How do doctors know if a period is really painful?: "There is nothing objective to measure it"

“You can’t take a bath with your period.” “With the rule you can not sunbathe.” “If you’re on your period, you can’t play sports.” Myths and myths have circulated about menstruation throughout history and, although it may seem like a thing of the past, the truth is that some of them have reached the present day. “My mother told me that I couldn’t go down to the beach with my rulerthat she had always been told that bathing was terrible”, says Beatriz, a 28-year-old girl who, every month, deals with the severe pain of her period. “It hurts the day before and, normally, the first day it goes down and the next“.

Contrary to the phrases at the beginning, period pain is not a myth. The dysmenorrhea -clinical term for menstrual pain- is recognized by the World Health Organization as a disorder.

Cristina, 27, knows very well what it is. “It has happened to me that I had to go to the final Baccalaureate exam and not be able to go because I felt so bad that my legs fell asleep“. One day, he says, he fainted from the pain. “There are times when you have to go to work and you don’t know if they’re going to tell you off because you are dizzy, wanting to vomit and not feeling well“.

Cristina has just exposed a vital point of menstrual pain, the sick leave to be introduced within the framework of the new sexual and reproductive security law. According to this new legislation, which will go to the Council of Ministers on Tuesday, May 17, women suffering from severe dysmenorrhea will be able to request a three days -expandable to five- for disabling pain. The question is, can this disabling pain be demonstrated?

There is nothing objective to measure it“, Teresa Castellanos, gynecologist and obstetrician at the Hospital Clínica Universitaria de Navarra, explains to EL ESPAÑOL. However, the doctor confirms that period pain is something very common in their consultations and that approximately 20% of them are due to this reason.

gynecologists in favor

From the Spanish Society of Gynecology and Obstetrics (SEGO) they celebrate that sick leave can be given due to incapacitating menstrual pain: “I am totally agree so that the woman can have a sick leave,” says Corazón Hernández, a gynecologist and secretary of the institution’s Board of Directors, on the other end of the phone.

Although, he also acknowledges that there is no method that can shed light on an objective measurement of pain. “In the end, that will depend on the own practitioner’s experience and trust in the patient”, details the expert.

Ana Rosa Lucena Torres, Gynecologist and Obstetrician at the Costa del Sol Hospital in Marbella and Lacibis Clinic and science communicator, is very blunt on the subject. “This is the eternal controversy in relation to sick leave, because not everyone is equally honest, but there is no need to frivolize the subject and you have to give it the importance it has,” he says. “If a woman has dysmenorrhea that doesn’t go away with diet, change in lifestyle (healthy diet and physical exercise), rest, anti-inflammatories or hormonal treatment, apart from, of course, , unsubscribe because is incapacitated for normal activity should be thoroughly studied by the gynecologist”.

The Andalusian Association of Pain points out that “pain has a physical component, but also a subjective one, influenced by the way in which each person perceives their pain, with personal experiences, with the pain threshold level, etc.” Therefore, “currently there is no absolutely objective procedure to measure the intensity of pain in the same way that blood pressure, fever or heart rate are measured”.

Teresa Castellanos, for example, points out that a good way to do it is to resort to pain scales, such as NRS numerical scale, where zero is ‘no pain’ and ten is ‘worst pain imaginable’. The patient must be located at a point between both numbers.

In addition, the gynecologist adds that some of the patients with severe menstrual pain come to consultations with associated symptomssuch as dizziness, vomiting or diarrhea, so detection is much easier in these cases.

“It is not an excuse”

Corazón Hernández, for her part, finds no reason to doubt a patient who comes to the consultation suffering from dysmenorrhea. “If we have a woman in front of us and she tells you that pain is very important, for her it is. It is true that the grading of pain is very complicated in dysmenorrhea and in any pathology, because the pain threshold is highly variable, but it is true that there are pains (period) that are really incapacitating. It is a minimum percentage, but there are“.

Gynecologists advocate trust in patients. Although there are no general studies on the prevalence of dysmenorrhea, his experience has shown that it exists. However, in society it is common for this misunderstanding to circulate towards period pain. “On my graduation day, a teacher he gave me a taunt as if I had made up the period thing to not go to the exam”, recalls Cristina.

Among women, even, it is also common not to understand it. “When I got off, my mother I thought it was an excuse to do nothing at home, but my grandmother told her to leave me alone, that it also hurt a lot when she was young”, says Beatriz, who remembers that her grandmother told her that to calm the pain they boiled ‘the panocha’ of corn and took it as a curative remedy. Anything went as long as the cramps stopped. Fortunately, those remedies are a thing of the past.

“It must be emphasized that, although our mothers have been taught that period pain is normal, if makes you incapable of your normal activities you should consult your family doctor,” details Lucena.

In addition, to the inherited cultural component, we must add that It doesn’t hurt all women equally, since that depends on certain factors, such as the position of the uterus, having a narrow cervical orifice or suffering from some pathology, such as endometriosis. We talked about all of this in this article.

Research is missing

There is also the lack of research and the ignorance that still revolves around menstruation. An article of The confidential He denounced precisely this point and collected the testimony of Carme Valls Llobet, an endocrinologist who has verified with her own experience the little interest that the subject generates in scientific spheres. “In the section of medical teaching, very little has been said about menstruation and little related to possible alterations that the woman may have”, she sentenced at the time. In addition, the doctor confessed that on one occasion she was denied a scholarship to study that field. “They told me it was not a relevant issue“.

For now, the disabling pain around the rule has been put on the table for debate as a result of the new abortion law. It is not clear if, finally, the measure will become law, since, as El ESPAÑOL detailed, there are members of the Government who they are not entirely convinced of its viability.

It is worth recalling a study published in the journal British Medical Journal (BMJ) which concluded that “menstruation-related symptoms cause great loss of productivity and presenteeism contributes more to this than absenteeism“.

According to the research, carried out in the Netherlands with a sample of 32,748 women from the Netherlands, between the ages of 15 and 45, only 13.8% of women were absent from their post from work due to period pain. 80.3% went to him. “The mean number of productive days lost per year due to presenteeism was seven times greater than the average number of productive days lost due to absenteeism,” the study concludes.

If you ask Cristina or Beatriz if they have ever been absent due to their menstrual pain, they say no. However, they celebrate that there is the option of being able to do so, even if they are not going to take advantage of it. “Rather than taking the drop or not, what seems good to me is let it be known that there are days when we have such a bad time that we can’t go to work. That companies take into account that, if you don’t go, it’s not because you don’t feel like it, it’s that you’re having a bad time.”

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