We need to talk about mental health and dysmenorrhea
Since having her first period aged 11, Tyra, who is now 25, would experience debilitating cramps, hot flushes, vomiting, migraines, and would even pass out. “It was so bad,” she says, “that I would have to take a day or two off school whenever it came.” For someone in full time education, that equates to over 100 days missed over the course of their high school years.
Tyra continues, adding that while her pain was unbearable, she spent years having to deal with people telling her she was being dramatic and that the pain she was experiencing couldn’t be as bad as she was making it seem. “My dad used to say that as I knew it was coming I should have been more prepared,” she says. “My friends didn’t understand, my mum didn’t even understand. She used to sit me in a hot bath and isolate me from my siblings, so they wanted nothing to do with me as they thought I was contagious.”
“My friends didn’t understand, my mum didn’t even understand. She used to isolate me from my siblings, so they thought I was contagious.”
Period pain, or dysmenorrhea, is, of course, definitely not contagious. Studies suggest that as many as 9 in 10 women have them, and of those who also work, more than half say the pain has affected their ability to do their job.1 Those with conditions such as endometriosis, which Tyra has, will experience it much worse, with the pain often occurring at other times of the month too.
The pain occurs as the contractions of the muscles of the womb during a period restrict the blood flow through the capillaries supplying the womb, starving the womb of oxygen. This releases chemicals, which stimulate the nerves, making them release chemicals which cause pain.2
Why are mental health issues relating to periods overlooked?
Recently the conversation around menstruation has reached mainstream media, meaning women feel increasingly able to open up about it. Some companies have started allowing ‘menstrual leave’, which acknowledges how bad the pain can be, and thus more women are happy to admit they’re in bed with period pain, rather than being ashamed and making up an excuse. Nonetheless, the mental repercussions of experiencing such severe pain on a regular basis are rarely acknowledged.
“Unfortunately, as mental health and reproductive health are two taboos topics, the intersection of the two is often neglected,” says Dr. Emmert Roberts, a psychiatrist and trustee of the Faculty of Sexual and Reproductive Healthcare. “People don’t like talking about these things, so when you bring them together people feel ashamed.”
One in four people will experience a mental health issue in their lifetime, Dr. Roberts continues, and it is well known that chronic pain is a risk factor for depression. “The more severe the chronic pain, the more likely it is that you will develop a mental health problem,” he adds.
“By the time I hit high school,” says Tyra, I was so depressed because I was going through this pain that I felt no one could relate to.” She dreaded getting her period, and just wanted, she says, to feel “normal”.
One in four people will experience a mental health issue in their lifetime and it is well known that chronic pain is a risk factor for depression.
Nonetheless, when she did get help, this only served to worsen the mental health issues caused by the shame she was feeling. She got the contraceptive patch, which, when spotted by her peers at school, caused rumours to spread that she must be sexually active to need contraception, and therefore she quickly became known as the “easy girl”.
“I was crushed,” Tyra remembers. “I asked to be taken out of swimming so I didn’t have to wear a bathing suit where the patch would be exposed.” She hated herself, and chose to come off the patch as being in severe pain was, she considered, a better option than being teased. A doctor prescribed her Percocet (which contains opioids) for the pain, to which she subsequently became dependent.
When the dependence started affecting her cheerleading performance, due to the woozy state it brought about, she was taken off the meds. The pain and depression came back, exacerbated by worries over her infertility because of her endometriosis. She was back to square one.
Menstruation and anxiety
Tyra isn’t the only woman who found her life severely affected by dysmenorrhea and subsequent mental health issues. Twenty-five-year-old Sadie also suffers both mentally and physically because of her menstrual cycle. She also has endometriosis, but found any form of hormonal contraception affected her mental health as much as the pain and heavy bleeding, so has decided to avoid it. This means that for the days she is on her period she is entirely dependent on pain killers, and regularly has to take time off work.
“It’s a constant form of anxiety. I worry I’m going to leak, and I’m always stressed that something is going to go wrong.”
Added to the fear of pain, she gets anxious about the heaviness of her period. “It’s a constant form of anxiety,” she says. “I worry I’m going to leak, and I’m always stressed that something is going to go wrong.” Sadie’s stress was exacerbated by the fact that until she got her endometriosis diagnosis, doctors would simply shrug and shake their heads, unsure of what to do with her, and would advise hormonal contraception despite her protesting that this affected her mood.
In this way, their remaining advice to simply “take more ibuprofen” seemed to cheapen her condition, leaving her feeling like she must be making a fuss about nothing. “When my pain is so bad,” Sadie adds, “I can’t move. All that is on my mind is the pain. I have to just lie there as still as possible.”
If period pain affects so many women, why are they still not getting mental support, as well as purely physical support? Part of the issue when it comes to pain and mental health is it can be difficult to tell which one comes first as the latter can cause the former.
How can doctors help?
For all of these reasons, Dr. Roberts says, if a person presents to a doctor with severe pain, be it chronic, or cyclical, they should be asked about their mental health. “Asking about mental health should be a routine part of any consultation, particularly in patients with chronic pain because they are high risk,” he says. The accumulation of issues, particularly when it comes to chronic pain and reproductive health, he continues, can lead to depression, and if you don’t treat it it can get much worse.
But, I ask, if patients have been to their doctor complaining about pain, and feel like they are being dismissed, what can they do? “For a start,” he says, “don’t grin and bear it.” Period pain, he continues, is a very valid condition, and there are good treatments available. In the meantime, or while you are waiting to be referred to specialists, while not a failsafe method of curing depression, certain apps, and guided self help books and therapies can be beneficial, and apps can also be used to track symptoms.
“Period pain is a very valid condition, and there are good treatments available.”
Fortunately for Tyra, she eventually got the help she needed. “All through college it was a journey of finding which medicine worked for me, and finding a way to live my life without being stopped by endo pains,” she says. “And eventually I did.” She found a birth control that stopped her menstruating and lived virtually pain free for years, but was still plagued by occasional bouts of depression regarding her fertility.
Thankfully, Tyra’s story has a happy ending: when she came off birth control, she got pregnant after a year. “It was such a stressful journey, but it has made me strong and has given me a confidence I never believed I could have,” she says.
If you find your mental health affected by your physical health, make sure you push for treatment. With conditions such as endometriosis, while finding a treatment that works for you takes time, there are a variety available, and pushing to have your mental health taken seriously in the meantime is important.
“You have to be honest with your doctor,” says Dr. Roberts. “While a lot has been done to raise the profile of mental health issues over the last few years, it is hard for GPs to be mind readers,” he adds, emphasising the need to continue the open and honest dialogue about both reproductive and mental health.
On top of this, he says, not only can talking to family and friends help, but it can also prepare you for a conversation with your doctor. “Even taking along a trusted friend to your consultation can then make you feel more relaxed at discussing the mental health side of your period pain with your doctor,” he says, and you should never feel ashamed of any symptoms you are experiencing.
- Matthew Smith, ‘Period pain makes it harder for most women to work’, YouGov, 2017 [accessed 16 February 2019].
- NHS, ‘Period Pain’, Health A-Z, 2017 [accessed 16 February 2019].