Periods: What’s Normal, and Why Doctors Often Don’t Listen When It’s Not

It’s considered a rite of passage for girls, a normal part of life for some women, and for others, a “curse.” Unfortunately, periods are also still often seen by the medical establishment as something to dismiss or deny.

Periods, in so many cultures, are simply not fair.

In Some Countries, Periods Are Unspeakable

Sure, in America period products are peddled on TV (Playtex with “wings,” anyone?), but in many other countries, it’s a total hindrance to diagnosis and care.

In the journal BMJ Total Health, an article entitled “Beyond Menstrual Hygiene: Addressing Vaginal Bleeding Throughout the Life Course in Low and Middle-Income Countries” found simple periods could keep women from basic services.

This has to do with cultural taboos surrounding vaginal bleeding (in many countries, words like “vagina” cannot be uttered, making communication almost impossible). The article points out that women end up denied information about their health, and early access to women’s healthcare.

“Additionally, the limited availability of clean, accessible water and sanitation facilities in many low and middle-income countries augments the challenges girls and women face in conducting daily activities while managing vaginal bleeding, including participating in school or work, going to the market or fetching water,” the Global Health article reported.

This means even basic sanitary supplies are often out of reach (called period poverty), leading to infections that can’t be treated because of the organ whose name cannot be uttered. It’s a true vicious cycle of discomfort, disruption and ill health.

American Attitudes Toward Periods Are Better…Sort Of

While menstruation has been more widely discussed both in homes and schools, and products are widely available, there are still some problems with the American approach to menstruation.

There’s even an entire website devoted to the discussion of these issues. It’s called Bad Periods.

The concept of a “bad period” covers a lot of ground, healthwise. It could just mean the usual cycle, but it’s also a euphemism. Bad Periods.com defines it thusly:

Bad Periods, n. 1. A chronic or sporadic condition usually waved away by your gynecologist as “bad periods” 2. A condition enshrined in mystery, myth, cultural shame, taboo and clinical gender bias 3. A condition caused by endocrine disruptors in our air, food and water

Here’s a typical scenario: you go to your MD because you have terrible cramps and heavy bleeding every month. It seems to affect your digestion and causes terrible bloating. But, your doctor can’t find anything “wrong” with you, and so terms it a “bad period.”

“What this means is that when you go to the doctor you get answers like “we can’t find anything wrong”, you have “IBS/fibromyalgia/constipation/hip pain etc.”, “you are just built that way” or “it must be hormonal,” the website explained. “ This leads to a lot of what are called treatment failures and gaps in care – basically doctors not sure what to do with you, not sure how to diagnose you or treat you.”

These care gaps might do no harm, simply because they do nothing, or there could be a misdiagnosis.

“At worst prescribing drugs or treatments based on myth, conventional wisdom or pharmaceutical marketing information that can result in permanent bodily and psychological damage,” Bad Periods said.

This is how women end up suffering from things like ovarian cysts, polycystic ovarian syndrome, endometriosis, and fibroids for years without treatment. Those aren’t bad periods. Those are treatable medical conditions masquerading as bad periods.

In addition to the medical side, there is simply a stigma attached to periods, even in the US. In an article in Sex Roles, entitled “The Menstrual Mark: Menstruation as Social Stigma,” the authors use a comprehensive literature review to bolster this claim.

“We argue that menstruation is a source of social stigma for women. The word stigma refers to any stain or mark that renders the individual’s body or character defective. This stigma is transmitted through powerful socialization agents in popular culture such as advertisements and educational materials. We demonstrate, in our review of the psychological literature concerning attitudes and experiences of predominantly American girls and women, that the stigmatized status of menstruation has important consequences for their health, sexuality, and well-being.”

Besides the stigma of periods, women and their pain responses have been medically misunderstood, with some dire consequences.

The Problem with Women and Pain

It’s the myth both sexes perpetuate: that the pain of childbirth is so intense, it couldn’t be tolerated by men, and thus women have a higher pain tolerance. The truth, of course, is much more complex.

According to the National Pain Report, women suffer from incredible gender bias when trying to discuss pain of any kind.

Over 2,400 women responded to an online survey conducted by National Pain Report and For Grace, a non-profit foundation. Its results were discouraging.

“Over 90% of women with chronic pain feel the healthcare system discriminates against female patients, according to the results of a groundbreaking survey that also found many women feel there is a gender bias in the way their pain is treated by physicians,” the report noted.

The survey results made one think women were left writhing on the floor on a regular basis.

Other feelings of gender bias uncovered in the survey include:

65% feel doctors take their pain less seriously because they are female.
84% feel they have been treated differently by doctors because of their sex.
55% feel more comfortable being treated by a female doctor.
49% feel female doctors understand their pain better than male doctors.
49% feel doctors are less inclined to prescribe an opioid pain medication to them because they are female.

Throw period pain into the mix, which still has the aforementioned stigma and lack of understanding, and women’s pain management becomes fraught with misdiagnoses and ignorance.

“This is a wake-up call for people who take care of women in pain,” Steve Passik, PhD, a psychologist and vice president of Research and Advocacy for Millennium Health, told the National Pain Report. “I think this survey is extraordinarily important, because I think the experiences of women in pain need to come out in the open and really need to be publicized.”

How To Talk To Your Doctor

It’s important to describe your experiences to your doctor, but that’s hard to do if you have no idea what is and is not “normal” during menstruation.

Meghan Cleary, writer, activist, and creator of Bad Periods, points out in an article for Medium that even gynecologists are often shabbily educated about certain disorders, especially since many of them mostly deliver babies.

“Anything that is below the belly button on women gets put in the ‘gyno ghetto,’” Cleary said in Medium. “Anything having to do with your period automatically is not as valued.”

Here’s what Bad Periods lists as NOT normal to experience during your period:

Gastrointestinal symptoms like diarrhea, vomiting, gas pains
Mild to severe pain in your GI tract (stomach, colon, intestines)
Painful urination, painful when the bladder is full
Pain while pooping
Pain during intercourse
Leg and back pain
Extreme fatigue
Debilitating acute or chronic pelvic pain
Chronic pelvic fullness: feeling as if you pelvic area is full, bloated and achy all month long
Lower back pain, acute and chronic
Migraines, acute extreme and chronic
Extreme mood swings
Hypoglycemia
Fainting
Depression
Dizziness
Vertigo
Anemia
Excessive bleeding (going through super tampons or maxi pads every 15 -45 minutes, soaking through bed sheets, clothing, etc.)

These symptoms could indicate treatable conditions such as endometriosis and fibroids, neither of which is a “bad period.” So, what’s normal?

“It is normal to have no or mild pain during your period. Mild fatigue, some mild gastrointestinal symptoms, mild bloating, mild moodiness,” states Bad Periods.