Dysmenorrhea: When period pain isn't just pain

Dysmenorrhea: When period pain isn't just pain (Photo: iStock) When Sheila got her first period at twelve, she thought the pain would get better with time. It didn't. Every month came with violent cramps, waves of nausea, dizziness and bouts of vomiting that left her curled up in bed, missing school, exams and eventually even work. Once, she collapsed at a matatu stage. "I thought I was dying," she says. "But everyone kept telling me it was normal. That I just needed to be strong." For years, she believed them. Like many girls and women, Sheila had internalised the idea that menstrual pain was simply part of being female, unpleasant, but expected. She tried painkillers, hot water bottles, herbal teas and even fasting. Nothing worked. It wasn't until she was 24 that a gynaecologist finally gave her pain a name: endometriosis. According to Dr Victoria Nelima, a Nairobi-based obstetrician-gynaecologist, many of her patients come in after enduring years of intense pain that's been dismissed as normal. "Painful periods, medically known as dysmenorrhea, are one of the most common yet under-discussed experiences among women and girls," she explains. "For some, the discomfort is mild and manageable, lasting a day or two. But for others, it can be so severe that it disrupts daily life, causing nausea, vomiting, fatigue and even fainting." Dr Nelima says dysmenorrhea falls into two categories: primary, which refers to regular menstrual cramps not linked to any other health issue and secondary, which is usually a sign of an underlying condition. "Secondary dysmenorrhea is often caused by things like endometriosis, fibroids, polycystic ovarian syndrome (PCOS), adenomyosis, or pelvic inflammatory disease (PID)," she says. "The pain tends to be more intense, starts earlier in the cycle and can last longer than ordinary cramps. The tragedy is that many women suffer silently for years because society has normalised their pain and failed to teach them that this is not how it's supposed to be." In Kenya and many parts of the world, excruciating menstrual pain is brushed off as "just part of being a woman." But for women like Sheila, it is not just discomfort. It's debilitating. It's isolating. And it's grossly underdiagnosed. Agnes, now 30, remembers being laughed at by her school nurse after collapsing from cramps in Form Two. "She told me to stop being soft, that real women work through it," she recalls. A decade later, after struggling with heavy bleeding, bloating and chronic pain, Agnes discovered she had multiple fibroids pressing against her uterus. This culture of minimising women's pain has real consequences. Studies show it can take up to seven to ten years for endometriosis to be diagnosed and that's in countries with strong healthcare systems. In Kenya, where access to specialised gynaecological care is limited and expensive, the wait is often longer. Many women are treated for stomach ulcers or stress long before anyone considers a reproductive health condition. Dr Nelima says many of her patients come in when symptoms have become unbearable; some are unable to have children, others are dealing with anxiety, depression, or even job loss. "We should not wait until women are bleeding out at work or collapsing in public to take them seriously," she says. "Pain is the body's way of telling us something is wrong." But even as science evolves, society lags. Menstrual pain remains a taboo topic, something girls are taught to hide or endure. Reproductive health is still poorly covered in many school curricula, with little to no mention of conditions like PCOS or endometriosis. As a result, many girls go through adolescence and adulthood, believing that debilitating pain is normal. The language we use around menstruation matters. Terms like "Aunt Flo" and "that time of the month" might be light-hearted, but they also contribute to a culture of secrecy. When girls are told to keep their periods quiet, they often keep their pain quiet too. Social stigma also makes it harder to speak up. Sheila remembers an aunt suggesting prayer and deliverance when she tried to open up about her periods. Another friend was told by her church elder that period pain was a punishment for Eve's original sin. "You learn to suffer quietly," Sheila says. "And to question your own sanity." The economic cost of menstrual disorders is rarely discussed. Women with chronic pain often miss school, university lectures, work days and promotions. They spend thousands on painkillers, doctor visits, ultrasounds, hormonal treatments and in some cases, surgery. Yet there are no subsidies or structured support systems for menstrual health in most public health facilities. Treatment is not one-size-fits-all. Some women find relief with hormonal therapies or minimally invasive surgery. Others turn to dietary changes, acupuncture, yoga, or support groups. What matters most, Dr Nelima emphasises, is giving women real options and believing them when they say they're in pain. "There is no medal for enduring pain," she says. "We need to normalise seeking help and challenging the idea that suffering is a rite of passage for women." If you are experiencing severe period pain, try tracking your symptoms consistently and talk to a specialist, not just a general doctor. Ask for specific tests: pelvic ultrasound, hormonal panels, or laparoscopy if needed. And try joining a support group or online forum for guidance.

Dysmenorrhea: When period pain isn't just pain

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