So, until the day comes when women and AFAB folk receive medals and public holidays for enduring excruciating pain, we’ll just stick to working to normalise period pain and seeking help from vetted specialists in women's health. 

What Are the Symptoms of Dysmenorrhea? 

As we briefly touched on before, the symptoms of dysmenorrhea differ from person to person and the pain experienced can also range from very mild to so severe that it impacts a person’s everyday life. 

So how do you know if you’re experiencing dysmenorrhea? 

Some of the more common symptoms of dysmenorrhea include: 

• Cramping pain in the pelvic area and lower abdomen. 
• Dull, aching pain in the stomach, lower back, and legs. 

Some of the less common symptoms of dysmenorrhea include: 

• Headaches and migraines. 
• Digestive problems, including constipation and diarrhoea. 
• Feelings of nausea. 
• Premenstrual symptoms (think all things from mood swings to breast tenderness, fatigue, irritability, and a swollen abdomen). 

What Are the Risk Factors for Dysmenorrhea?

While period pain isn’t always avoidable, there are two types of risk factors that impact a menstruating person’s likelihood of experiencing dysmenorrhea; non-modifiable risk factors and behavioural risk factors. 

Non-Modifiable Risk Factors for Dysmenorrhea 

Non-modifiable risk factors for dysmenorrhea include: 

• A family history of the condition. 
• Being younger than 20 years of age (symptoms are more severe and pronounced throughout adolescence). 
• Menarche before the age of 12 (aka having your first period before the age of 12). 
• Long and heavy menstrual flows. 

Behavioural Risk Factors for Dysmenorrhea 

Behavioural risk factors for dysmenorrhea include: 

• Smoking. 
• High caffeine and alcohol consumption. 
• Low levels of physical activity. 
• Depression, stress and anxiety. 

While some of these factors (such as your age and having a family history of dysmenorrhea) are unavoidable, there are some small lifestyle changes you can factor into your everyday life to decrease the prevalence of dysmenorrhea and its symptoms. So, pop those runners on and go for that hot girl walk, put that cigarette down, and be responsible with the booze. 

Pssst, we’re not saying you have to quit the Aperol Spritzes cold turkey, but limiting yourself to 1-2 glasses instead of 6 won’t hurt.

How Is Dysmenorrhea Treated?

Down with the culture of silence, it’s 2023. Speaking up and championing for your health is in. 

Speaking of it being 2023, gone are the days where The Pill is the only treatment option available to you. Don’t get us wrong though, if The Pill works for you, we love that for you. Buuuuut, we also know how many menstruating people have been made to feel as though The Pill was their only option (even after stating they didn’t want it), and we don’t love that. 
Here at Hazel, we understand the complexity of this condition, and we know that no two people have the same symptoms; so why should your treatment plans be the exact same? 

We aren’t here to trivialise your pain and tell you that a few deep breaths and a green tea are going to be the magic solution to treating your dysmenorrhea (but if they do work for you, we’re jealous), but what we are going to do is present you with the full range of treatment options available to you. 

NSAIDs 

Also known as Nonsteroidal anti-inflammatory drugs, NSAIDs are often considered the first line of treatment for dysmenorrhea. NSAIDs are one of the more common treatments your conventional doctor will likely prescribe.

Common types of NSAIDs include: 

• Ibuprofen. 
• Naproxen. 
• Mefenamic acid. 
• Aspirin. 

NSAIDs may be most effective when used before the onset of menstruation and pain. For some patients, they may work just fine, but for those of you interested in exploring natural or alternative options, don’t worry, we’ve got you covered below. 

Acupuncture 

Acupuncture and acupressure is a natural alternative for those looking for alternative methods of pain relief. They work to stimulate the nerve fibres and receptors in a complex interaction with endorphins and serotonins. 

One study showed that 12 months after beginning acupuncture as a treatment option for dysmenorrhea, sufferers experienced a significant decrease in both the intensity and duration of menstrual pain, as well as less need for pain relief medication. 

Another study reported that 91% of patients received pain relief for dysmenorrhea whilst undergoing acupuncture. 

