In March 2015, Canadian art student Rupi Kaur received a notification from Instagram informing her that a photograph on her account depicting her on her period, lying in bed with bloodied pants, was blocked for violating “community guidelines”. As Kaur pointed out, Instagram is filled “with countless photos/accounts where women … are objectified. pornified. and treated less than human”, so why was a photograph of “a source of life for our species” considered offensive?

Given the contradictory nature of the seemingly universally silenced experience of menstruation, I set out to interview ANU women on this topic.[1] I wanted to focus on the nebulous topic of period pain, and to understand how women negotiate the social and physiological implications of recurring, and sometimes debilitating pain, in addition to their treatment by medical professionals and the wider public.

I put out a call for participants in the closed ANU Women’s Department Facebook group and conducted 20 – 60 minute interviews with four women. My four interviewees – Paula, Jenny, Shannon and Danielle – felt so strongly about sharing their experiences that when I explained that I would be using pseudonyms, all four women responded that they did not care if it was attributable to their actual names.[2] As Shannon stated, she would take “any chance to talk about period pain” given the dearth of information she experienced.

Period pain[3] is estimated to affect 20 – 90 per cent of women. This absurdly wide-ranging figure alludes to the difficulty of measuring or even researching the topic, so much so that there does not even exist a clear consensus among medical practitioners and researchers on the definition of period pain. Despite the experience of period pain differing for different women, however, there are symptoms that are commonly cited. It is also important to note that symptoms of period pain are non-exhaustive, and that women rarely experience just one symptom in isolation. My interviewees described their own symptoms as including “striking pain” in the abdominal area, back pain, vomiting, diarrhoea, mood swings, immobility, heavy bleeding, and in one case, fainting.

The development of modern biomedicine has rendered certain forms of suffering – including emotional suffering – void, in that illness and discomfort that cannot be proven via test tubes, autopsies, screens or monitors are often dismissed as non-existent. What’s more, even though multitudinous symptoms are a part and parcel of period pain, my reading revealed that in medical school, young doctors-in-training are often taught that the greater the number of symptoms a patient reports, the less likely they are to be telling the truth. Instead, complaints deemed too complicated are dismissed as fictional or caused by indefinable stress.

Shannon is painfully aware that since the symptoms of period pain are “not physically showing” doctors often “don’t understand.” Shannon’s experience of period pain was so painful, in fact, that she found herself regularly exceeding the recommended daily limit of over-the-counter painkillers. Her menstrual flow was also so heavy that she felt like she was “swimming in it” and needed to change pads every two hours. She started taking the pill at 14 to escape the pain, but went off the pill at 18 due to social pressure from her friends. Since then, she has resorted to taking Panamax, as well as Panadeine, which contains codeine. As painkillers are heavily regulated, Shannon is unable to get refills on her prescriptions, so has to visit a bulk-bill doctor each time she has her period. On one particular visit to the health clinic, when Shannon complained of severe pain and clotting, her male doctor implied that it might have been due to a miscarriage. On other occasions, male doctors countered Shannon’s complaints by telling her that by their estimations she was “the epitome of good health.” Shannon later switched to a female doctor, who she found more receptive to her medical complaints.

Although the pill has offered relief for women such as Shannon, it is not an option for everyone. Paula started taking the pill in year 12 to deal with the severe period pain and clotting. However, after three months, Paula had to stop because of the side effects – feeling miserable, lethargic, unhappy, and “cry[ing] myself to sleep” – and also because it exacerbated her Turrets condition.

Given the socially taboo nature of periods, it follows that women’s experiences of period pain are similarly silenced. Women are more likely to opt for over-the-counter pain relief medication which may not even work, and to practice self-management strategies instead of seeing a doctor – and if they do seek medical attention, often feel they’re not being taken seriously. The delegimisation of women’s pain and suffering is reinforced by an array of people – doctors, boyfriends, and even mothers and other women – ultimately conditioning women to think of their pain as natural and their suffering as isolated. Shannon spoke with frustration about her boyfriend’s inability and unwillingness to empathise with her. On the occasions she expressed her pain to him, he responded that because in past periods she “didn’t die [and] made it through” that she could “handle it”. He also asked: “Aren’t you used to it by now?”

Discussing period pain with other women may also inadvertently normalise the pain, in that the sheer commonality of period pain, in conjunction with public silencing, condition women to think of period pain as a non-medical issue and simply part of being a woman. For example, although Jenny had experienced period pain to the point where she had to miss work, she did not seek medical attention, instead thinking that the pain was “just how it was” and that “it’s not a medical problem, everyone gets it.” Jenny’s mother works in the medical field as a nurse, and refers to periods by other names. Jenny recalls hearing her mother refer a period as being in the “red tent”, and that when her grandmother went shopping she would write “chocies” (short for chocolate) on her shopping list as a pseudonym for sanitary pads. The themes of shame and stigma present in my interviews were disturbingly similar to the studies I came across in my reading, some of which were with women born in the 1940s.

