WEBVTT 1 00:00:00.440 --> 00:00:04.360 Hi Taboo Science listeners. This show is still on Hiatus. 2 00:00:04.559 --> 00:00:07.040 I'm brewing up some ideas for a new season as 3 00:00:07.040 --> 00:00:09.839 we speak, but for now, I wanted to turn you 4 00:00:09.919 --> 00:00:13.160 on to another show you might like. It's called Cramped. 5 00:00:13.800 --> 00:00:17.519 It's an investigative podcast that answers the question why are 6 00:00:17.600 --> 00:00:21.359 so many people with uteruses in unexplained and untreated pain. 7 00:00:22.480 --> 00:00:26.120 It's hosted by Kate Helen Downeye, who experiences this pain herself. 8 00:00:26.640 --> 00:00:30.960 It's something called severe dysminerihea, which sounds very official until 9 00:00:31.000 --> 00:00:35.759 you find out it just means really painful periods. Throughout 10 00:00:35.759 --> 00:00:39.479 the season, Kate interviews experts and other uterus has to 11 00:00:39.520 --> 00:00:42.880 get to the bottom of what causes this debilitating pain 12 00:00:43.359 --> 00:00:47.159 and how she and others might find relief. Spoiler alert, 13 00:00:47.560 --> 00:00:50.640 she does get a diagnosis, so look forward to that. 14 00:00:51.560 --> 00:00:56.039 I absolutely love this podcast and I think you will too, 15 00:00:56.159 --> 00:00:58.880 So without further ado, here's the first episode. 16 00:00:59.119 --> 00:01:01.439 Enjoy. 17 00:01:02.759 --> 00:01:06.680 When I say I get really bad cramps. What does 18 00:01:06.719 --> 00:01:09.760 that look like to you? Maybe you get a picture 19 00:01:09.760 --> 00:01:13.280 in your head from a TV show or a movie. Oh, 20 00:01:13.280 --> 00:01:16.439 my period, You're all fired. Maybe you think of the 21 00:01:16.560 --> 00:01:19.280 stock image that pops up if you google image search 22 00:01:19.400 --> 00:01:23.319 period cramps. A young, thin, white woman sitting bent over 23 00:01:23.359 --> 00:01:26.959 on a couch and wincing, wearing jeans. For some reason, 24 00:01:27.439 --> 00:01:31.560 maybe you're like me, and you know this twisting, horrific 25 00:01:31.719 --> 00:01:35.680 pain that comes in waves and just doesn't stop. Maybe 26 00:01:35.719 --> 00:01:37.599 you know what it's like to spend a day or 27 00:01:37.640 --> 00:01:40.719 two dead to the world outside the bathroom floor. Unless 28 00:01:40.760 --> 00:01:44.439 you personally have experienced this pain, or you are very 29 00:01:44.480 --> 00:01:47.239 close to someone who does experience it, like close enough 30 00:01:47.239 --> 00:01:49.799 to actually see with your eyes what it does to them, 31 00:01:50.159 --> 00:01:53.319 you're probably thinking this is not a big deal. This 32 00:01:53.480 --> 00:01:58.959 is cramps. Everybody gets cramps. Respectfully, buckle up. I want 33 00:01:58.959 --> 00:02:01.000 to tell you about just one of the times my 34 00:02:01.120 --> 00:02:04.640 cramps really fucked up my life. And this probably goes 35 00:02:04.640 --> 00:02:09.319 without saying since this is a podcast explicitly about period cramps. 36 00:02:09.520 --> 00:02:14.719 But this episode has graphic descriptions of menstruation, blood, and 37 00:02:14.919 --> 00:02:17.479 other bodily functions. So if that doesn't work for you, 38 00:02:17.719 --> 00:02:19.919 that's fine, just this is not the podcast for you. 39 00:02:21.400 --> 00:02:24.280 It's the Lunch Rush at Upstairs on the Square in 40 00:02:24.400 --> 00:02:28.159 Harvard Square and Cambridge. It's kind of a manic Pixie 41 00:02:28.240 --> 00:02:32.680 dream restaurant. It's got pink walls and zebra striped banquettes, 42 00:02:32.800 --> 00:02:36.759 but also old school wood. The waiters wear black pants 43 00:02:36.840 --> 00:02:41.599 and crisp white button downs and fun ties. I'm twenty two, 44 00:02:41.879 --> 00:02:45.159 and this is by far the fanciest and best paying 45 00:02:45.159 --> 00:02:48.479 waitressing job I'd ever had in my short career. I 46 00:02:48.719 --> 00:02:51.439 barely absorbed any of the wine training, and I still 47 00:02:51.479 --> 00:02:54.280 don't remember which fork goes where in the place settings. 