Medicinal Cannabis 

The use of medicinal cannabis in obstetrics and gynaecology can be traced back to over 5000 years ago. It has been shown to help patients manage a wide range of symptoms including chronic pain, inflammation and insomnia.

One study found that when used in the treatment of dysmenorrhea, patients reported that medicinal cannabis had a significant effect on improving the quality of sleep. In another study, participants who found that NSAIDs, heat and other non-pharmaceutical pain management options did not provide them with adequate relief from their pain, reported that medicinal cannabis was effective for the management of dysmenorrhea pain.  

Heat Therapy 

Time to pull out that old trusty hot water bottle from your teenage years – she’s worthy of a second chance. 

Studies have found that when used in the treatment of dysmenorrhea, superficial heat in the form of hot water bottles, heat packs and heat pads ranging from 40-45°C is effective in easing menstrual pain, reducing muscle tension and relaxing abdominal muscles to reduce pain caused by muscle spasms. 

Lifestyle Changes 

As mentioned earlier, there are several things you can do to decrease your chances of experiencing dysmenorrhea. 

We’re not telling you to overhaul your current routine, dive head-first into whatever culty fitness trend is currently taking over in any given week, or solely survive off of grains and nuts. But, what we are telling you to do is to: 

• Move your body, every day, in a way that feels good for you (yes, even if that may be culty fitness trends). 
• Say no to cigs. 
• Decrease your caffeine and alcohol intake (a responsible drink every now and then and an overpriced iced latte are a-okay!). 
• Rest, recover and get those 8 hours every night. No excuses.

“Adding in a healthy diet is key – we know that ultra-processed foods cause a significant amount of inflammation and also have a direct impact on weight, so REAL foods are best. Most people can slowly add in healthy foods over time to where they can cut out most of the ultra-processed foods.” – Dr. Melissa Catanzarite MBBS. 

How to Identify When Your Pain is Not “Normal” 

With 91% of menstruating folk experiencing period pain (and 29% of those reporting severe pain), it’s important to be able to identify when your period pain is no longer classified as “normal”. 

We know, we know – we’ve already said it a hundred times…but we’ll say it a hundred more times (or until you listen to us, whichever comes first): 

Seek. Support. For. Your. Period. Pain. 

Why? 

1. Period pain can often be an indicator of the presence of a more serious condition at play, such as endometriosis or adenomyosis.
2. We’re all about empowering you to take your pain seriously here. You deserve relief and support. You are worthy of a life free from debilitating pain. 

Unsure if your pain is classified as normal or not? Allow us to be of assistance. 

Period pain is classified as “normal” when: 

• You experience pain 1-2 days before your period or when your period begins. 
• Your pain lasts no longer than 3 days. 
• Pain-relief treatments improve your pain. 

But remember, if you feel like something isn’t right, even if you fit the “normal” criteria - Speak. Up. 

No one knows your body better than you.

When to See a Doctor For Your Period Pain

For many of us, after spending the majority of our menstruating lives hearing that our pain is “normal”, the thought of seeking support can seem daunting. 

But, as your big sister in healthcare, we’re here to tell you that it’s time to swallow your pride, ignore anyone who tells you “period pain is normal” and start speaking up. 

If you experience any of the following symptoms, we recommend speaking to an experienced doctor who understands - and won’t dismiss - your period pain:

• Cramps and pain that interfere with your daily life (such as school, work, social plans, etc.,).
• Pain that lasts longer than 3 days.
• Over-the-counter pain medication offers you little to no relief from your pain. 

TLDR; just because period pain is common, that doesn’t make it normal.

If you’re experiencing periods that are painful enough to impact your daily life and prevent you from doing the things that you love, you don’t need a doctor to tell you that that’s not normal.

You don’t have to live with painful periods. If you suspect that your period pain is something more sinister than a twang or two, stop second-guessing yourself (and your pain) and book a consultation with an expert in period pain to receive the care and answers you’ve always deserved.

Tell your friends, tell your colleagues, tell your sisters and tell your doctor. To end the stigma surrounding period pain, we need to keep talking about period pain.