Speaker 1: Hi Taboo Science listeners. This show is still on Hiatus.
Speaker 1: I'm brewing up some ideas for a new season as
Speaker 1: we speak, but for now, I wanted to turn you
Speaker 1: on to another show you might like. It's called Cramped.
Speaker 1: It's an investigative podcast that answers the question why are
Speaker 1: so many people with uteruses in unexplained and untreated pain.
Speaker 1: It's hosted by Kate Helen Downeye, who experiences this pain herself.
Speaker 1: It's something called severe dysminerihea, which sounds very official until
Speaker 1: you find out it just means really painful periods. Throughout
Speaker 1: the season, Kate interviews experts and other uterus has to
Speaker 1: get to the bottom of what causes this debilitating pain
Speaker 1: and how she and others might find relief. Spoiler alert,
Speaker 1: she does get a diagnosis, so look forward to that.
Speaker 1: I absolutely love this podcast and I think you will too,
Speaker 1: So without further ado, here's the first episode.
Speaker 2: Enjoy.
Speaker 3: When I say I get really bad cramps. What does
Speaker 3: that look like to you? Maybe you get a picture
Speaker 3: in your head from a TV show or a movie. Oh,
Speaker 3: my period, You're all fired. Maybe you think of the
Speaker 3: stock image that pops up if you google image search
Speaker 3: period cramps. A young, thin, white woman sitting bent over
Speaker 3: on a couch and wincing, wearing jeans. For some reason,
Speaker 3: maybe you're like me, and you know this twisting, horrific
Speaker 3: pain that comes in waves and just doesn't stop. Maybe
Speaker 3: you know what it's like to spend a day or
Speaker 3: two dead to the world outside the bathroom floor. Unless
Speaker 3: you personally have experienced this pain, or you are very
Speaker 3: close to someone who does experience it, like close enough
Speaker 3: to actually see with your eyes what it does to them,
Speaker 3: you're probably thinking this is not a big deal. This
Speaker 3: is cramps. Everybody gets cramps. Respectfully, buckle up. I want
Speaker 3: to tell you about just one of the times my
Speaker 3: cramps really fucked up my life. And this probably goes
Speaker 3: without saying since this is a podcast explicitly about period cramps.
Speaker 3: But this episode has graphic descriptions of menstruation, blood, and
Speaker 3: other bodily functions. So if that doesn't work for you,
Speaker 3: that's fine, just this is not the podcast for you.
Speaker 3: It's the Lunch Rush at Upstairs on the Square in
Speaker 3: Harvard Square and Cambridge. It's kind of a manic Pixie
Speaker 3: dream restaurant. It's got pink walls and zebra striped banquettes,
Speaker 3: but also old school wood. The waiters wear black pants
Speaker 3: and crisp white button downs and fun ties. I'm twenty two,
Speaker 3: and this is by far the fanciest and best paying
Speaker 3: waitressing job I'd ever had in my short career. I
Speaker 3: barely absorbed any of the wine training, and I still
Speaker 3: don't remember which fork goes where in the place settings.
Speaker 3: We are slammed, and I am at the pos system,
Speaker 3: putting in entree orders for my big table, sweating and
Speaker 3: desperately trying to remember if the guy with a mustache
Speaker 3: wanted a Caesar or a Vinaigret dressing. When I realized
Speaker 3: something that makes my heart stop. I have cramps. I
Speaker 3: have been focusing on getting all the details right on
Speaker 3: lunch service so I can have one day where the
Speaker 3: chef doesn't yell at me, and I missed the crucial
Speaker 3: early signs that dull backache and upset stomach chills. And
Speaker 3: these aren't just regular cramps. The pain in my belly
Speaker 3: that I just felt means I'm about to have what
Speaker 3: I call death cramps, and there's nothing I can do
Speaker 3: about it. It's too late for ibuprofen. I realize that
Speaker 3: the layer of sweat over my whole body right now
Speaker 3: isn't because I've been hustling between my tables. It's because
Speaker 3: I'm starting to have a full body reaction to whatever
Speaker 3: my uterus is doing. The pressure in my gut isn't
Speaker 3: because I chugged an entire pint of diet coke during
Speaker 3: service prep. It's because I'm going to start throwing up
Speaker 3: any second now. The weakness I'm feeling in my legs
Speaker 3: isn't because these dance coat clogs are so bad for
Speaker 3: climbing the stairs to the second floor dining room. It's
Speaker 3: because I'm going to pass out from the pain shortly
Speaker 3: after I throw up. And I have four tables at
Speaker 3: varying stages of fancy multi course lunches, drinks up at
Speaker 3: the bar, and special requests to verbalize to the kitchen
Speaker 3: that they are probably not going to appreciate, and four
Speaker 3: seasoned waiters who already treat me like an annoying little sister.
Speaker 3: But unless I want to throw up on the quirky
Speaker 3: polka dot rug, I don't have a choice. I find
Speaker 3: the waiter who has been the nicest to me, even
Speaker 3: though I know it's because he's going to try to
Speaker 3: sleep with me, and I say very quickly, I'm sick.
Speaker 3: I'm so sorry. Can you please cover my tables? A
Speaker 3: fourteen wants no dairy any taliatel? Can you tell the kitchen.
Speaker 3: I'm so sorry, it's an emergency, and I lock myself
Speaker 3: in the employee bathroom. I take off my stupid white
Speaker 3: button down and my black dress pants and I hang
Speaker 3: them up on the coat hook so they won't get
Speaker 3: drenched in sweat, and I kneel in front of the
Speaker 3: toilet just as the heaving starts, knowing I'm in for
Speaker 3: between one and six hours of hell. I come back
Speaker 3: to consciousness on the floor of the employee bathroom because
Speaker 3: someone is pounding on the door and yelling my name.
Speaker 3: I'm groggy, but the cramps have stopped, as have the
Speaker 3: alternating waves of vomiting and diarrhea. I say, I'm okay, sorry,
Speaker 3: coming out in a second, just so they'll stop making noise.