At the level of scientific research, medical researchers tend to adopt a silver-bullet approach to finding solutions to period pain. Numerous studies have been conducted, but each primarily focuses on isolating and testing one product to assess its potential in alleviating pain. In surveying scientific literature and interviewing my subjects, however, I found that women employ a myriad of strategies to alleviate period pain, including: over-the-counter drugs like Codeine, Ibuprofen, Naprogesic and Ponstan; the pill; alternative medicines, such as acupuncture, naturopathy, herbal supplements; home-remedi­es, like hot-water bottles, heating pads, hot baths, compression socks; dietary changes; intrauterine devices (IUDs); and trying to avoid stressful environments.

Over-the-counter drugs are perhaps the quickest and easiest way to deal with period pain, but can have alarming side-effects and unintended consequences. In 2007, two doctors wrote to the British Medical Journal to raise an alarm over the abuse of over-the-counter painkillers, citing menstrual cramps as one of the ways in which patients begin their spiral into addiction.

There are, however, concrete and tangible ways to reduce women’s suffering during their periods. Instead of seeking answers to period pain strictly from within biomedicine, we must examine biomedicine within its social embeddedness, which assumes and exacerbates existing tensions, to also address the ‘non-medical’ issues that contribute to women’s suffering. Advocating for better and more comprehensive treatment for period pain is thus not simply a medical issue, but one which requires a strategic and political reframing of the menstrual cycle to an integrated and valid part of a woman’s total life. In other words, we need concerted and consistent efforts to expand the view whereby women are reduced to their reproductive ability. This essentialised notion of womanhood as defined by the experience of menstrual pain and suffering has meant attitudes on period pain have remained largely stagnant for the past 30 years. The non-exhaustive list below offers potential strategies that serve as possible steps toward addressing women’s period pain.

Infrastructure: On the most basic level, adequate service provision in the form of bathrooms needs to be taken seriously. My reading has revealed that while faecal and urinary matters are sometimes discussed within the context of human waste, menstruation is rarely considered an issue worth discussing. This has resulted in women being less accommodated for with fewer facilities than men, despite their need arguably being greater. Women in general are provided less equitable services and suffer disproportionately when public toilets are not available or closed – my reading even revealed a correlation between health referrals for urinary tract infections, distended bladders and a range of other uro-gynaecological problems with public toilet closures. As mentioned earlier, some of my interviewees who faced heavy flows during their periods need to change pads every two hours to keep blood from leaking onto their clothes, so unobstructed access to bathrooms is essential. Ultimately, ‘gender-blind’ approaches to research, city planning, and architecture inadvertently obscure the differentiated needs of women and reinforce the taboo nature of women’s health issues.  

Couples therapy and alternative medicines: Some studies reassert periods into the web of social relations by conducting randomised control trials to show that therapy – especially for heterosexual couples – can help to reduce PMS. In addition, a study on acupuncture emphasised the need for empathetic medical providers that listen to their patients. These methods may not provide the silver bullet that is biomedical research is so often predicated on, but they serve to counter the ultimately dehumanising nature of biomedicine.

Pop culture and art: Societal change requires both legislative and cultural transformations, and art is one powerful vehicle for changing public attitudes. Artists and activists – such as Rupi Kaur and Kiran Gandhi – audaciously counter the taboo surrounding menstruation and period pain that justifies the policing of women’s bodies, and the shame that women learn to internalise. By showing periods as they are, they uncover the way in which social meaning is embedded in biomedical categories.

Paid menstruation leave: The Victorian Women’s Trust announced in May 2017 that they would begin to offer paid leave for staff who were experiencing severe period pain. Critics of the policy point to the way menstrual leave could be used to undermine women’s ability to perform at work at the same level as men and ossify gender differences, whereas proponents argue that menstruation leave recognises the lived experiences of women and that women should not need to act like men to succeed in the workplace. These arguments point to the unresolved tensions between second- and third-wave feminism and are unlikely to be resolved soon. Even in countries such as Japan, where period leave has been in place for decades, the debate is far from over, and this topic deserves much further research and scrutiny.

Ultimately, the treatment of women’s pain is informed by the complex and intersecting dynamics of biomedicine, gender and culture, and there are no easy solutions. The small and diverse strategies listed above may not dismantle patriarchal gender norms overnight, but they offer some concrete and non-exhaustive ways of addressing women’s period pain, while recognising the crucial social-cultural dimensions of their treatment in biomedicine. Given the ways in which the biomedical approach seeks to make the social invisible and keep sickness inside the individual, it is through research, writing and open discussions that we can shine a spotlight on and dismantle the harmful and pervasive gender stereotypes hidden within medicine.

[1] Although I focus on those who identify as women in this essay, it is important to note that periods and period pain is also experienced by those who do not identify as women, and that not all those who identify as women experience periods and period pain.

[2] Please note that despite respondents stating that they do not mind attribution, I have adhered to using pseudonyms to protect respondents’ anonymity throughout this piece.

[3] While widespread gynaecological conditions such as endometriosis and uterine fibroids share commonalities in terms of stigmatisation and women’s reluctance to seek medical help, delving into diagnosed medical conditions and the minutiae of the menstrual process are outside the scope of this piece.