48 00:02:54.919 --> 00:02:58.080 We are slammed, and I am at the pos system, 49 00:02:58.120 --> 00:03:01.400 putting in entree orders for my big table, sweating and 50 00:03:01.759 --> 00:03:04.360 desperately trying to remember if the guy with a mustache 51 00:03:04.479 --> 00:03:08.000 wanted a Caesar or a Vinaigret dressing. When I realized 52 00:03:08.039 --> 00:03:12.560 something that makes my heart stop. I have cramps. I 53 00:03:12.639 --> 00:03:15.280 have been focusing on getting all the details right on 54 00:03:15.360 --> 00:03:17.759 lunch service so I can have one day where the 55 00:03:17.879 --> 00:03:20.639 chef doesn't yell at me, and I missed the crucial 56 00:03:20.719 --> 00:03:26.360 early signs that dull backache and upset stomach chills. And 57 00:03:26.400 --> 00:03:30.000 these aren't just regular cramps. The pain in my belly 58 00:03:30.039 --> 00:03:33.439 that I just felt means I'm about to have what 59 00:03:33.520 --> 00:03:36.960 I call death cramps, and there's nothing I can do 60 00:03:37.039 --> 00:03:40.759 about it. It's too late for ibuprofen. I realize that 61 00:03:40.840 --> 00:03:43.439 the layer of sweat over my whole body right now 62 00:03:43.639 --> 00:03:46.840 isn't because I've been hustling between my tables. It's because 63 00:03:46.879 --> 00:03:50.240 I'm starting to have a full body reaction to whatever 64 00:03:50.280 --> 00:03:53.560 my uterus is doing. The pressure in my gut isn't 65 00:03:53.599 --> 00:03:56.319 because I chugged an entire pint of diet coke during 66 00:03:56.360 --> 00:03:59.639 service prep. It's because I'm going to start throwing up 67 00:03:59.719 --> 00:04:03.319 any second now. The weakness I'm feeling in my legs 68 00:04:03.400 --> 00:04:06.199 isn't because these dance coat clogs are so bad for 69 00:04:06.319 --> 00:04:09.280 climbing the stairs to the second floor dining room. It's 70 00:04:09.360 --> 00:04:12.319 because I'm going to pass out from the pain shortly 71 00:04:12.400 --> 00:04:15.599 after I throw up. And I have four tables at 72 00:04:15.719 --> 00:04:19.639 varying stages of fancy multi course lunches, drinks up at 73 00:04:19.639 --> 00:04:22.360 the bar, and special requests to verbalize to the kitchen 74 00:04:22.600 --> 00:04:25.199 that they are probably not going to appreciate, and four 75 00:04:25.319 --> 00:04:28.839 seasoned waiters who already treat me like an annoying little sister. 76 00:04:29.319 --> 00:04:31.079 But unless I want to throw up on the quirky 77 00:04:31.120 --> 00:04:34.399 polka dot rug, I don't have a choice. I find 78 00:04:34.399 --> 00:04:36.360 the waiter who has been the nicest to me, even 79 00:04:36.399 --> 00:04:38.120 though I know it's because he's going to try to 80 00:04:38.160 --> 00:04:40.720 sleep with me, and I say very quickly, I'm sick. 81 00:04:40.920 --> 00:04:43.000 I'm so sorry. Can you please cover my tables? A 82 00:04:43.079 --> 00:04:46.199 fourteen wants no dairy any taliatel? Can you tell the kitchen. 83 00:04:46.240 --> 00:04:49.000 I'm so sorry, it's an emergency, and I lock myself 84 00:04:49.000 --> 00:04:52.959 in the employee bathroom. I take off my stupid white 85 00:04:52.959 --> 00:04:55.079 button down and my black dress pants and I hang 86 00:04:55.120 --> 00:04:56.600 them up on the coat hook so they won't get 87 00:04:56.639 --> 00:04:59.120 drenched in sweat, and I kneel in front of the 88 00:04:59.160 --> 00:05:02.360 toilet just as the heaving starts, knowing I'm in for 89 00:05:02.439 --> 00:05:07.879 between one and six hours of hell. I come back 90 00:05:07.920 --> 00:05:10.759 to consciousness on the floor of the employee bathroom because 91 00:05:10.800 --> 00:05:12.800 someone is pounding on the door and yelling my name. 92 00:05:13.000 --> 00:05:15.560 I'm groggy, but the cramps have stopped, as have the 93 00:05:15.600 --> 00:05:20.600 alternating waves of vomiting and diarrhea. I say, I'm okay, sorry, 94 00:05:21.000 --> 00:05:23.720 coming out in a second, just so they'll stop making noise. 95 00:05:24.160 --> 00:05:26.600 I sit up and behind me on the bathroom floor, 96 00:05:26.920 --> 00:05:30.319 there's a perfect outline of my body in sweat. My 97 00:05:30.399 --> 00:05:33.800 hair is soaked, my muscles are rubbery as I stand up, 98 00:05:34.040 --> 00:05:36.759 my abs and my back are sore from all the puking, 99 00:05:36.800 --> 00:05:39.360 and my forearms are sore, and I know i'll have 100 00:05:39.399 --> 00:05:41.839 bruises tomorrow from where I leaned too hard on the 101 00:05:41.920 --> 00:05:44.000 edge of the toilet. But I feel the kind of 102 00:05:44.040 --> 00:05:48.040 amazing that you only feel when intense pain has finally 103 00:05:48.079 --> 00:05:51.600 gone away. I am so relieved to not be in 104 00:05:51.680 --> 00:05:55.120 that nightmare of pain anymore. I don't have my phone 105 00:05:55.120 --> 00:05:57.040 on me, and there's no window, so I have no 106 00:05:57.120 --> 00:06:00.519 idea how long I've been locked in the only employee bathroom. 