Speaker 3: I sit up and behind me on the bathroom floor,
Speaker 3: there's a perfect outline of my body in sweat. My
Speaker 3: hair is soaked, my muscles are rubbery as I stand up,
Speaker 3: my abs and my back are sore from all the puking,
Speaker 3: and my forearms are sore, and I know i'll have
Speaker 3: bruises tomorrow from where I leaned too hard on the
Speaker 3: edge of the toilet. But I feel the kind of
Speaker 3: amazing that you only feel when intense pain has finally
Speaker 3: gone away. I am so relieved to not be in
Speaker 3: that nightmare of pain anymore. I don't have my phone
Speaker 3: on me, and there's no window, so I have no
Speaker 3: idea how long I've been locked in the only employee bathroom.
Speaker 3: My first feeling is guilt that a bunch of waiters
Speaker 3: picked up my slack while holding their pee, and then
Speaker 3: embarrassment that so many people know I was locked in
Speaker 3: the bathroom for hours. I wonder if they all think
Speaker 3: I was doing drugs in here, and if that will
Speaker 3: make me cooler or less cool in their eyes. I
Speaker 3: put my pants and my white button down back on,
Speaker 3: which is hard because I'm so sweaty. It's like trying
Speaker 3: to put your clothes back on after getting out of
Speaker 3: the ocean. I come out and the manager, who's a woman,
Speaker 3: is standing there. She's definitely concerned, but I can also
Speaker 3: see a look of annoyance and impatience, like right behind
Speaker 3: the concern, I am immediately in smooth it over mode.
Speaker 3: I'm so sorry I was having an emergency. Uh no,
Speaker 3: I don't need you to call an ambulance. Everything's okay now.
Speaker 3: I'm so sorry it happened at work. I really appreciate
Speaker 3: everyone covering for me. I'm okay now. I said whatever
Speaker 3: I needed to say in order to keep my job.
Speaker 3: Take two buses back to my apartment, and sleep for
Speaker 3: the next twelve hours. Since I was fourteen, I've never
Speaker 3: known why I am in so much pain when I
Speaker 3: get my period. I've never had a diagnosis, and I've
Speaker 3: never really found a treatment that helps. This podcast is
Speaker 3: my search for answers to some of the most basic
Speaker 3: questions about my body.
Speaker 4: Morning sickness and the materiosis, menopause, migraines, b CEO, that's
Speaker 4: happening to your body?
Speaker 2: We don't know because we've.
Speaker 4: Never really studied the female body, so it's all in
Speaker 4: my head when the research is quite sunny. No, we
Speaker 4: never really studied the female.
Speaker 2: Buddy, I go to the doctor to get dismissed.
Speaker 5: Try to losing weight.
Speaker 6: You're just anxious.
Speaker 2: That's my medical I'm not pissed.
Speaker 4: Just wait ten years for a diagnosis. Psychosomatic you're so dramatic, hysterical, emotional, hormonal, eerotic,
Speaker 4: heart disease, chronic fatigue, depression, and anxiety.
Speaker 2: Do you have pain?
Speaker 4: No, you don't.
Speaker 2: You've never really studied the female fund.
Speaker 3: Hi. I'm Kate, and that's what it's like when I
Speaker 3: have death cramps. At least that's what I've always called them,
Speaker 3: because really bad cramps didn't quite do them justice. Now
Speaker 3: I know that the medical term for really bad cramps
Speaker 3: is dismnareea. It's happened to me since I was fourteen,
Speaker 3: right after getting my period, but it's not what I
Speaker 3: experience every single month. Sometimes I just have your basic
Speaker 3: run of the mill cramps, which also suck, by the way,
Speaker 3: but they don't ruin my life. Sometimes it escalates into
Speaker 3: death cramps, and sometimes it doesn't, with no pattern or
Speaker 3: trigger that I have ever been able to identify, which
Speaker 3: is just a super fun game of chicken to play
Speaker 3: with your uterus twelve times a year for twenty plus years.
Speaker 3: So I just said that the medical term for my
Speaker 3: death cramps is dysmenoriea, but that's not exactly accurate. The
Speaker 3: term dismenoreea comes from Greek dis meaning difficult, painful or
Speaker 3: abnormal meno meaning month and rhea meaning flow, so literally
Speaker 3: painful monthly flow. So dos menarea can mean any pain
Speaker 3: you have related to your period, like quote unquote normal cramps,
Speaker 3: and then sometimes people will use it to describe severe
Speaker 3: or abnormal amounts of pain related to your period, like
Speaker 3: my death cramps, and sometimes doctors will use the term
Speaker 3: severe dismnerya for a death cramps kind of pain. How
Speaker 3: someone uses the term mostly comes down to what they
Speaker 3: consider a normal amount of period pain, and there's no
Speaker 3: real consensus for that because we just don't talk about
Speaker 3: it enough to have a sense of normal. Now, aside
Speaker 3: from this mysterious period pain, I am pretty much healthy
Speaker 3: across the board, and not to brag. And my mother
Speaker 3: never experienced this level of pain with her period, so obviously,
Speaker 3: after the first time I experienced this insane pain, we
Speaker 3: went to a doctor. I expected some answers that would
Speaker 3: make this pain make sense, like I had appendicitis or
Speaker 3: some kind of horrible infection. It's kind of rooting for
Speaker 3: horrible infection, you know that, doctor, I am not kidding.
