Dysmenorrhea otherwise known as period cramps is a painful symptom experienced by some women during menstruation. Research indicates that nine out of ten women experience period pain, these can be of varying levels and due to various causes. Despite the high rate of prevalence, dysmenorrhea as a problem is not addressed. The silence associated with menstruation itself is extended to dysmenorrhea. Women often suffer in silence because of the social taboos associated with the same. Moreover, some medical professionals tend to dismiss it as regular and 'normal'.
John Guillebaud, a professor of reproductive health at University College London, in an interview with Quartz Media shared how some patients described their menstrual cramps as “almost as bad as having a heart attack.” Generally, contractions of a low pressure (50-80 mm Hg), which last 15-30 seconds at a frequency of 1-4 contractions every 10 minutes are experienced when a woman has menstrual cramps, when contractions are of a higher pressure (they may exceed 400 mm Hg), last longer than 90 seconds, and often occur less than 15 seconds apart. 1
When I was younger, my friends and I used blame it on Adam and Eve, and the Apple. Sometimes, we still do.
In reality, the fruit changes, the pear-shaped uteri (singular: uterus) and their contractions during menstruation cause menstrual cramps. The uterine muscle walls are composed of numerous blood vessels. These blood vessels are compressed during contractions resulting in a further cut off of blood supply and oxygen. At the chemical level, the lining of the uterus releases a chemical, prostaglandin, that increases the strength of the contractions. An increase in levels of prostaglandins may also cause nausea and/or diarrhoea.
The causes of dysmenorrhea can be many, therefore, it is important to talk about and seek help especially if it disrupts daily activities. Dysmenorrhea is often classified as primary and secondary.
Primary dysmenorrhea: is the most common kind and is characterized by cramping in the lower abdomen. It may start 1-2 days before the period and can last 2-4 days.
Secondary dysmenorrhea: is more severe and might be caused when tissue similar to the uterine lining is found in other locations (endometriosis) or due to poly-cystic ovarian syndrome where an imbalance in the sex hormones - estrogen and progesterone results in the formation of benign masses on the ovaries.
Growing up, young girls are told that discomfort and cramping during menstruation are normal. While each person's experience varies, the problem is to be acknowledged. Some women (the lucky ones) never experience any cramps, some experience mild cramps that allow them to carry on with their work (as one would do with a headache), while some others experience severe pain, nausea, diarrhoea (all together or one or more).
Personally, I belonged to the category that pass out due to the pain (I don't anymore). The first time I passed out, everyone around me thought it was a heat stroke. But since then, it became the only day of the month that I sleep for more than 5 hours straight. Luckily for me, this lasts only for a day. I am not alone, the women I know who have painful periods far exceed the ones that don't.
Each individual body type is different and hence, the reasons for dysmenorrhea and the ways to address is it different. I personally, have a low pain threshold, others might have a different issue that might need to be identified and treated differently.
Besides medical help, social and family support goes a long way in supporting women who have painful periods. Both men and women play a crucial role in respecting and supporting a woman undergoing this monthly trauma. Instead of dismissing the issue by saying 'but every other woman has the same problem', the problem itself needs to be addressed.
Research on dysmenorrhea is considerably low and underfunded. It must be treated as a public issue and taken into account.
Menstrual leave is an issue up for debate. Menstrual leave is problematic. While on the one hand, it offers women the opportunity to take days off from work (paid/unpaid) and take the required rest to recover, it can be used to question women's work efficiency and reinforce sexism in the workplace. Japan, Taiwan, Indonesia and South Korea are some of the countries that offer women menstrual leave. Since 2007, the Nike Code of Conduct offers menstrual leave and the company via a Memorandum of Understanding expects its business partners to comply to the same.
Ideally, labour rights must include the safety and protection of all parties concerned. But in a world where this might be misused, it is important to work out a sustainable system with women workers who require the days off that does not affect the output of their work but also ensures their comfort.
[^1] For the bit on period pain measurement. http://www.medicinenet.com/menstrual_cramps
2 For a bit of satire - read Gloria Steinem's essay on 'If Men Could Menstruate'. https://ww3.haverford.edu/psychology/ddavis/p109g/steinem.menstruate.html