107 00:06:00.720 --> 00:06:03.360 My first feeling is guilt that a bunch of waiters 108 00:06:03.399 --> 00:06:05.800 picked up my slack while holding their pee, and then 109 00:06:06.079 --> 00:06:09.040 embarrassment that so many people know I was locked in 110 00:06:09.040 --> 00:06:11.560 the bathroom for hours. I wonder if they all think 111 00:06:11.600 --> 00:06:13.800 I was doing drugs in here, and if that will 112 00:06:13.800 --> 00:06:16.480 make me cooler or less cool in their eyes. I 113 00:06:16.519 --> 00:06:18.439 put my pants and my white button down back on, 114 00:06:18.519 --> 00:06:20.600 which is hard because I'm so sweaty. It's like trying 115 00:06:20.600 --> 00:06:22.279 to put your clothes back on after getting out of 116 00:06:22.279 --> 00:06:27.000 the ocean. I come out and the manager, who's a woman, 117 00:06:27.279 --> 00:06:31.120 is standing there. She's definitely concerned, but I can also 118 00:06:31.279 --> 00:06:35.040 see a look of annoyance and impatience, like right behind 119 00:06:35.079 --> 00:06:38.439 the concern, I am immediately in smooth it over mode. 120 00:06:38.560 --> 00:06:41.920 I'm so sorry I was having an emergency. Uh no, 121 00:06:42.000 --> 00:06:44.399 I don't need you to call an ambulance. Everything's okay now. 122 00:06:44.600 --> 00:06:48.240 I'm so sorry it happened at work. I really appreciate 123 00:06:48.279 --> 00:06:52.160 everyone covering for me. I'm okay now. I said whatever 124 00:06:52.279 --> 00:06:54.399 I needed to say in order to keep my job. 125 00:06:54.720 --> 00:06:57.319 Take two buses back to my apartment, and sleep for 126 00:06:57.360 --> 00:07:01.800 the next twelve hours. Since I was fourteen, I've never 127 00:07:01.879 --> 00:07:04.959 known why I am in so much pain when I 128 00:07:04.959 --> 00:07:08.399 get my period. I've never had a diagnosis, and I've 129 00:07:08.439 --> 00:07:11.879 never really found a treatment that helps. This podcast is 130 00:07:11.920 --> 00:07:14.720 my search for answers to some of the most basic 131 00:07:14.879 --> 00:07:16.240 questions about my body. 132 00:07:16.800 --> 00:07:20.560 Morning sickness and the materiosis, menopause, migraines, b CEO, that's 133 00:07:20.560 --> 00:07:21.439 happening to your body? 134 00:07:21.519 --> 00:07:22.720 We don't know because we've. 135 00:07:22.560 --> 00:07:26.639 Never really studied the female body, so it's all in 136 00:07:26.680 --> 00:07:29.959 my head when the research is quite sunny. No, we 137 00:07:30.120 --> 00:07:31.879 never really studied the female. 138 00:07:31.959 --> 00:07:36.639 Buddy, I go to the doctor to get dismissed. 139 00:07:36.759 --> 00:07:37.439 Try to losing weight. 140 00:07:37.439 --> 00:07:38.480 You're just anxious. 141 00:07:38.680 --> 00:07:40.399 That's my medical I'm not pissed. 142 00:07:40.399 --> 00:07:49.600 Just wait ten years for a diagnosis. Psychosomatic you're so dramatic, hysterical, emotional, hormonal, eerotic, 143 00:07:50.120 --> 00:07:53.439 heart disease, chronic fatigue, depression, and anxiety. 144 00:07:53.920 --> 00:07:54.639 Do you have pain? 145 00:07:54.879 --> 00:07:55.439 No, you don't. 146 00:07:55.720 --> 00:07:58.160 You've never really studied the female fund. 147 00:07:59.160 --> 00:08:01.959 Hi. I'm Kate, and that's what it's like when I 148 00:08:02.000 --> 00:08:04.800 have death cramps. At least that's what I've always called them, 149 00:08:05.199 --> 00:08:09.279 because really bad cramps didn't quite do them justice. Now 150 00:08:09.319 --> 00:08:12.439 I know that the medical term for really bad cramps 151 00:08:12.680 --> 00:08:15.759 is dismnareea. It's happened to me since I was fourteen, 152 00:08:15.959 --> 00:08:18.600 right after getting my period, but it's not what I 153 00:08:18.680 --> 00:08:21.879 experience every single month. Sometimes I just have your basic 154 00:08:21.959 --> 00:08:24.720 run of the mill cramps, which also suck, by the way, 155 00:08:24.720 --> 00:08:28.199 but they don't ruin my life. Sometimes it escalates into 156 00:08:28.240 --> 00:08:31.680 death cramps, and sometimes it doesn't, with no pattern or 157 00:08:31.759 --> 00:08:34.440 trigger that I have ever been able to identify, which 158 00:08:34.480 --> 00:08:36.159 is just a super fun game of chicken to play 159 00:08:36.159 --> 00:08:38.799 with your uterus twelve times a year for twenty plus years. 