Speaker 3: You told me. Yeah, some women get painful, but they
Speaker 3: usually go away when you have your first baby, which
Speaker 3: is such an unhelpful thing to say to a fourteen
Speaker 3: year old. Over the last twenty two years, in many
Speaker 3: different cities, with many different insurances, after many ultrasounds and
Speaker 3: tests to rule out the obvious potential causes, I have
Speaker 3: never gotten answers or a diagnosis. For a long time,
Speaker 3: I didn't talk to people about my death cramps. The
Speaker 3: reactions I got from my parents, the school nurses, and
Speaker 3: my doctors early on all communicated to me that this
Speaker 3: was just some freak thing my weird body was doing,
Speaker 3: that they didn't know anything about this, that they had
Speaker 3: never heard of this happening to someone. I didn't talk
Speaker 3: about it because I was afraid of it, and I
Speaker 3: was embarrassed about it, and I was ashamed that my
Speaker 3: body didn't work right. It was so scary to be
Speaker 3: in the worst pain I'd ever been in in my
Speaker 3: life but not know why, and have doctors not know
Speaker 3: why that I just tried to forget about it every
Speaker 3: time it happen. And when I finally started talking to
Speaker 3: more people about my death cramps, I was shocked at
Speaker 3: how many times someone would say, oh my god, yeah,
Speaker 3: I get those two. Oh my god. I thought I
Speaker 3: was the only one men who would say. I had
Speaker 3: a girlfriend who had that. She never knew what it was,
Speaker 3: but it was scary. I couldn't believe all these people
Speaker 3: had somehow also been experiencing the same thing and we
Speaker 3: just never talked about it. How could it be true
Speaker 3: that so many people experience this and yet doctors just
Speaker 3: shrug at me when I ask them about this, like
Speaker 3: they never heard of it. How can all these people
Speaker 3: be dealing with this intense pain but there isn't a
Speaker 3: real treatment for it. Looking back, I understand how naive
Speaker 3: this thought was. To be shocked and confused about why
Speaker 3: a system doesn't help you means that up until that moment,
Speaker 3: the system did help you. I know now that as
Speaker 3: a generally healthy, CIS white woman, I have enormous privilege
Speaker 3: within a system like our healthcare system in a country
Speaker 3: like the US. This disbelief and confusion I felt when
Speaker 3: I realized there were other people experiencing this pain but
Speaker 3: it was ignored and dismissed by doctors. That confusion was
Speaker 3: a privileged person encountering discrimination for the first time and
Speaker 3: having a lot of cognitive dissonance about it. I know
Speaker 3: more now about the experiences of others who have less
Speaker 3: privileged than me, and the experiences of people who have
Speaker 3: more privilege than me in the medical system, but I
Speaker 3: still don't understand exactly why I haven't been able to
Speaker 3: get a diagnosis. I'm doing this podcast because I want answers,
Speaker 3: and if I'm being honest, I want an excuse to
Speaker 3: sit some doctors down and not let them leave until
Speaker 3: they tell me something real. I don't want other people
Speaker 3: who experienced his Manaea to feel isolated like I did,
Speaker 3: to feel like their bodies are wrong or weird, to
Speaker 3: feel like they just have to find a way to
Speaker 3: tolerate it, that there's no help for them. I want
Speaker 3: to get these answers for myself, and then I want
Speaker 3: to share them with anyone else looking for answers, or
Speaker 3: at the very least, I want to understand why I
Speaker 3: can have these answers and what would have to change
Speaker 3: for me to get them. My first and most obvious
Speaker 3: question is what even are cramps. I know that the
Speaker 3: uterus has muscles, and when it needs to squeeze the
Speaker 3: blood out because a fertilized egg has not shown up
Speaker 3: to grow into a baby, the muscles contract, But what
Speaker 3: makes the muscles contract and why does it hurt so much?
Speaker 3: After reading a bunch of medical papers and googling a
Speaker 3: lot of medical definitions, here's how it works. Hormones run
Speaker 3: the show when it comes to periods duh. After an
Speaker 3: egg is released from an ovary ovulation, the ovary makes
Speaker 3: a hormone called progesterone. Progesterone signals to the lining of
Speaker 3: the uterus that it has to thicken up and prepare
Speaker 3: to house of fetus. If a fertilized egg doesn't show up,
Speaker 3: the ovary stops making progesterone, basically saying never mind. This
Speaker 3: drop in progesterone signals a new player to show up
Speaker 3: on the scene. Prostaglandins. I had never heard of prostaglandins
Speaker 3: before I started doing my recent but they are huge
Speaker 3: players in the period paying games. Prostaglandins aren't officially a hormone,
Speaker 3: but they also do a lot of signaling. Their job
Speaker 3: across the whole body is to show up when there's
Speaker 3: an injury or damage bind to the prostaglandin receptors and
Speaker 3: trigger reactions. So we've got progesterone dipping, prostaglandin's getting released
Speaker 3: into the bloodstream. Those prostaglandins then hurry over to the uterus.
Speaker 3: They bind with the prostaglandin receptors in the muscle, and
Speaker 3: they tell the muscle to contract or squeeze. That squeezing
Speaker 3: is what pushes out the blood and tissue that's been
Speaker 3: building up in the uterus ever since ovulation. Without that
Speaker 3: muscle contracting, there wouldn't be a way to clear out
Speaker 3: the uterus. So it can try again next month. So
Speaker 3: there's nothing wrong with prostaglandins making the uterus contract. That's
Speaker 3: everything going according to plan. And because that muscle is
Speaker 3: contracting and working hard, some mild aching and soreness can happen,
Speaker 3: just like if any muscle is working hard. But sometimes
Speaker 3: for some people things start to go off the rails.
Speaker 3: Too many prostaglandins might get released, and they're all screaming
Speaker 3: at the muscle of the uterus to cramp, cramp, cramp,
Speaker 3: and so instead of squeezing and releasing like normal, the
Speaker 3: muscle just squeezes and squeezes and squeezes until the muscle
Speaker 3: is so constricted that the blood vessels can't get fresh
Speaker 3: oxygenated blood to parts of the muscle. Muscle cells will
Speaker 3: die if they can't get oxygen, so they really want
Speaker 3: to bring attention to this problem by causing pain. This
Speaker 3: is called ischemia, and it hurts like a motherfucker no
Speaker 3: matter where it happens in your body. When it happens
Speaker 3: in other muscles, it's called a Charlie horse. This is
Speaker 3: actually a useful pain, or what medicine calls adaptive pain.
Speaker 3: If you can shift positions to increase blood flow or
Speaker 3: like shake out the cramp, that helps get more oxygen
Speaker 3: to the spot that needs it. But when it's happening
Speaker 3: in your uterus, you can't do much about that. Prostaglandins
Speaker 3: are also responsible for period poops because when they flood
Speaker 3: into the bloodstream at super high levels, they don't stop
Speaker 3: at the uterus. They also bind with receptors in the colon,
Speaker 3: and they make the muscles in your colon contract too.
Speaker 3: Same deal for vomiting. For those lucky individuals who sometimes
Speaker 3: throw up when we get cramps, those prostaglandins are binding
Speaker 3: with receptors in our stomach muscles and causing a vomiting reaction.
