Many people don't realize that severe period pain isn't normal. While some discomfort during menstruation is common, pain that interferes with daily life can be a sign of an underlying condition that needs medical attention . The medical term for painful periods is dysmenorrhea, and it comes in two forms. Primary dysmenorrhea refers to menstrual cramps with no underlying cause, and the pain typically subsides within a few days. Secondary dysmenorrhea, however, is caused by a condition or infection in the reproductive organs. Pain from secondary dysmenorrhea begins earlier in the menstrual cycle, lasts longer, and may actually worsen as the period progresses .
Several conditions can cause abnormal period pain, including:
Adenomyosis: Tissue that normally lines the uterus grows into the muscle wall, causing the uterus to expand to two or three times its normal size .
Endometriosis: Tissue similar to the uterine lining grows in other parts of the body, such as the fallopian tubes or ovaries .
Pelvic inflammatory disease (PID): A bacterial infection that starts in the uterus and can spread to other reproductive organs .
Severe menstrual pain that is unbearable is a sign that something is wrong. According to experts, symptoms that require medical attention include pain so severe that painkillers are necessary or stronger medication is required, pain that lasts more days than usual (including pain before, during, and after the period), chronic pain that intensifies during menstruation, pain during sexual intercourse, and accompanying symptoms like blood in urine or stool during menstruation .
The Heavy Bleeding Warning
Heavy menstrual bleeding (HMB) is another symptom that's often dismissed. According to a guideline published by the College of Obstetricians and Gynaecologists, Academy of Medicine, Singapore, an estimated one in ten to one in 20 women suffer from HMB .
Signs of heavy menstrual bleeding include changing a sanitary pad or tampon more than once an hour for several hours in a row, getting up at night to change pads or tampons, bleeding for more than a week, passing large clots frequently, and experiencing excessive flow that soaks through pads and causes leakage onto clothing or bedding . Heavy menstrual bleeding can lead to significant blood loss, resulting in iron-deficiency anaemia, which, if left untreated, can cause life-threatening complications such as heart attacks, strokes, fainting, or falls .
Why Women Don't Seek Help
The silence around menstrual health isn't accidental. It's cultural. It's taught. And it's dangerous.
Dr. Aziza Sesay, a GP and women's health champion with the Royal College of General Practitioners, describes the problem clearly: "We don't talk about what's normal and what's not. So people assume suffering is just part of being a woman" . That silence has consequences: heavy menstrual bleeding dismissed as routine, iron-deficiency anaemia overlooked, and conditions such as fibroids, endometriosis, and adenomyosis diagnosed later than necessary .
The stigma starts early. In many communities, menstruation is treated as something shameful or dirty. Dr. Sesay notes that she avoids terms like "sanitary towels" and "menstrual hygiene" because "the word 'sanitary' implies that periods are dirty. They're not" . She reframes menstruation as a biological process rather than a hygiene issue, explaining that "periods are the shedding of the uterine lining when pregnancy hasn't occurred. They're part of the cycle of life. But when we frame them as unclean, we reinforce shame" .
What Needs to Change
Ana's death is a tragic reminder that menstrual health is not a luxury—it's a necessity. Experts are calling for systemic changes to improve menstrual health literacy and reduce stigma.
Better education. Health literacy around menstruation remains low. A systematic review of adult women's knowledge of reproductive and menstrual health found that correct knowledge scores ranged from just 35.6% to 57.3% across studies . Women were only 58.9% correct at identifying menstrual cycle length and 44.6% correct at identifying the duration of menstruation . Better education can empower women to understand what's normal and when to seek help.
Less stigma. The silence around menstrual health must be broken. Healthcare professionals are encouraged to use precise terminology and discuss periods as a normal biological process . Women and girls deserve to ask questions, share symptoms, and seek care without shame.
Earlier diagnosis. Late diagnosis of conditions like endometriosis and fibroids is a preventable problem. Early intervention can prevent complications associated with heavy menstrual bleeding and severe iron-deficiency anaemia .
Frequently Asked Questions
Is it normal to have severe period pain?
No. While some pain during periods is common, pain that disrupts your daily life or requires strong painkillers is not normal. It may be a sign of an underlying condition like endometriosis, fibroids, or adenomyosis .
How much bleeding is too much during a period?
If you need to change your pad or tampon more than once an hour for several hours, bleed for more than a week, or pass large clots frequently, you should consult a healthcare provider .
What conditions can cause severe period pain?
Conditions that can cause severe period pain include endometriosis, adenomyosis, fibroids, and pelvic inflammatory disease (PID) .
Why don't women seek help for menstrual symptoms?
Shame, stigma, embarrassment, and lack of knowledge often prevent women from seeking help. Many women grow up believing that suffering is just part of being a woman .
What should I do if I'm worried about my menstrual symptoms?
Talk to a healthcare provider. Be honest about your symptoms, and don't be afraid to ask questions. If you feel dismissed, seek a second opinion. Your health matters.
A Final, Honest Thought
Ana's death didn't have to happen. And that's the worst part. She was young. She was healthy. And she died because something went wrong with her body—something that might have been caught if she had known what to look for, if she hadn't been told her pain was normal, if she hadn't been afraid to speak up.
Her story is a tragedy. But it's also a warning.
To every woman reading this: your body is not a burden. Your pain is not imaginary. And your period is not supposed to make you miserable.
Trust yourself. Speak up. Ask questions. And if a doctor dismisses you, find one who won't. Because your health is too important to stay silent about.
Ana didn't have that chance. We owe it to her to make sure other women do.
Have you ever experienced menstrual symptoms that were dismissed by a doctor or family member? What helped you finally get the care you needed? Share your story in the comments—we need to break the silence together. 🩸