160 00:08:39.559 --> 00:08:41.759 So I just said that the medical term for my 161 00:08:41.919 --> 00:08:46.080 death cramps is dysmenoriea, but that's not exactly accurate. The 162 00:08:46.200 --> 00:08:50.840 term dismenoreea comes from Greek dis meaning difficult, painful or 163 00:08:50.879 --> 00:08:55.519 abnormal meno meaning month and rhea meaning flow, so literally 164 00:08:55.600 --> 00:09:00.000 painful monthly flow. So dos menarea can mean any pain 165 00:09:00.159 --> 00:09:03.879 you have related to your period, like quote unquote normal cramps, 166 00:09:04.480 --> 00:09:07.320 and then sometimes people will use it to describe severe 167 00:09:07.480 --> 00:09:10.320 or abnormal amounts of pain related to your period, like 168 00:09:10.360 --> 00:09:13.440 my death cramps, and sometimes doctors will use the term 169 00:09:13.600 --> 00:09:17.480 severe dismnerya for a death cramps kind of pain. How 170 00:09:17.519 --> 00:09:20.279 someone uses the term mostly comes down to what they 171 00:09:20.360 --> 00:09:24.559 consider a normal amount of period pain, and there's no 172 00:09:24.679 --> 00:09:27.759 real consensus for that because we just don't talk about 173 00:09:27.759 --> 00:09:31.039 it enough to have a sense of normal. Now, aside 174 00:09:31.039 --> 00:09:34.320 from this mysterious period pain, I am pretty much healthy 175 00:09:34.360 --> 00:09:37.240 across the board, and not to brag. And my mother 176 00:09:37.320 --> 00:09:40.759 never experienced this level of pain with her period, so obviously, 177 00:09:40.879 --> 00:09:44.519 after the first time I experienced this insane pain, we 178 00:09:44.600 --> 00:09:47.320 went to a doctor. I expected some answers that would 179 00:09:47.360 --> 00:09:50.559 make this pain make sense, like I had appendicitis or 180 00:09:50.600 --> 00:09:53.440 some kind of horrible infection. It's kind of rooting for 181 00:09:53.519 --> 00:09:56.840 horrible infection, you know that, doctor, I am not kidding. 182 00:09:56.840 --> 00:10:00.720 You told me. Yeah, some women get painful, but they 183 00:10:00.840 --> 00:10:03.759 usually go away when you have your first baby, which 184 00:10:03.799 --> 00:10:06.639 is such an unhelpful thing to say to a fourteen 185 00:10:06.720 --> 00:10:09.679 year old. Over the last twenty two years, in many 186 00:10:09.720 --> 00:10:14.919 different cities, with many different insurances, after many ultrasounds and 187 00:10:15.000 --> 00:10:18.240 tests to rule out the obvious potential causes, I have 188 00:10:18.519 --> 00:10:22.840 never gotten answers or a diagnosis. For a long time, 189 00:10:23.240 --> 00:10:25.840 I didn't talk to people about my death cramps. The 190 00:10:25.879 --> 00:10:29.399 reactions I got from my parents, the school nurses, and 191 00:10:29.480 --> 00:10:32.559 my doctors early on all communicated to me that this 192 00:10:32.759 --> 00:10:35.919 was just some freak thing my weird body was doing, 193 00:10:36.159 --> 00:10:39.000 that they didn't know anything about this, that they had 194 00:10:39.120 --> 00:10:42.240 never heard of this happening to someone. I didn't talk 195 00:10:42.279 --> 00:10:44.240 about it because I was afraid of it, and I 196 00:10:44.320 --> 00:10:46.639 was embarrassed about it, and I was ashamed that my 197 00:10:46.720 --> 00:10:49.360 body didn't work right. It was so scary to be 198 00:10:49.519 --> 00:10:51.879 in the worst pain I'd ever been in in my 199 00:10:52.120 --> 00:10:56.440 life but not know why, and have doctors not know 200 00:10:56.559 --> 00:10:59.480 why that I just tried to forget about it every 201 00:10:59.519 --> 00:11:02.320 time it happen. And when I finally started talking to 202 00:11:02.360 --> 00:11:05.720 more people about