Speaker 3: Fun staff. One more thing about prostaglandins, the reason ibuprofen
Speaker 3: and other n sids or non steroidal anti inflammatory medications
Speaker 3: can be so helpful for period cramps is that they
Speaker 3: can lower the amount of prostaglandins you produce. They also
Speaker 3: bind with the proseaclanin receptors, blocking the prostaglandins from signaling
Speaker 3: to the muscles to cramp. They are the heroes of
Speaker 3: this story. But this is the first of many times
Speaker 3: in my research my mind got blown. I've been taking
Speaker 3: hyboprofen wrong my whole life. I've always taken it when
Speaker 3: I feel my cramps starting. It hurts, so you take
Speaker 3: the medicine to make it stop hurting. Right In the
Speaker 3: case of cramps and iberprofen wrong. If you take hyberprofin
Speaker 3: after your cramps have already started, you're kind of too late.
Speaker 3: The prostaglandins are already swimming around in your bloodstream and
Speaker 3: binding with receptors. The key is to take the hyberprofen
Speaker 3: before your period is even supposed to start. And yeah,
Speaker 3: that means tracking your period and starting to pop a
Speaker 3: few iboprofen forty eight hours before you expect to get
Speaker 3: your period. That way, the iberprofen is already binding to
Speaker 3: those receptors and reducing prostaglanin production before it even starts.
Speaker 3: And sure, if the cramps aren't too bad, you can
Speaker 3: probably just deal with the discomfort until the hyperprofen kicks
Speaker 3: in aka catches up to the prostaglandins and the receptors.
Speaker 3: But if you're like me, taking the hyberprofen after cramps
Speaker 3: have already started might be too late. There might already
Speaker 3: be enough prostaglandins in your bloodstream binding to receptors to
Speaker 3: cause vomiting, which means you can't keep any more meds down.
Speaker 3: So for me, taking iyberprofin prophylactically or before I need
Speaker 3: it is a huge life stay. And just a quick
Speaker 3: disclaimer here, I am not a doctor. I'm just a
Speaker 3: research nerd with a microphone and a uterus telling you
Speaker 3: things I learned. This is not medical advice. So prostaglandins
Speaker 3: cause cramps and Iberprofen blocks prostaglandins. Oh my god, I
Speaker 3: think we did it, you guys. Medical mystery solved. Yeah,
Speaker 3: that'd be great. If the answer for all severe period
Speaker 3: pain was just take iberprofen, it'd be a pretty short
Speaker 3: podcast series. Unfortunately, as helpful as Iberprofen can be, it
Speaker 3: doesn't work for everybody all the time. For some people
Speaker 3: like me, it might help sometimes and then other times
Speaker 3: do nothing at all. So how do you find out
Speaker 3: what's going on? Why do some of us produce so
Speaker 3: many prostaglandins. Why would cramps be normal some months and
Speaker 3: completely debilitating other months? These are questions I could not
Speaker 3: find the answers to in my research, so I brought
Speaker 3: in an expert. We're going to take a quick break
Speaker 3: and when we come back. I talked to doctor Karen Tang, gynecologist, author,
Speaker 3: and TikToker about what severe period pain like mine could mean.
Speaker 2: Because we've never really started a female.
Speaker 3: Fund adding welcome back to Krampt. After doing all the
Speaker 3: research I could do on my own into what's actually
Speaker 3: happening inside my body when I have death cramps, I
Speaker 3: went to an expert with my unanswered questions.
Speaker 2: I'm doctor Karen Tang, I'm a Bortzer gynecologist. I do
Speaker 2: a lot of talking and social media, and I have
Speaker 2: a book called It's Not Hysteria. Everything you Need to
Speaker 2: Know about your reproductive health. But we're never.
Speaker 3: Told when we get into the kind of severe dismentaria
Speaker 3: that I experience, where it is debilitating pain. I am
Speaker 3: throwing up every ten minutes, even though there's nothing left
Speaker 3: in my stomach, I'm having diarrhea, I'm passing out. Is
Speaker 3: that just the regular pain turned up or is something
Speaker 3: physiologically different happening inside my body?
Speaker 2: So whenever somebody's having that degree of pain, we always
Speaker 2: start to think what else could be going on? That's
Speaker 2: obviously not normal. So anytime something is affecting your ability
Speaker 2: to function, you're throwing up, you're missing work or school,
Speaker 2: we start to think, is it not just run of
Speaker 2: the mill cramps anymore? Could it be something like enemy triosis,
Speaker 2: which is probably the most common cause of really bad,
Speaker 2: painful cramps, or fibroids, add innomiosis.
Speaker 3: There's lots of underlying conditions that could cause period pain
Speaker 3: to be excruciating. Let's lay them out real quick, and
Speaker 3: just for fun, I'm going to list them in order
Speaker 3: of how easy they are to identify and get treatment for.
Speaker 3: Ovarian cysts. Ovarian cysts are little fluid filled sacs that
Speaker 3: form on your ovaries. These can be a totally normal
Speaker 3: part of ovulation, and little cysts can just go away
Speaker 3: by themselves, but if they become a problem, if they
Speaker 3: get too big or there's too many of them. It
Speaker 3: can cause ovarian torsion, which means the ovary twists, and
Speaker 3: it can rupture a fallopian tube. Ovarian cysts can also burns.
Speaker 3: It can cause fever, sharp pain, nausea. Many people mistake
Speaker 3: the feeling of an ovarian cyst rupturing for an appendix bursting.
Speaker 3: That's how much it can hurt. Cysts can usually be
Speaker 3: found on a pelvic ultrasound, so that makes it pretty
Speaker 3: easy to spot. Fibroids. Fibroids are non cancerous tumors that
Speaker 3: grow inside the uterus. They can be teeny tiny, like
Speaker 3: the size of a seed, or as big as a watermelon,
Speaker 3: which is terrifying. Some people have fibroids that don't cause
Speaker 3: any symptoms at all, and some people have fibroids that
Speaker 3: cause enormous pain. Fibroids most often cause heavy, painful periods
Speaker 3: and pelvic pain in general, but it can also cause
Speaker 3: pain in your stomach and your low back, or pain
Speaker 3: during sex. Fibroids are incredibly common. Up to seventy seven
Speaker 3: percent of people with uteruses will develop fibroids before menopause,
Speaker 3: and yet despite how common they are, we still don't
Speaker 3: know what causes them. Fibroids usually show up on a
Speaker 3: pelvic ultrasound, but you can also get an MRI or
Speaker 3: something called a hysteroscopy, which is a little camera that
Speaker 3: goes up into the uterus. They might need to do
Speaker 3: different kinds of imaging to get a good picture of it.
