Do you know someone who experiences intense pain during menstruation? It wouldn’t surprise me if you did…
Not that long ago, I was treating a client in Kingaroy who confided in me about some concerns she had for her teenage daughter who had been experiencing extremely painful and debilitating periods; frequently missing school and other activities due to her pain.
My client’s daughter is not alone. Researchers estimate that anywhere between 45 – 90% of women have painful menstrual cramps, or dysmenorrhea. It can be a primary problem, meaning without a clear cause; or secondary – caused by another medical condition, eg. endometriosis. The pain can range from mild to severe in the lower abdomen, lower back, or thigh; and can accompanied by other symptoms like nausea, vomiting, and diarrhoea.
Listening to my patient reminded me of something that health providers and patients need to keep in perspective… We all know that dysmenorrhea is common – we all know someone who has experienced terrible period pain; however, just because something is common, does not mean that it is normal.
The mother had been made to believe that her daughter’s debilitating pain was normal and had been given very little information, support or treatment options. The result is: her daughter is left alone with her abnormal pain and no sufficient period pain relief, and her mother with her normal parental concerns. This is a common story – with menstrual pain often being poorly treated or untreated for years.
“After all, it happens only once a month!”.
Due to the intensity and regularity of period pain, it has been demonstrated that those who endure regular painful periods suffer identifiable structural changes to the brain.
“Just toughen up, sunshine”
Cases like this remind me of my first day in Uni, when I first started my studies to become a physiotherapist… Professor Fernando (it took me a while to understand and admire him as a professional due to my own immaturity at the time – 22 years ago!), recounted us a short fable entitled: “jacaré embaixo da maca” meaning “the crocodile under the bed” in Brazilian Portuguese. A rough translation of the story goes like this…
Mr João was a patient being cared for in hospital. His Nurse, Maria asked him,
“How are you feeling?”,
to which Mr João replied,
“I’m well, but that crocodile under the bed is giving me the creeps! Can you please remove it!?”
The nurse did the expected: she laughed, quickly replying without a second thought,
“Don’t worry Mr João, there is absolutely no way a crocodile is in your hospital room.”
Days went by, and Mr João quickly became the joke of the week. Every health professional who paid him a visit, would hear his same story about the crocodile. To the frustration of the patient, each health professional gave him the same response. Nurse Maria visited Mr João a week later, only to find his room empty. She asked the other nurse on duty what had happened, who, in tears of guilt, replied:
“Remember Mr João’s story about the croc? Well, I know it’s crazy but he was right… there was indeed a croc under his bed… and now, Mr. João isn’t here anymore.”
Although this story is about as real as the one about Crocodile Dundee fighting crocs with a machete, it points out an unfortunate phenomenon: the of a lack of empathy (and in some cases belief!) that we, as providers, can develop towards people’s symptoms, stories, and perceptions – especially when we can’t see a clear cause for the ailment. There are many reasons we do this but at the end of the day, we must take our responsibility to listen and assess seriously, or mistakes will happen. We must remember that people are relying on our clinical help and evidence-based guidance.
Many people, including my patient from Kingaroy, don’t realise that there are many ways in-which Physiotherapists can assist with menstrual pain management and offer period pain relief. This can be by assessing and treating muscles in the abdominal, pelvic, and lower back areas; stimulating with manual therapy, acupuncture, and TENS machine – the innervation that reaches the uterus and modulates the inflammation associated with the menstrual cycles; advising and guiding exercise strategies to manage the pain; and so on. Research shows the efficacy of these treatment approaches in lowering acute dysmenorrhea. These are easily available with physiotherapists trained in women’s health and can benefit many women, but only if they know that they can and should seek professional help.
Once I was discussing with a friend, and young physiotherapist, about how physiotherapists can play a vital role in managing pelvic pain as discussed in this article. That professional told me:
“Diego, I rarely see any patient complaining about this. Are there actually that many women needing treatment for it?!”
The answer is simple: if no one knows we can help, no one will ask for treatment.
So remember, severe period pain is not normal. Louder for the people in the back? Just because it is common does not mean it is normal. I ask that you to share this message far and wide – it may significantly improve someone’s life.
Oh, and just in case, check under your bed for crocs!
Diego De Farias Diehl,
Senior Physiotherapist, Vital Health Kingaroy
Iacovides, S et al. Hum Reprod Update. 2015;21:762-778.