my death cramps, I was shocked at 203 00:11:05.759 --> 00:11:08.159 how many times someone would say, oh my god, yeah, 204 00:11:08.240 --> 00:11:10.320 I get those two. Oh my god. I thought I 205 00:11:10.399 --> 00:11:12.879 was the only one men who would say. I had 206 00:11:12.879 --> 00:11:14.960 a girlfriend who had that. She never knew what it was, 207 00:11:15.000 --> 00:11:17.559 but it was scary. I couldn't believe all these people 208 00:11:17.639 --> 00:11:21.759 had somehow also been experiencing the same thing and we 209 00:11:21.960 --> 00:11:24.480 just never talked about it. How could it be true 210 00:11:24.639 --> 00:11:27.960 that so many people experience this and yet doctors just 211 00:11:28.120 --> 00:11:30.159 shrug at me when I ask them about this, like 212 00:11:30.200 --> 00:11:32.720 they never heard of it. How can all these people 213 00:11:32.879 --> 00:11:36.279 be dealing with this intense pain but there isn't a 214 00:11:36.320 --> 00:11:40.320 real treatment for it. Looking back, I understand how naive 215 00:11:40.480 --> 00:11:43.720 this thought was. To be shocked and confused about why 216 00:11:43.759 --> 00:11:46.679 a system doesn't help you means that up until that moment, 217 00:11:46.960 --> 00:11:49.799 the system did help you. I know now that as 218 00:11:49.840 --> 00:11:54.120 a generally healthy, CIS white woman, I have enormous privilege 219 00:11:54.200 --> 00:11:57.120 within a system like our healthcare system in a country 220 00:11:57.159 --> 00:12:01.080 like the US. This disbelief and confusion I felt when 221 00:12:01.120 --> 00:12:03.799 I realized there were other people experiencing this pain but 222 00:12:03.840 --> 00:12:07.399 it was ignored and dismissed by doctors. That confusion was 223 00:12:07.679 --> 00:12:11.720 a privileged person encountering discrimination for the first time and 224 00:12:11.840 --> 00:12:14.759 having a lot of cognitive dissonance about it. I know 225 00:12:14.919 --> 00:12:17.720 more now about the experiences of others who have less 226 00:12:17.720 --> 00:12:20.759 privileged than me, and the experiences of people who have 227 00:12:20.879 --> 00:12:23.519 more privilege than me in the medical system, but I 228 00:12:23.639 --> 00:12:27.159 still don't understand exactly why I haven't been able to 229 00:12:27.200 --> 00:12:31.360 get a diagnosis. I'm doing this podcast because I want answers, 230 00:12:31.639 --> 00:12:33.879 and if I'm being honest, I want an excuse to 231 00:12:33.960 --> 00:12:37.399 sit some doctors down and not let them leave until 232 00:12:37.440 --> 00:12:40.360 they tell me something real. I don't want other people 233 00:12:40.399 --> 00:12:43.600 who experienced his Manaea to feel isolated like I did, 234 00:12:43.759 --> 00:12:46.519 to feel like their bodies are wrong or weird, to 235 00:12:46.559 --> 00:12:48.320 feel like they just have to find a way to 236 00:12:48.320 --> 00:12:50.799 tolerate it, that there's no help for them. I want 237 00:12:50.799 --> 00:12:53.960 to get these answers for myself, and then I want 238 00:12:53.960 --> 00:12:57.080 to share them with anyone else looking for answers, or 239 00:12:57.120 --> 00:12:59.720 at the very least, I want to understand why I 240 00:12:59.759 --> 00:13:02.960 can have these answers and what would have to change 241 00:13:03.200 --> 00:13:06.840 for me to get them. My first and most obvious 242 00:13:06.919 --> 00:13:11.600 question is what even are cramps. I know that the 243 00:13:11.720 --> 00:13:14.200 uterus has muscles, and when it needs to squeeze the 244 00:13:14.200 --> 00:13:16.600 blood out because a fertilized egg has not shown up 245 00:13:16.639 --> 00:13:19.759 to grow into a baby, the muscles contract, But what 246 00:13:19.960 --> 00:13:23.360 makes the muscles contract and why does it hurt so much? 247 00:13:23.799 --> 00:13:26.440 After reading a bunch of medical papers and googling a 248 00:13:26.480 --> 00:13:30.480 lot of medical definitions, here's how it works. Hormones run 249 00:13:30.519 --> 00:13:33.480 the show when it comes to periods duh. After an 250 00:13:33.519 --> 00:13:37.159 egg is released from an ovary ovulation, the ovary makes 251 00:13:37.159 --> 00:13:41.080 a hormone called progesterone. Progesterone signals to the lining of 252 00:13:41.120 --> 00:13:43.440 the uterus that it has to thicken up and prepare 253 00:13:43.480 --> 00:13:46.519 to house of fetus. If a fertilized egg doesn't show up, 254 00:13:46.600 --> 00:13:51.279 the ovary stops making progesterone, basically saying never mind. This 255 00:13:51.480 --> 00:13:54.480 drop in progesterone signals a new player to show up 256 00:13:54.480 --> 00:13:58.720 on the scene. Prostaglandins. I had never heard of prostaglandins 257 00:13:58.720 --> 00:14:01.720 before I started doing my recent but they are huge 258 00:14:01.759 --> 00:14:06.000 players in the period paying games. Prostaglandins aren't officially a hormone, 259 00:14:06.000 --> 00:14:08.519 but they also do a lot of signaling. Their job 260 00:14:08.559 --> 00:14:11.080 across the whole body is to show up when there's 261 00:14:11.080 --> 00:14:15.120 an injury or damage bind to the prostaglandin receptors and 262 00:14:15.240 --> 00:14:20.519 trigger reactions. So we've got progesterone dipping, prostaglandin's getting released 263 00:14:20.559 --> 00:14:24.360 into the bloodstream. Those prostaglandins then hurry over to the uterus. 264 00:14:24.399 --> 00:14:27.679 They bind with the prostaglandin receptors in the muscle, and 265 00:14:27.759 --> 00:14:31.399 they tell the muscle to contract or squeeze. That squeezing 266 00:14:31.480 --> 00:14:33.919 is what pushes out the blood and tissue that's been 267 00:14:33.960 --> 00:14:36.919 building up in the uterus ever since ovulation. Without that 268 00:14:37.039 --> 00:14:39.679 muscle contracting, there wouldn't be a way to clear out 269 00:14:39.679 --> 00:14:42.200 the uterus. So it can try again next month. So 270 00:14:42.279 --> 00:14:46.399 there's nothing wrong with prostaglandins making the uterus contract. That's 271 00:14:46.519 --> 00:14:49.919 everything going according to plan. And because that muscle is 272 00:14:50.000 --> 00:14:54.639 contracting and working hard, some mild aching and soreness can happen, 273 00:14:54.879 --> 00:14:58.240 just like if any muscle is working hard. But sometimes 274 00:14:58.519 --> 00:15:01.519 for some people things start to go off the rails. 275 00:15:02.039 --> 00:15:06.039 Too many prostaglandins might get released, and they're all screaming 276 00:15:06.080 --> 00:15:08.080 at the muscle of the uterus to cramp, cramp, cramp, 277 00:15:08.320 --> 00:15:11.519 and so instead of squeezing and releasing like normal, the 278 00:15:11.600 --> 00:15:15.679 muscle just squeezes and squeezes and squeezes until the muscle 279 00:15:15.759 --> 00:15:19.720 is so constricted that the blood vessels can't get fresh 280 00:15:19.799 --> 00:15:23.200 oxygenated blood to parts of the muscle. Muscle cells will 281 00:15:23.279 --> 00:15:25.960 die if they can't get oxygen, so they really want 282 00:15:26.000 --> 00:15:28.679 to bring attention to this problem by causing pain. This 283 00:15:28.840 --> 00:15:31.519 is called ischemia, and it hurts like a motherfucker no 284 00:15:31.559 --> 00:15:34.120 matter where it happens in your body. When it happens 285 00:15:34.200 --> 00:15:37.559 in other muscles, it's called a Charlie horse. This is 286 00:15:37.559 --> 00:15:40.919 actually a useful pain, or what medicine calls adaptive pain. 287 00:15:41.320 --> 00:15:44.519 If you can shift positions to increase blood flow or 288 00:15:44.559 --> 00:15:47.559 like shake out the cramp, that helps get more oxygen 289 00:15:47.559 --> 00:15:49.600 to the spot that needs it. But when it's happening 290 00:15:49.679 --> 00:15:53.360 in your uterus, you can't do much about that. Prostaglandins 291 00:15:53.360 --> 00:15:56.720 are also responsible for period poops because when they flood 292 00:15:56.759 --> 00:15:59.679 into the bloodstream at super high levels, they don't stop 293 00:15:59.720 --> 00:16:03.039 at the uterus. They also bind with receptors in the colon, 294 00:16:03.360 --> 00:16:05.720 and they make the muscles in your colon contract too. 295 00:16:06.159 --> 00:16:09.159 Same deal for vomiting. For those lucky individuals who sometimes 296 00:16:09.240 --> 00:16:12.840 throw up when we get cramps, those prostaglandins are binding 297 00:16:12.840 --> 00:16:16.360 with receptors in our stomach muscles and causing a vomiting reaction. 