Speaker 3: EC topic pregnancy Okay, this one usually doesn't cause painful
Speaker 3: period cramps because you don't get your period because you're pregnant,
Speaker 3: but it does cause pain that you might mistake for
Speaker 3: period pain. An Ectopic pregnancy is when a fertilized egg
Speaker 3: implants somewhere outside the uterus, usually in the philopian tube,
Speaker 3: and starts growing. These pregnancies are non viable. The fetus
Speaker 3: cannot survive and as it grows, it will burst the
Speaker 3: filopian tube around six to eight weeks. That causes internal
Speaker 3: bleeding and that can be fatal. Weirdly, one of the
Speaker 3: things to look out for is shoulder pain because of
Speaker 3: the nerves in that area referring to the shoulder, so
Speaker 3: watch out for that. You can see an ectopic pregnancy
Speaker 3: on an ultrasound, and usually they'll also do a blood
Speaker 3: test to confirm the pregnancy. IUD issues if you have
Speaker 3: an IUD and you have unusually bad pain, either during
Speaker 3: your period or not, get to a doctor. It's very rare,
Speaker 3: but it is possible for an IUD to pierce the
Speaker 3: wall of your uterus. It's called perforation, and it's really bad.
Speaker 3: If a doctor suspects an IUD perforation, they will first
Speaker 3: do a manual exam and check for the IUD strings.
Speaker 3: If they can't find them, then they'll do an ultrasound
Speaker 3: to locate the IUD. Uterine abnormalities Okay, I didn't know
Speaker 3: this until today, but uteruses can be lots of different shapes.
Speaker 3: There's quote unquote normal uteruses, but then there's also dysmorphic,
Speaker 3: which is T shaped, bi corporeal, and septate, heart shaped
Speaker 3: or hemi sort of one sided. Usually these different shapes
Speaker 3: of the uterus don't cause problems or pain, although some
Speaker 3: shapes may make it harder to conceive, so most people
Speaker 3: with uterine abnormalities don't find out about it until they're
Speaker 3: investigating a fertility issue. But there are some abnormalities that
Speaker 3: cause period blood to be trapped inside one part of
Speaker 3: the uterus with no way to get out, and that
Speaker 3: can cause severe pain. See a uterine abnormality through an ultrasound,
Speaker 3: an MRI, or a histeroscopy, or a combination of all
Speaker 3: three PCOS or polycystic ovary syndrome. This is a condition
Speaker 3: where hormones are way out of whack. Small cysts can
Speaker 3: grow on the ovaries and produce androgens or male hormones,
Speaker 3: which cause a ton of symptoms and can either make
Speaker 3: your periods much lighter or much heavier. Hormones are fun
Speaker 3: that way, so desmenteria can be a symptom of PCOS,
Speaker 3: though it's usually paired with a lot of other symptoms
Speaker 3: like excess body hair, acne, thinning hair, dark patches of skin.
Speaker 3: PCOS is usually diagnosed with an ultrasound to look at
Speaker 3: your ovaries and check for cysts, plus a blood test
Speaker 3: to check your hormone levels. Endometriosis Endometriosis is when your
Speaker 3: endometrial tissue, which is the stuff that makes up the
Speaker 3: lining of your uterus, the thing that thickens and then
Speaker 3: comes out during your period, when that tissue grows anywhere
Speaker 3: else in your body outside your uterus. Most often it's
Speaker 3: in the pelvic cavity, like near your ovaries, or your
Speaker 3: bladder or your bowels, but there are documented cases of
Speaker 3: people having endometrial tissue in their nose, in their brain,
Speaker 3: in their lungs. Because endometrial tissue responds to hormone signals,
Speaker 3: no matter where it is or how inconvenient it would
Speaker 3: be for you to bleed there, it thickens and bleeds
Speaker 3: despite the fact that it's not inside your uterus but
Speaker 3: on your ovary or in your nose. This causes a
Speaker 3: lot of problems when it happens once a month for
Speaker 3: years and years and years. These problems are caused by inflammation,
Speaker 3: scar tissue, and something called adhesions that basically glue your
Speaker 3: organs together so they can't function normally. Endometriosi's symptoms can
Speaker 3: vary a ton from person to person because the endometrial
Speaker 3: tissue can be anywhere and the symptoms will be different
Speaker 3: depending on where the tissue is. But for obvious reasons,
Speaker 3: folks with endometriosis tend to be in the most pain
Speaker 3: around their period. A super fun fact is that endometriosis
Speaker 3: is one of the most common causes of dysmenorrhea, but
Speaker 3: it still takes a woman in the US an average
Speaker 3: of seven to ten years to be diagnosed, and that's
Speaker 3: partly because getting diagnosed requires laparoscopic surgery to look inside
Speaker 3: the abdominal cavity and visually confirm the presence of scarring
Speaker 3: or adhesions. If endometriosis is really advanced or has caused
Speaker 3: a lot of scar tissue, it might show up in
Speaker 3: an ultrasound or MRI, but just because it doesn't show
Speaker 3: up on one doesn't mean you don't have it. Adenomiosis.
Speaker 3: Adenomiosis is like endometriosis in that there is endometrial tissue
Speaker 3: that is somewhere it is not supposed to be, But
Speaker 3: with adenomiosis, the endometrial tissue is inside the muscle of
Speaker 3: the uterus rather than outside on your ovaries or bladder.
Speaker 3: A big symptom is very heavy, painful periods. Adenomiosis usually
Speaker 3: happens to people between thirty five and fifty, often people
Speaker 3: who have already given birth, especially if they've had a
Speaker 3: C section. Adenomiosis is diagnosed first with a pelvic exam,
Speaker 3: where they feel for a quote spongy enlarged uterus. Nice
Speaker 3: they might do an ultrasound to rule out fibroids, and
Speaker 3: then they might do an MRI to get a more
Speaker 3: detailed picture of how much endometrial tissue has grown into
Speaker 3: the uterine muscle. Okay, that's a lot of things that
Speaker 3: could be causing severe dysmenory ea. So how do you
Speaker 3: figure out which one it is? I asked doctor Tang
Speaker 3: what this process of getting to a diagnosis with your
Speaker 3: doctors should look like.
