At 14 years old, I laid curled up in a hospital bed in the emergency department with my mom by my side. The pain in my abdomen was so excruciating that I was vomiting. My gastrointestinal system had been messed up for days. We were sure something was seriously wrong, especially since this kept happening to me over and over.
When the doctor finally came in, he asked one simple question – did the symptoms happen around my menstrual cycle? I’d never thought about it before. Neither had my mom. So, we didn’t really know the answer. But when we described my symptoms, again, and said that they recurred regularly, the doctor nodded and told us that some people get gastrointestinal symptoms before their periods and that the pain was “just” cramps, and probably some gas pain. He told me that everyone had a different “normal” when it came to menstrual cycles, and this was probably my “normal.”
A while later, I sat in a small office with a gynecologist who seemed older than my grandmother. She interrogated me about my menstrual cycle and sexual activity, then shamed me when I reluctantly told her I was having sex. She followed up by saying that since I was already having sex, I should go on birth control because it would probably cure my menstrual pain, which she admitted was on the more distressing end of normal, but insisted was still normal.
I spent at least a week each month curled up in a ball in my bed, unless I was curled up in a ball on my bathroom floor.
Meanwhile, I spent at least a week each month curled up in a ball in my bed, unless I was curled up in a ball on my bathroom floor. My mom told me that really bad periods ran in the family. Two of her sisters had periods like this. Most days, I dragged myself to school, with a pharmacy of NSAIDs and several Super Plus tampons in my backpack because a Super Plus only lasted me a few hours. Sometimes my periods were so bad I had to stay home, but I couldn’t stay home all the time. So, I dragged myself to school.
I switched gynecologists multiple times throughout high school, trying to find the one who could fix my pain.The last one I saw during those high school years listened to me describe my symptoms, nodding sympathetically. Then she said, “Periods hurt honey. You’re going to have to get used to it.” And she wrote me a script for yet another brand of birth control pills.
When I walked out of her office, I knew that I was done talking to doctors about my period pain. By then, I’d been hearing for years that my periods were at the bad end of normal. So, it must be me, I thought. I must be dramatic or have a really low pain tolerance. So, I stopped talking to doctors about my menstrual cycle. If they asked, I said I had “pretty bad periods, but nothing abnormal.”
The Common Reality of Period Cramps
Unfortunately, most people with menstrual cycles get the message that cramping and pain is just a normal part of having a cycle. Though research shows that about 85% of people have period pain at some point in their lives, only about half of those people have pain with every menstrual cycle. The other half have painful periods occasionally, and about 15% of people have never had menstrual pain.
Studies have found that up to 29% of people have severe menstrual pain similar to what I was describing to my doctors. But there's a big caveat — many studies measure the intensity of period pain in terms of whether or not it keeps a person home from school or work. If you've ever pushed through your day while half doubled over in excruciating pain, you know that's a ridiculous metric.
Extensive research has been done in an attempt to figure out why some people have dysmenorrhea, the medical term for period pain, and others don’t. Though research hasn’t pinpointed a clear cause, a review of studies found that the two strongest risk factors include chronic high stress and a family history of dysmenorrhea (note that this doesn’t necessarily mean that period pain is genetic, since the association could be due to conditioned behavior or common lifestyle factors).
The cyclic pain that can be tied to your period is often described as a cramping in your lower abdominal area which can spread to the low back, vulva, and even down into your legs.
Other symptoms commonly associated with painful periods include:
- Cramping/pain in the lower abdominal area which can radiate into the low back, and thighs
- Swollen chest or breast tissues
- Varying gastrointestinal symptoms including bloating, nausea/vomiting, diarrhea, constipation
- Urinary frequency
- Mood and appetite changes
The Two Types of Period Pain & What Causes Them
Period pain can be distinguished into two types – primary dysmenorrhea and secondary dysmenorrhea. Most period pain is primary dysmenorrhea, which means that the pain is caused by the physiological processes of the menstrual cycle itself.
As long as you’re not pregnant, your uterus will shed its lining each month — for that to happen, the smooth muscles of the uterus contract to help push out the lining (aka the endometrium). It is thought that period pain is a result of this contracting during menstruation, and more specifically due to a chemical known as prostaglandin.
Prostaglandins are known for their infamous role in pain-inducing inflammation, but they also assist the uterus in contracting during menstruation. Prostaglandins can also constrict the blood vessels in the uterus, which is thought to contribute to dysmenorrhea by reducing blood flow and irritating the nerves. Research shows that the level of prostaglandins may be higher in those who experience dysmenorrhea, and people with high prostaglandin levels often have bigger inflammatory reactions, which causes bigger pain responses.
A smaller number of people who have painful periods have secondary dysmenorrhea – menstrual pain caused by an underlying condition of the reproductive system such as uterine fibroids, pelvic inflammatory disease (PID), endometriosis, or adenomyosis. People with secondary dysmenorrhea tend to have more intense and long lasting period pain than those with primary dysmenorrhea, and their pain tends to get worse over time. When it comes to secondary dysmenorrhea, diagnosing and treating the underlying condition is key to finding relief.