298 00:16:16.879 --> 00:16:21.200 Fun staff. One more thing about prostaglandins, the reason ibuprofen 299 00:16:21.320 --> 00:16:25.440 and other n sids or non steroidal anti inflammatory medications 300 00:16:25.519 --> 00:16:27.919 can be so helpful for period cramps is that they 301 00:16:27.960 --> 00:16:31.759 can lower the amount of prostaglandins you produce. They also 302 00:16:31.879 --> 00:16:36.080 bind with the proseaclanin receptors, blocking the prostaglandins from signaling 303 00:16:36.120 --> 00:16:38.720 to the muscles to cramp. They are the heroes of 304 00:16:38.759 --> 00:16:41.480 this story. But this is the first of many times 305 00:16:41.480 --> 00:16:45.360 in my research my mind got blown. I've been taking 306 00:16:45.399 --> 00:16:48.759 hyboprofen wrong my whole life. I've always taken it when 307 00:16:48.799 --> 00:16:51.639 I feel my cramps starting. It hurts, so you take 308 00:16:51.679 --> 00:16:54.720 the medicine to make it stop hurting. Right In the 309 00:16:54.759 --> 00:16:59.360 case of cramps and iberprofen wrong. If you take hyberprofin 310 00:16:59.600 --> 00:17:02.919 after your cramps have already started, you're kind of too late. 311 00:17:03.159 --> 00:17:06.359 The prostaglandins are already swimming around in your bloodstream and 312 00:17:06.400 --> 00:17:09.839 binding with receptors. The key is to take the hyberprofen 313 00:17:10.240 --> 00:17:14.039 before your period is even supposed to start. And yeah, 314 00:17:14.079 --> 00:17:16.640 that means tracking your period and starting to pop a 315 00:17:16.640 --> 00:17:19.880 few iboprofen forty eight hours before you expect to get 316 00:17:19.920 --> 00:17:23.079 your period. That way, the iberprofen is already binding to 317 00:17:23.119 --> 00:17:28.559 those receptors and reducing prostaglanin production before it even starts. 318 00:17:29.000 --> 00:17:32.119 And sure, if the cramps aren't too bad, you can 319 00:17:32.160 --> 00:17:35.759 probably just deal with the discomfort until the hyperprofen kicks 320 00:17:35.759 --> 00:17:39.400 in aka catches up to the prostaglandins and the receptors. 321 00:17:39.759 --> 00:17:43.079 But if you're like me, taking the hyberprofen after cramps 322 00:17:43.079 --> 00:17:46.440 have already started might be too late. There might already 323 00:17:46.440 --> 00:17:49.960 be enough prostaglandins in your bloodstream binding to receptors to 324 00:17:50.079 --> 00:17:53.319 cause vomiting, which means you can't keep any more meds down. 325 00:17:53.759 --> 00:17:57.799 So for me, taking iyberprofin prophylactically or before I need 326 00:17:57.839 --> 00:18:01.559 it is a huge life stay. And just a quick 327 00:18:01.599 --> 00:18:04.240 disclaimer here, I am not a doctor. I'm just a 328 00:18:04.279 --> 00:18:07.039 research nerd with a microphone and a uterus telling you 329 00:18:07.160 --> 00:18:11.599 things I learned. This is not medical advice. So prostaglandins 330 00:18:11.640 --> 00:18:16.680 cause cramps and Iberprofen blocks prostaglandins. Oh my god, I 331 00:18:16.680 --> 00:18:21.160 think we did it, you guys. Medical mystery solved. Yeah, 332 00:18:21.200 --> 00:18:23.880 that'd be great. If the answer for all severe period 333 00:18:23.880 --> 00:18:26.920 pain was just take iberprofen, it'd be a pretty short 334 00:18:26.960 --> 00:18:31.319 podcast series. Unfortunately, as helpful as Iberprofen can be, it 335 00:18:31.359 --> 00:18:34.880 doesn't work for everybody all the time. For some people 336 00:18:35.119 --> 00:18:38.480 like me, it might help sometimes and then other times 337 00:18:38.599 --> 00:18:41.039 do nothing at all. So how do you find out 338 00:18:41.160 --> 00:18:44.039 what's going on? Why do some of us produce so 339 00:18:44.079 --> 00:18:47.640 many prostaglandins. Why would cramps be normal some months and 340 00:18:47.759 --> 00:18:51.440 completely debilitating other months? These are questions I could not 341 00:18:51.559 --> 00:18:54.640 find the answers to in my research, so I brought 342 00:18:54.680 --> 00:18:56.920 in an expert. We're going to take a quick break 343 00:18:56.960 --> 00:19:01.480 and when we come back. I talked to doctor Karen Tang, gynecologist, author, 344 00:19:01.559 --> 00:19:06.000 and TikToker about what severe period pain like mine could mean. 345 00:19:08.119 --> 00:19:10.640 Because we've never really started a female. 