Speaker 2: So, in general, if someone is having really painful periods,
Speaker 2: typically what a kind of collas will do is, depending
Speaker 2: on how old they are, they might order a pelvic ultrasound.
Speaker 2: That's the easiest thing. It's a test that doesn't have radiation,
Speaker 2: there's no real harm to it. It's very easily accessible,
Speaker 2: and it gets a great look at your uterus and
Speaker 2: your ovaras just to make sure that structurally they look okay. So,
Speaker 2: fibroids do show up on imaging, so you can find
Speaker 2: those on ultrasounds very easily. Enemytross and atinmiosis are actually
Speaker 2: a lot harder to see and in fact don't typically
Speaker 2: show up on image studies until they're really fairly severe.
Speaker 2: It's not uncommon for someone who is going through an
Speaker 2: evaluation for painful periods to be told, oh, everything looks normal.
Speaker 2: Your ultrasound is completely normal. There's nothing wrong with your uterus,
Speaker 2: but you're like, but I'm still like in devastating pain
Speaker 2: and throwing up all the time.
Speaker 3: To address this pain, Doctor Tang says birth control is
Speaker 3: usually where doctors start.
Speaker 2: A lot of times, and those of you listening to
Speaker 2: this have probably been told we try birth control. The
Speaker 2: reason that we do that is that the progesterone in
Speaker 2: birth control thins the tissue that comes out like period blood,
Speaker 2: So the endimutrial tissue that's what actually comes out when
Speaker 2: you're actually bleeding. It's this tissue mixed with the blood
Speaker 2: from inside the eaters. It thins that so there's not
Speaker 2: as much to come out. In general, the more your
Speaker 2: uterus is working to try and push out blood clots,
Speaker 2: the stronger the cramps are. As well. I say, it's
Speaker 2: like you're used to trying to birth the clots. So
Speaker 2: the less bleeding, the less clots, the less usually the
Speaker 2: cramping in general. And then also you're preventing ovulation. Sometimes
Speaker 2: you can even use birth control to totally skip your periods.
Speaker 2: Nor the signal to your body to have a period
Speaker 2: is controlled by ovulation, and so if you don't release
Speaker 2: an egg, you don't start that timer. And so sometimes
Speaker 2: people can actually go. And there's different ways that we
Speaker 2: will purposely skip the periods using birth control in this way.
Speaker 2: So if we're like, you're not in pain when you're
Speaker 2: not having periods, can we take away your periods or
Speaker 2: make them much lighter to see if that helps. So
Speaker 2: that's the reason why people are usually given a birth
Speaker 2: control method as like the first line, and also because
Speaker 2: it's very common if people need contraception to prevent pregnancy anyway,
Speaker 2: they're like two birds with.
Speaker 3: Lovestone birth control that makes you not have your period.
Speaker 3: When I was growing up, which again was twenty years ago,
Speaker 3: I was told maybe not by medical professionals, but like
Speaker 3: my mother, oh, that it was dangerous, yeah, that it's
Speaker 3: unnatural to skip your period, And so I never tried that.
Speaker 3: Is there anything to that or is it fine now?
Speaker 2: It's a good question. And the reason that myth exists
Speaker 2: is because on your own, it is dangerous to not
Speaker 2: have a period if you have functioning over east. And
Speaker 2: the reason is for conditions like PCOS polycystic ovarian syndrome,
Speaker 2: they don't ovulate regularly. People with PCOS don't tend to
Speaker 2: have periods regularly. They may skip many months or even
Speaker 2: a year with no periods. The danger of that is
Speaker 2: that the tissue in your uters can build up over time,
Speaker 2: and that is actually a risk for uterine pre cancer
Speaker 2: or cancer. You can get build up of abnormal cells.
Speaker 2: And also if you skip a bunch of periods on
Speaker 2: your own, when you finally bleed, it is a nightmare.
Speaker 2: It's six months worth of periods coming out all at once.
Speaker 2: So people with pcos will sometimes bleed for weeks and
Speaker 2: weeks just like pouring out blood because there's so much
Speaker 2: stuff in the uterus that hasn't been shit. The difference
Speaker 2: when we use a per control with progesterone is that
Speaker 2: the progesterone is controlling the growth and keeping it from
Speaker 2: growing so you don't get that build up inside. So
Speaker 2: we say when we take over and we are preventing
Speaker 2: the periods or doing it in a way that you
Speaker 2: don't actually medically need to shed the tissue to clean
Speaker 2: it out, so to speak. It's keeping it from growing
Speaker 2: so it doesn't build up. So it is different, and
Speaker 2: that's where the moms and people are like, oh, it's
Speaker 2: unhealthy not have your period. That's where they get that from,
Speaker 2: is that it is unhealthy on your own, but under
Speaker 2: these circumstances, we can skip the periods safely, and that's
Speaker 2: what we do actually, or first line for people who
Speaker 2: are like the periods are miserable, they bleed so much
Speaker 2: and so much pain. If we can get rid of
Speaker 2: the periods, then that's helpful. We do that also for
Speaker 2: not just pain, but for things like crementional dysporic disorder,
Speaker 2: for severe mood symptoms right before your period, or menstrual migraines.
Speaker 2: If you get horrible migraines right before your period, it's
Speaker 2: the same idea. It's to keep those ups and downs
Speaker 2: of the hormone fluctuations from happening.
Speaker 3: Yeah, that makes total sense, and it makes me wish
Speaker 3: I had considered that more because that could have saved
Speaker 3: me years of pain. Every time I go to a
Speaker 3: doctor for my cramps, they order an ultrasound, it comes
Speaker 3: back normal and they say, well, nothing's wrong, it's just
Speaker 3: bad cramps, and they write primary dysmenorrhea in my chart.
Speaker 3: And that seems like the end of the road. At
Speaker 3: what point do you start trying to figure out is
Speaker 3: this pain being caused by something else or is this
Speaker 3: just pain caused by your period that doesn't have an
Speaker 3: underlying cause.
