Wed | Dec 12, 2018

Bloody monthly mayhem

Published:Monday | February 22, 2016 | 12:00 AMMichael Abrahams

Menstruation is a fascinating phenomenon, capable of inducing a vast spectrum of emotions, and physical sensations in those experiencing it. The arrival of a period can be a welcome event to be celebrated, for a woman who had unplanned or unprotected intercourse and does not wish to become pregnant.
Conversely, its presence can precipitate bouts of depression in women who wish to conceive, especially those who have been attempting unsuccessfully for a long time. Similarly, menopause, the permanent cessation of periods, is welcomed by some women who gladly bid good riddance to what they perceive as a recurring nuisance, and dreaded by ladies who realise that chances of conception, at least naturally, have dwindled to naught, and that senior citizenship may be just around the corner.
So menstruation is supposed to be a minor monthly inconvenience, interrupting sexual activity (for some women), and necessitating the purchasing of feminine hygiene products, usually a minor economic burden. But for a significant number, it is a recurring nightmare. A nerve-wracking, gut-wrenching experience leaving many incapacitated, and of little use to themselves or loved ones, because of severe pain and/or excessive or prolonged bleeding.
Unfortunately, we are socialised to believe that women are designed and expected to experience and handle pain. A teenager recently related an incident to me that she witnessed at her school. A girl in her class was feeling unwell, experiencing menstrual cramps, and had been resting her head on her desk. When the teacher, a man, enquired and was told by the student what was transpiring, he responded, rather flippantly, by saying that women were made to feel pain, and that it was in the Bible. A young woman also related a story to me about experiencing severe menstrual cramps at work, and being told by her female boss “not to make it look so bad”.
Both men and unafflicted women have a tendency to dismiss women’s complaints about menstrual pain. Even health professionals, who should know better, are often guilty of trivialising women’s pain. A study conducted at the Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, and published by Academic Emergency Medicine, found significant gender disparity regarding the attention paid to patients presenting to an emergency unit with acute abdominal pain. The study found that women were less likely to receive painkillers then men, and that those who did receive such medication waited longer than men (median time 65 minutes versus 49 minutes).
But all periods are not created equal, and period pain, or dysmenorrhoea, is the commonest menstrual complaint. Primary dysmenorrhoea, painful periods not caused by an underlying disorder, interferes with the daily lives of approximately one in five women, according to the American Academy of Family Physicians. Secondary dysmenorrhoea occurs as a result of an existing condition, the most common and devastating of which is endometriosis, a gynaecological disorder in which tissue similar to the internal lining of the uterus is found not just outside the uterus in the pelvis, but in some cases, at distant sites such as the umbilicus or even the lungs. Endometriosis can cause crippling pain, not just during the periods, but even when menstruation is not taking place, and is also a common cause of infertility.
Recently, John Guillebaud, professor of reproductive health at University College London, during an interview with the digital news outlet Quartz, said that period cramps can be “as bad as having a heart attack”, going on to say that “men don’t get it and it hasn’t been given the centrality it should have”, and adding, “I do believe it’s something that should be taken care of, like anything else in medicine.” I agree. There is quite possibly a gender bias interfering with research and development of treatments for dysmenorrhoea. American expert Richard Legro, from Penn State College of Medicine, also told Quartz that while investigating dysmenorrhoea, he found evidence that sildenafil (also known as Viagra) can treat the condition, but claimed that he was unable to obtain funding for his research. According to him, “I’ve applied three or four times but it always gets rejected. I think the bottom line is that nobody thinks menstrual cramps is an important public health issue.”
This dismissive attitude can seriously endanger the lives of women. Many females believe that period pain is just their lot in life, suffer in silence, and, as a result, fail to seek help when serious gynaecological conditions such as endometriosis ravage their bodies. The expectation of period pain is such that many women, and some physicians, forget that diseases affecting other organ systems, such as gastrointestinal and urinary disorders, can present with pelvic pain in women, resulting in missed diagnoses, and even death.
Menstrual pain needs to be taken more seriously. A good start would be to socialise our children, both boys and girls, at appropriate ages, to understand that severe period pain is not normal, and must be investigated and treated. Employers, teachers and administrators also need to be educated about menstruation, including the fact that pain associated with it can sometimes be pathological, necessitating absence from the workplace or classroom. The notion that all women experiencing periods will have to just deal with it, no matter how severe the pain may be, must be eradicated from the psyches of us all.

-Michael Abrahams is a gynaecologist and obstetrician, comedian and poet. Email feedback to and, or tweet @mikeyabrahams.