This Is Why You're Getting Extreme Period Pains
The Debrief: Hello, you! Yes, you, crying into the hot water bottle and brandishing the box of Extra Super Absorbent Night Plus! We're here to help...
Illustration by Assa Ariyoshi
When I was a teenager, I could tell which of my five sisters had their period just by looking at them. Because when we were menstruating, and it was going badly, we’d all spend the first bad day wearing our Mum’s elderly, enormous, Winnie The Pooh patterned jumper. The garment was a red and yellow flag, a slightly grubby hug, and a way of communicating to the outside world that everything had gone to shit. I remember seeing Beth lying across the stairs, her feet on the landing and her head by the beginning of the bannister, a hot water bottle up the jumper of doom. ‘THIS CANNOT BE GOD’S PLAN FOR MEEEEEEE!’ she wailed, sobbing and clutching the hot water bottle, which was filled with incongruously jaunty plastic tropical fish.
Heavy periods are completely debilitating, and it doesn’t seem fair to spend three weeks of the month feeling like the bosses of our bodies only to then get stuck crying on the stairs. It’s rare that a heavy or painful period means that you have anything to worry about, but sometimes our bad cramps or a heavy flow will be a symptom of another health issue. Dr Linda Bradley, the director of the Centre for Menstrual Disorders in Ohio says ‘Women who have normal menstrual cycles should not be incapacitated by their period. They should not have to miss work, school, hobbies, sports or other activities that they enjoy.’ It’s normal not to feel like yourself on Day One, but if the feelings persist, it’s definitely worth getting checked out. Here’s what your extreme period pain might mean, and how to manage it.
When my period pains are bad, they come in regular intervals right across my lower body. It’s like standing on the shoreline of the world’s worst beach, and being knocked back by the force of the sea every time I try to stand up – while what feels like all my internal organs are trying to fall out of me from the bottom. Imagine a soggy, overcooked quiche that collapses at the base when you try to take it out of the oven, but with menses.
The medical name for this pain is dysmenorrhoea. It’s caused by the uterus contracting and relaxing in order to release menstrual blood, and releasing prostaglandins. These hormones can cause pain, inflammation, fever and blood clotting. If your body is producing a lot of prostaglandins, it might be a sign that you have endometriosis, a common condition which happens when womb-like tissue is found outside the womb.
Endometriosis isn’t currently curable, but its symptoms can be managed with hormone medication and if your symptoms are really severe, it’s possible to undergo surgery to remove patches of the tissue. Your GP is a brilliant source of advice and support, and there’s some NHS information here. Dr Linda says ‘I believe very strongly in journaling. Women should write down when their symptoms started, when they ended and what they did to alleviate them. Generally, we wait for trends, but if you think something is really wrong and you feel uncomfortable waiting two or three months, call your doctor right away.’
Lots of blood
If you’re lucky enough to use the tampons that tend to come in a yellow box, you might think a heavy flow is what you heard on the last Angel Haze album. If you’re dealing with what Dr Linda calls ‘A Niagara Falls situation’ and doubling down on tampons and pads, you know the truth. Dr Linda explains that extremely heavy periods could lead to anemia. ‘[Anemia] is one of the first blood tests we do when a women reports heavy bleeding. Diets aren’t as fortified with iron as they used to be, so anemia is more likely to develop.’ So why is your period so heavy? Annoyingly there’s no one clear answer, but a common cause is uterine fibroids – non cancerous growths in the womb that cause pelvic pain. Sometimes an IUD contraceptive can increase your flow too. Most women lose less than 80mls of blood during their period, changing their tampon every three to four hours. If you need to change more frequently than this, it’s worth talking to your GP to make sure everything is OK. You could also consider taking some iron supplements.
If you’re the sort of person who has ever watched a YouTube video of a giant blackhead squeezing, or gone to get your ears syringed and demanded to look at the wax that came out, you might be grimly fascinated when big bits of actual blood come out during your period. Equally, you might be plain terrified.
In almost every case this is nothing to worry about – it’s to do with your actual flow itself. If the blood is released slowly, there might be an excess of fibrin, a naturally produced clotting agent, causing the blood to collect. If there’s a lot of clotted blood, it could be caused by a delay in uterus contractions, and everything being suddenly released all at once. It’s only potentially problematic if you feel your flow is too heavy to deal with, in which case your GP should be able to help. And get on those iron tablets!
As well as making us feel physically dreadful, periods can mess with our emotions more effectively than a decade’s worth of John Lewis Christmas campaigns. Obviously you have to be a total failure as a human to think it’s OK to ask a distressed woman: 'Are you getting your period?’ But I have gone to bed believing the world was ending and been weirdly relieved to wake up in a pool of blood. Dr Linda explains that intense emotional episodes can be the result of an oestrogen surge. ‘Women who are overweight have fat stores in the stomach, abdomen and buttocks that make a chemical called androstenedione that is changed into oestrogen. This causes the patient to have more oestrogen surges.’ So it’s worth doing what you can to maintain a healthy weight. The NHS suggests cutting down on alcohol and caffeine in order to manage mood swings, and says that some studies have shown that magnesium supplements could help, although more research is needed.
The never-ending period
‘Dear log. It is Day 27 and I am still bleeding. The man in Superdrug saw me come in and waved a box of pads that he had been keeping behind the counter for me.’ At some point, most of us will deal with the menstrual equivalent of the Hundred Years War, and it’s usually nothing to worry about (although definitely worth remembering and revisiting during dull family dinners when your great Uncle starts talking about his memories of the Cuban Missile Crisis.)
The most common cause is Adenomyosis, a non-malignant disease that happens when the uterine lining becomes very thick. It could also be a sign of some of the illnesses already mentioned – endometriosis, uterine fibroids or polyps – all potentially painful, but manageable. It’s best to see your GP who can give you some tailor made tips. Follow Dr Linda’s advice and keep a journal. As well as helping you to find the best, most appropriate treatments, it will make you feel like you control your body and your periods are not the boss of you.
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Illustration by Assa Ariyoshi
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