Speaker 2: When we say primary and secondary in gynecology, there's usually
Speaker 2: a couple things that we could mean. So primary meaning
Speaker 2: right off the bat, like this is something that you've
Speaker 2: always had. So primary dys memory, like you've always right
Speaker 2: from the second that you've had periods is just how
Speaker 2: your uters functions. That's how you experience it, as opposed
Speaker 2: to secondary meaning like time past, you were doing okay,
Speaker 2: then you started developing this later. Sometimes we'll use that
Speaker 2: expression as primary being it's just based on the uterus
Speaker 2: itself versus secondary it came from something else. So in
Speaker 2: terms of when we start to think about other issues
Speaker 2: in general, we do think about other things. If it
Speaker 2: came out of nowhere, you're like I was actually doing
Speaker 2: okay and then things started getting worse. Infections can cause that,
Speaker 2: like worsening pelvic pain that develops suddenly, including with your period,
Speaker 2: or fibers can grow later. Abnomiosis develops usually later in
Speaker 2: people in their thirties and forties. It's not usually something
Speaker 2: that's there when you're in your teens. Fibrises don't ually
Speaker 2: show up in your teens. It helps a little bit
Speaker 2: in terms of guessing what could be going on, but
Speaker 2: in general, like we do go through the same motions
Speaker 2: of the work up, the evaluation, the treatment options almost regardless,
Speaker 2: but it does in our mind where we're thinking through.
Speaker 2: We call it the differential diagnosis, which is just our
Speaker 2: list of what we think could be happening, and we
Speaker 2: go through we rule it in or rule it out.
Speaker 2: We use those distinctions a little bit.
Speaker 3: We learned earlier why n sets like fiberprofen can help
Speaker 3: with cramps for some people that they reduce the amount
Speaker 3: of prostaglandins and they block the receptors. But what if
Speaker 3: fiberprofin doesn't work for you, does that help doctors narrow
Speaker 3: down what could be causing the pain?
Speaker 2: The people with things like enemetriosis are typically the ones
Speaker 2: who are, you know, like, maybe it worked for a
Speaker 2: little bit or a tiny bit of an edge off,
Speaker 2: but it really didn't take away all the pain. It's
Speaker 2: another signal to us maybe there's something different going on.
Speaker 2: Maybe it's not just regular cramps. If you're taking max
Speaker 2: doses of ibupres and it's barely touching it, it should
Speaker 2: make us wonder if there's something different going on. Unfortunately,
Speaker 2: and this is sadly just the fact of women's health.
Speaker 2: In general, pain is so normalized. People are told, oh,
Speaker 2: it's just periods. Everyone has bad periods, just deal with it,
Speaker 2: or just take some breath control, just take some mightbprofen
Speaker 2: and those who are doing it and saying, I'm still
Speaker 2: in a ton of pain. This really isn't working. The
Speaker 2: problem is sometimes people get stuck at that phase and
Speaker 2: then the doctor doesn't think about other things like what
Speaker 2: else could be going on? Is it nimetrios? Should we
Speaker 2: talk about a laparoscopy to look for endo, could it
Speaker 2: be fibor should we get an ultrasound? They get stuck
Speaker 2: in the you just have periods like everyone else. Just
Speaker 2: deal with it and don't get that next step of
Speaker 2: evaluation and treatment. So in general, I tell people, if
Speaker 2: you're trying something, and we all just try these same
Speaker 2: first steps, but you shouldn't have person getting stuck in
Speaker 2: the none of this is working. I'm just trying like
Speaker 2: pale after pill. Clearly there's something amiss. Those are the
Speaker 2: situations I tell people to really advocate for yourselves, say
Speaker 2: this really isn't working for me. Should we be thinking
Speaker 2: about something else? Could it be an a metriosis? Should
Speaker 2: we get some imaging what's next, and then if the
Speaker 2: doctor isn't offering that next step, that's where you get
Speaker 2: second opinions. See a specialist, see a pelvic pain or
Speaker 2: enemytriosis specialist, and look elsewhere if the doctor's not helping
Speaker 2: you with that evaluation process.
Speaker 3: Yeah, which is a lot to ask for. Like fourteen
Speaker 3: fifteen year old going through horrible pain and I really scared
Speaker 3: of it.
Speaker 2: So they really need a parent, an adult, a pediatrician
Speaker 2: like someone to help advocate for them to be like, yeah,
Speaker 2: that's not normal. We should figure this out. And pediatricians
Speaker 2: sometimes are really great. Enemeytriosis groups are actually reaching out
Speaker 2: to school nurses now to educate them. If you have
Speaker 2: a girl who's just constantly, you know, coming out of class,
Speaker 2: has to go home throwing up in the bathroom, that's
Speaker 2: not normal.
Speaker 3: That was me.
Speaker 2: Yeah, talk to the parents and say ask your pediatricians,
Speaker 2: see a pediatric gynecologist, think about edmetriosis, because that's not normal.
Speaker 2: And like a strong percentage of people who have very
Speaker 2: bad period pain will end up having enemetriosis, the most
Speaker 2: common cause of abnormally painful periods. So it is something
Speaker 2: that any of you who are listening who are in
Speaker 2: that phase of suffering. Now you're just like, no one's listening.
Speaker 2: I don't know what to do. That's what you do
Speaker 2: is you try and find a specialist to focus on this.
Speaker 2: Because enemeytriosis is typically diagnosed and managed surgically, some obedns
Speaker 2: don't do those surgery, so they might be like, well,
Speaker 2: why would I send you for surgery? I don't really
Speaker 2: do them. Let's just keep on doing medications. That's where
Speaker 2: you say we maybe reached the end of what this
Speaker 2: doctor can offer. Let's look for someone else. And it
Speaker 2: may just be a matter of the doctor themselves are
Speaker 2: not super experienced with management of enemeutriosis, pelvic pain and
Speaker 2: some of these surgical issues. So in general, you should
Speaker 2: never be stuck in that phase of I don't know
Speaker 2: what to do. Now, I've tried these couple of things
Speaker 2: and they seem to think that was the only option.
Speaker 2: Clearly it's not working. Then you should look elsewhere for
Speaker 2: specialists and ask. You're within your rights to be like,
Speaker 2: what do you think we should do now? What could
Speaker 2: be going on? What's next?
Speaker 3: It's so frustrating that it feels like we're doing the
Speaker 3: doctor's job a little bit of Hey, isn't this a
Speaker 3: question you should be asking?
Speaker 2: Yeah, if you feel like your spidy sense is there's
Speaker 2: something wrong, this cannot be just normal, then you definitely
Speaker 2: should go get a second opinion, because again there's limitations,
Speaker 2: like I don't know everything about everything. Clearly, I've offerred
Speaker 2: people all the time. I'm like, I'm a little mystified.