With both primary and secondary dysmenorrhea, studies suggest that chronic inflammation plays a role. Although more research is needed, it has been shown that people with higher levels of systemic inflammation experience more menstrual pain than those with lower levels of systemic inflammation. In people with primary dysmenorrhea, this may be because of higher prostaglandin levels. In secondary dysmenorrhea, this may be because the underlying pain condition has a systemic inflammation component.
The Connection Between Your Pelvic Floor & Period Pain
Dr. Ashley Rawlins, an Origin Pelvic Floor Physical Therapist who specializes in pelvic pain, notes that another, often overlooked cause of menstrual pain is muscle issues in and around the pelvic floor.
When you have menstrual pain, the muscles in the abdomen, pelvic floor, and hips may respond by holding tension and even referring pain to the pelvic area, adding to your already intense period cramps. Over time, the muscles may become so used to this constant tension that they actually shorten and disrupt the blood flow, irritating the abundance of nerve endings in the area and causing even more pain. So, even if pelvic floor dysfunction isn’t the ultimate cause of menstrual pain, it becomes a major contributor.
“The pelvic floor muscles can be a huge driver of pelvic pain,” Rawlins explained. “There is also a correlation between chronic pelvic pain and pelvic floor dysfunction. So, even if it is unclear if the pain or the muscle issues came first, pelvic pain and muscle dysfunction tend to go hand-in-hand. When we have pain, our body will respond with gripping, sustained muscle tension, and changes in the fascia surrounding the muscles that can all add up to even more pain and tension in your body.”
Period Pain Is DOWNPLAYED & DISMISSED
Way too many people put up with painful period cramps because of the pervasive message that period pain is normal. One study that examined the reasons why people don’t seek treatment for period pain found that nearly 40% of the 509 participants assumed their pain was normal. Participants told the researchers that they believed menstrual pain was a “natural product of having your period,” “a fact of life,” and “something that comes with the territory.”
Participants explained that they believed their menstrual pain was normal because painful periods were common among their family and friends, the cultural narrative that periods are supposed to be painful, and their doctors telling them that it’s normal to have pain with each cycle.
More than 6% of the participants said they didn’t seek care for their menstrual pain, even unbearable menstrual pain, because they believed that their doctors wouldn’t do anything to help. Of these women, several described awful experiences, similar to mine, with medical providers, which either prompted or confirmed their belief that doctors wouldn’t do anything to address their symptoms.
Just because menstrual pain is common doesn’t mean it’s normal. In fact, the National Library of Medicine states that though period pain is normal during the first few years of menstruation, it should get better or stop completely as you age.
Rawlins agreed. “Pain is a very very common symptom when you’re first starting your period, even sticking around for the few menstrual cycles, or for a few years as things are regulating, but unfortunately all too many people who menstruate are having to deal with this pain for decades before finally getting relief. So, I hesitate to say that there is anything normal about it, especially when using this normative narrative leads to lack of treatment and continued suffering.”
Why NORMALIZING Period Pain is a Problem
Here’s the thing, normalizing period pain leads to two serious problems: First, it prevents menstruating individuals who have primary dysmenorrhea from getting effective and evidence-based pain relief that they deserve, and second it keeps those with secondary dysmenorrhea from having their health thoroughly considered so that they can understand, and treat what is driving excessive pain.
So, let’s address the first problem. Even though period related cramps are common, and even normal in certain instances, pain can be so intense that it can impact your ability to fully function. For example, research shows that menstruating individuals who go into work despite being in pain are much less productive.
Treating period pain as 'normal' part of life not only forces you to suffer without relief, but it can distract research from focusing on finding the cause of period pain, finding effective treatments options, and leaves you subject to medical gaslighting where your pain is trivialized and dismissed by healthcare providers.
Many women come to believe that they’re just overreacting or have a low pain tolerance or that it’s all in their head.
Like me, many women come to believe that they’re just overreacting or have a low pain tolerance or that it’s all in their head. They wonder why they can’t just deal with a “normal period” like everyone else. And like me, many of them suffer through years, even decades of menstrual pain before they find out it’s not normal. Some of them never do.
Which brings me to the second point of missed diagnoses. For those, like me, who suffer from period pain that is far outside of what is expected of the process of menstruation, normalizing pain leaves us vulnerable to having other reproductive system related diseases, from ever being diagnosed and properly treated.
I didn’t find out my pain wasn’t normal until my late twenties, when one of the many doctors I saw back then suggested that I go off hormonal birth control because he thought my chronic, intense GI issues could be caused by a hormonal imbalance because I’d been on birth control so long. It seemed logical to me. So, I went off hormonal birth control for the first time since I was 14.
My pain became so excruciating that I went to the ER multiple times, doubled over in pain, sometimes even openly crying. The first time, the doctors did a thorough examination to rule out appendicitis, a bladder or kidney infection, gallstones, and damage to my spleen. But as soon as I mentioned my pain might be related to my cycle, they stopped listening to me completely.
