The time has come to talk openly about the pain of periods. Every month - journalist Olivia Goldhill provocatively stated in an article in Quartz - all the women around you who are between puberty and menopause bleed from the vagina. It is one of the most basic things in nature. And yet, an uncomfortable conversation.
In a silent and politically correct way, thousands of women suffer from very serious menstrual pain every month. Not a nuisance; real pain This has a clinical name -dysmenorrhea- and can interfere with the daily life of these women who represent between 20% and 50% of the female population, depending on their degrees of severity.
How bad is that pain? Answers Dr. Javier de Andrés, coordinator of the Pain Unit at the Hospital Universitario de la Paz, in Madrid: “It can resemble a heart attack, pain in the pleura - the tissue that covers the lung -, appendicitis, a kidney stone or gastritis, all of them visceral pain.”
An agony that we have been taught to silence. In my case, the pain far exceeds that of gastritis or kidney stones, pathologies that I have experienced. One morning I woke up with all the symptoms listed to describe dysmenorrhea: cold sweats, vomiting, diarrhea, back and leg pain, pelvic spasms...
I couldn't get up, but I needed to go to the bathroom. Bending at 90 degrees, I went around the house looking for one or two ibuprofen that I couldn't find. I walked the path to the pharmacy holding onto the wall and as soon as I arrived I fell to the ground twisted by the pain. Already at the hospital, the gynecologist who treated me urgently told me that what had happened could be compared to childbirth. Every month, I take drugs that allow me to go to work, but not always on time and not without pain.
Visceral pain, explains De Andrés, is difficult to describe and focus on: “Just as the arm hurts in a heart attack, with dysmenorrhea the spasm spreads to other areas,” such as the back or legs. “It is what we call referred pain, which is produced by innervation [the action of the nervous system on the organs].”
I have sometimes commented on these pains around me. On occasions I have received crooked gestures, made uncomfortable by the conversation. Among women, stories such as those of a friend diagnosed with endometriosis who for years, and at the direction of her mother, considered that this was “normal” (as a reference measure, 20% of women with endometriosis have to go through a unit of pain). Another woman told me that her family doctor even told her that she was exaggerating.
Outside of medical consultations it can be much worse. Recently, the Bristol company Coexist announced that it would give sick days to employees who needed it during the days of menstruation, but there are those who interpreted it as a measure to avoid tension in the work environment.
Silence not only causes ignorance and incomprehension. It has made period medical research insufficient. This is what Deborah Mason of Wellbeing Women, a British foundation that has been funding research in reproductive health, claims. “There is little research and, therefore, new information on the subject, partly because women do not complain.”
De Andrés recognizes that “menstruation, specifically, is little studied; although work is being done to mitigate visceral pain in general, and these advances apply in the same way to dysmenorrhea.”
age matters
Dysmenorrhea, according to Juan Troyano, president of the Scientific Committee of the SEGO (Spanish Society of Gynecology and Obstetrics), can be - depending on the age of the woman - primary or secondary.
Primary dysmenorrhea can develop up to approximately the age of 20 and occurs when the cervix is very narrow: blood remains in the uterine cavity and becomes a foreign body that the uterus tries to expel.
When pain appears in adulthood with or without symptoms in previous years, it is called secondary dysmenorrhea, the causes of which may be linked to benign tumors, endometriosis or inflammatory disorders caused by sexually transmitted diseases.
Women who suffer from endometriosis, according to the Association of People Affected by Endometriosis of Catalonia, can take up to nine years to be diagnosed with the disease, which "in some cases can be disabling." Hence, complaining in time is essential.
From ibuprofen to morphine derivatives
The most common thing is to treat menstrual pain with anti-inflammatories or hormones. Both have side effects: possible gastritis in the first case, effects on circulation in the second. When dysmenorrhea is acute, the treatments - explains the coordinator of the Pain Unit - are distributed in four degrees of intensity:
- The first, based on non-steroidal anti-inflammatory drugs (such as ibuprofen). At an early age it can be administered chronically - that is, daily - although it is not advisable to do so at older ages.
- When the pain is not resolved with the previous treatment, minor opioids are used, such as tramadol or codeine. These medications have a ceiling dose, and if it is necessary to exceed it, you should go to the next step.
- In the third degree there are major opioids, derived from morphine, but they must be applied only in certain patients, since it is a benign and non-oncological pain.
- Finally, if none of the above is effective, "we intervene by blocking the autonomic nervous system - which is everything that we do not cognitively control - by applying a local anesthetic in the hypogastric plexus or in Walter's or odd ganglion."
Also, “intrauterine devices such as the IUD, which have progesterone, a hormone that is used to help the development of pregnancy,” explains Troyano, “can also be applied.”
The last option proposed is treatment with GnRH molecules, which “reduce symptoms by more than 50%, but which means leaving the woman without a period. You have to be very careful".
“Some of the techniques we use,” admits Dr. De Andrés, “are dangerous. For me it is a success to get 50% pain relief. But patients [those with any visceral pain] always want more.”