Speaker 2: I don't know what's going on. You. Let me send
Speaker 2: you to a specialist, a hormone specialist, pelvic floor specialist.
Speaker 2: But it should never be that you are just left
Speaker 2: to no recourse, no treatments, no answers. That's not okay.
Speaker 2: So you almost feel like it's like a public health crisis.
Speaker 2: You know, there's just like this lack of basic information.
Speaker 3: So why didn't I know that my pain wasn't normal?
Speaker 3: Why didn't I know that it was likely being caused
Speaker 3: by an underlying issue? If at fourteen I had had
Speaker 3: more information about what a normal period was, maybe I
Speaker 3: would have been able to push back a little when
Speaker 3: doctors tried to tell me my horrible pain was normal.
Speaker 3: And even though that was over twenty years ago, and
Speaker 3: one hopes things have got better since then, In twenty
Speaker 3: twenty four. Just this past year, several studies found that
Speaker 3: teens in the US are not getting enough information on periods.
Speaker 3: Our health education in the US generally sucks, and our
Speaker 3: healthcare for people with uteruses generally sucks. It's kind of
Speaker 3: a chicken egg situation. I don't know which to blame,
Speaker 3: but it ends up in a situation where we don't
Speaker 3: even know what we don't know. We don't know when
Speaker 3: we're getting shitty care or when we have an uninformed doctor.
Speaker 3: Our health depends on us advocating for ourselves, but the
Speaker 3: information we need can be really hard to get and do.
Speaker 3: I think people with uteruses should have to become experts
Speaker 3: in gynecology just to be able to get the appropriate
Speaker 3: tests and diagnosis. Of course, not any gynecologist should have
Speaker 3: this information, should believe that their patient is in an
Speaker 3: abnormal amount of pain. If they say they are, should
Speaker 3: be able to get you to a diagnosis and treatment.
Speaker 3: But that is not the world we currently live in.
Speaker 3: So if a doctor is not helping you, you have
Speaker 3: to get your hands on the information yourself. And after
Speaker 3: talking to doctor Tang, it seems like I should look
Speaker 3: into whether I have endometriosis or adenomiosis. Based on the
Speaker 3: fact that my dysmenoria started up right away when I
Speaker 3: first started getting periods, the fact that ibuprofen sometimes helps
Speaker 3: and sometimes doesn't, and that my ultrasounds come back normal
Speaker 3: every time. It seems like I've just constantly gotten stuck
Speaker 3: at that spot. Doctor Tang was talking about that spot
Speaker 3: where my ultrasound comes back normal. The doctor either doesn't
Speaker 3: know what to do next, or doesn't want to refer
Speaker 3: me to a specialist for some reason, or just doesn't
Speaker 3: think my painful periods are really a problem. So it
Speaker 3: looks like I have to find a doctor who specializes
Speaker 3: in endometriosis. This was episode one of Krampt. They are
Speaker 3: nine more coming out. Here's a little preview of what
Speaker 3: else we're getting into.
Speaker 2: They teach you a lot in medical school about the science,
Speaker 2: the biology, the pathology, but I do not remember to
Speaker 2: this day a class on how to talk to people.
Speaker 5: That's not what I was actually saying when I said
Speaker 5: my homeans were out of bells.
Speaker 3: What it is trying to say is I'm suffering.
Speaker 5: Those are all strategies that help reduce fear and that
Speaker 5: feeling of isolation which our brains don't like that feeling,
Speaker 5: and so they're going to signal more pain when we
Speaker 5: feel that way.
Speaker 2: They vilify physicians, but it's been insurance companies who are
Speaker 2: creating the biggest nightmare. We put them in an MRI
Speaker 2: facill I mean they squeeze the bulb every time they
Speaker 2: have a cramp.
Speaker 6: If you keep on having painful periods, is that like
Speaker 6: getting cut over and over again by a surgeon, Like
Speaker 6: where eventually the are you keep going an opera and
Speaker 6: gets hyper sensitive.
Speaker 3: I'm like, yeah, this science is fake. And also I'm
Speaker 3: taking the supplement every day.
Speaker 2: Mensi's itself has healing properties. Can we make a wound
Speaker 2: repair model with what's in minster blood.
Speaker 3: That's the same ten thousand dollars for cramps.
Speaker 2: I am a full time journalist where my job is
Speaker 2: to ask questions, and I didn't know what to ask.
Speaker 1: I was embarrassed that I didn't even know what fibroids were.
Speaker 6: We weren't even able to advertise anything about menstruation until
Speaker 6: nineteen seventy two, and it wasn't until nineteen eighty five
Speaker 6: where Courtney Cox during a Tafex commercial actually used the
Speaker 6: word period.
Speaker 2: The existence of data, and particularly the existence of quality
Speaker 2: data on something is a direct representative of how much
Speaker 2: we as a society care about that thing.
Speaker 3: We'll be back next week. Be sure to subscribe to
Speaker 3: the Cramped feed wherever you listen to podcasts and tell
Speaker 3: a fellow cramper about it. We're an independent show, and
Speaker 3: the more people we can reach with this information, the
Speaker 3: fewer people will be in pain alone. Cramped is hosted
Speaker 3: and created by me Kate Helen Downey. Kelsey Delonzo is
Speaker 3: our editorial producer. Sound design and mixing is by Kelly
Speaker 3: Kromeric at Maven Postmedia. Our associate producer is Katelyn Sabatar.
Speaker 3: Cramp's Incredible theme song is written and performed by Faraday.
Speaker 3: Our podcast art was created by Nicholas Sheppard. This podcast
Speaker 3: is supported by the Simons Foundations Science, Society and Culture Initiative.
Speaker 3: Fiscal sponsorship for Cramped is provided by the Arkansas Podcast Collaborative.
Speaker 3: You can find doctor Karen Tang on Instagram and TikTok
Speaker 3: at Karen Tang, MD, and her book is called It's
Speaker 3: Not Hysteria. Everything you need to know about your reproductive
Speaker 3: health but We're never told. Special thanks to Mia Lobel
Speaker 3: Event Modenau and Matthew Starr.
Speaker 4: What's happening to your body? We know now because we've
Speaker 4: never really started fee more