Because of my history of addiction, I was never prescribed strong painkillers for my pain, but some people with a history of chronic pelvic pain, especially those who’ve been diagnosed with endometriosis, are prescribed opioids to manage their symptoms. However, one study found that women with pain related to endometriosis who were prescribed opioids were four times more likely to develop a dependence on the drugs or overdose.
Thirteen years after my first visit to the ER for pelvic pain, I got an unofficial endometriosis diagnosis based on my symptoms. The only way to get a definitive diagnosis is laparoscopic surgery, which I got three years later when my symptoms got so bad I was literally disabled. Since then, I’ve had two more surgeries to treat endometriosis. My uterus, fallopian tubes, and ovaries have all been removed, along with massive amounts of diseased pelvic tissue, scar tissue from adhesions, and, one time, a chocolate cyst the size of a walnut.
Six months later, I’m finally pain-free, though I’m also period free, which I’m fine with considering everything my uterus put me through.
Speaking Up About Period pain
It may feel frustrating having to advocate for your own health, and even challenge what your healthcare provider is telling you, but this is all too often the case when discussing concerns over period pain.
Prior to the point when I was finally able to get a diagnosis, when I finally went back to that doctor for a follow up, I told him how much pain I’d been in for the past few months. Hesitantly, I said that I’d been reading about symptoms like mine on the Internet and thought I had endometriosis. He hung his head and admitted that severe GI symptoms are common with endometriosis, but the diagnosis had never occurred to him. I’d never even mentioned abnormal periods. When I told him I’d always been told my periods were normal, he became the first doctor to tell me that the horrible period pain I had was not normal.
Period pain is not normal. It’s ok to bring up your concerns, and ask for a second opinion.
Believe it or not, your menstrual pain isn’t normal either. Even if a doctor has told you it is. Even if you think it’s not that severe. Even if you’re not in a lot of pain or you don’t have pain every month. Period pain is not normal. It’s ok to bring up your concerns, and ask for a second opinion in order to have your pain taken seriously.
Physical Therapy Can Help You Get Relief for Period Pain & Cramping
At home, I tried to manage my pain on my own and followed the advice gynecologists had given me in the past including:
- Cycling Ibuprofen and Tylenol, taking one or the other every three hours.
- Heating pads or hot water bottles on the abdomen or back (my preference was one heating pad under me and another on my pelvis as I laid on my favorite recliner).
- Hot baths with Epsom salt.
- A cheap TENS machine I got from the pharmacy.
- Dozens of dietary modifications and supplements
- Regular exercise and stress relief techniques — none of which gave me significant relief.
I even tried various alternative treatments like acupuncture and herbal medicine. Still, no relief, which is unsurprising given that experts agree the current treatments for menstrual pain are woefully inadequate.
Unfortunately, none of the medical providers I saw ever suggested pelvic floor physical therapy. Rawlins explained that a pelvic floor physical therapist can perform an in-depth assessment of the muscles in the pelvic floor, back, hips, and abdomen to determine whether muscle tension, shortening, or dysfunction is contributing to menstrual pain.
Research has shown that pelvic floor physical therapy techniques can be very effective for treating menstrual pain.
If they identify musculoskeletal dysfunction in any of those areas, they’ll teach you techniques for releasing and lengthening the muscles. They’ll also work with you to improve the muscle’s mobility so it can stretch, lengthen, and move through its full range of motion without pain. Research has shown that pelvic floor physical therapy techniques can be very effective for treating menstrual pain, especially in those with primary dysmenorrhea.
Even if you are suffering with intense period pain related to secondary dysmenorrhea, physical therapy can still be a great option. Along with comprehensive treatment for the reproductive system condition that is contributing to intensified period pain, pelvic floor physical therapy has been shown to be effective for easing pain related to many causes of chronic pelvic pain including endometriosis.
Rawlins emphasizes that “pain-free periods are absolutely possible.” She continues, “As pelvic floor physical therapists we know that because we’ve seen that. We’ve seen so many patients that we’ve been able to move away from those painful moments so they can feel like they have their body back. It’s okay to get help. You don’t have to put up with it.”
Though my experience is similar to the experiences of so many others with menstrual pain, it doesn’t have to be this way for you. If you have painful periods, take this as your sign to truly believe that pain-free periods are possible, and get yourself to a pelvic pain specialist ASAP.
Work with a Pelvic Floor PT at Origin
At Origin, our dedicated group of pelvic floor physical therapists is committed to providing comprehensive support for your overall well-being. Equipped with specialized clinical expertise, they are prepared to assist you in all things period pain. And if you need medical treatment to address aspects of your pain, our physical therapists will be sure to refer you to trusted providers, who won’t brush off your pain.
Rest assured that our team at Origin is devoted to providing holistic care that considers both the physical and emotional aspects of your well-being. We are here to support you every step of the way on your journey towards improved health and comfort.