346 00:19:10.359 --> 00:19:14.039 Fund adding welcome back to Krampt. After doing all the 347 00:19:14.079 --> 00:19:16.759 research I could do on my own into what's actually 348 00:19:16.799 --> 00:19:19.960 happening inside my body when I have death cramps, I 349 00:19:20.000 --> 00:19:22.880 went to an expert with my unanswered questions. 350 00:19:23.519 --> 00:19:27.559 I'm doctor Karen Tang, I'm a Bortzer gynecologist. I do 351 00:19:27.640 --> 00:19:29.519 a lot of talking and social media, and I have 352 00:19:29.519 --> 00:19:31.799 a book called It's Not Hysteria. Everything you Need to 353 00:19:31.839 --> 00:19:34.000 Know about your reproductive health. But we're never. 354 00:19:33.799 --> 00:19:37.000 Told when we get into the kind of severe dismentaria 355 00:19:37.119 --> 00:19:41.319 that I experience, where it is debilitating pain. I am 356 00:19:41.480 --> 00:19:44.200 throwing up every ten minutes, even though there's nothing left 357 00:19:44.240 --> 00:19:48.880 in my stomach, I'm having diarrhea, I'm passing out. Is 358 00:19:48.920 --> 00:19:52.160 that just the regular pain turned up or is something 359 00:19:52.240 --> 00:19:55.279 physiologically different happening inside my body? 360 00:19:55.440 --> 00:19:58.599 So whenever somebody's having that degree of pain, we always 361 00:19:58.599 --> 00:20:00.920 start to think what else could be going on? That's 362 00:20:00.960 --> 00:20:05.000 obviously not normal. So anytime something is affecting your ability 363 00:20:05.039 --> 00:20:08.200 to function, you're throwing up, you're missing work or school, 364 00:20:08.640 --> 00:20:10.559 we start to think, is it not just run of 365 00:20:10.559 --> 00:20:14.359 the mill cramps anymore? Could it be something like enemy triosis, 366 00:20:14.359 --> 00:20:16.920 which is probably the most common cause of really bad, 367 00:20:17.000 --> 00:20:20.319 painful cramps, or fibroids, add innomiosis. 368 00:20:20.319 --> 00:20:24.039 There's lots of underlying conditions that could cause period pain 369 00:20:24.079 --> 00:20:26.759 to be excruciating. Let's lay them out real quick, and 370 00:20:26.920 --> 00:20:28.680 just for fun, I'm going to list them in order 371 00:20:28.759 --> 00:20:31.759 of how easy they are to identify and get treatment for. 372 00:20:32.599 --> 00:20:38.480 Ovarian cysts. Ovarian cysts are little fluid filled sacs that 373 00:20:38.599 --> 00:20:41.839 form on your ovaries. These can be a totally normal 374 00:20:41.920 --> 00:20:46.079 part of ovulation, and little cysts can just go away 375 00:20:46.079 --> 00:20:49.160 by themselves, but if they become a problem, if they 376 00:20:49.160 --> 00:20:51.920 get too big or there's too many of them. It 377 00:20:51.960 --> 00:20:55.839 can cause ovarian torsion, which means the ovary twists, and 378 00:20:56.039 --> 00:21:00.160 it can rupture a fallopian tube. Ovarian cysts can also burns. 379 00:21:00.519 --> 00:21:05.680 It can cause fever, sharp pain, nausea. Many people mistake 380 00:21:06.079 --> 00:21:10.559 the feeling of an ovarian cyst rupturing for an appendix bursting. 381 00:21:10.720 --> 00:21:12.920 That's how much it can hurt. Cysts can usually be 382 00:21:12.960 --> 00:21:15.599 found on a pelvic ultrasound, so that makes it pretty 383 00:21:15.640 --> 00:21:20.799 easy to spot. Fibroids. Fibroids are non cancerous tumors that 384 00:21:20.880 --> 00:21:23.839 grow inside the uterus. They can be teeny tiny, like 385 00:21:23.880 --> 00:21:26.799 the size of a seed, or as big as a watermelon, 386 00:21:26.839 --> 00:21:29.599 which is terrifying. Some people have fibroids that don't cause 387 00:21:29.640 --> 00:21:32.359 any symptoms at all, and some people have fibroids that 388 00:21:32.440 --> 00:21:37.640 cause enormous pain. Fibroids most often cause heavy, painful periods 389 00:21:37.680 --> 00:21:40.480 and pelvic pain in general, but it can also cause 390 00:21:40.519 --> 00:21:43.200 pain in your stomach and your low back, or pain 391 00:21:43.279 --> 00:21:47.920 during sex. Fibroids are incredibly common. Up to seventy seven 392 00:21:48.000 --> 00:21:52.000 percent of people with uteruses will develop fibroids before menopause, 393 00:21:52.240 --> 00:21:55.119 and yet despite how common they are, we still don't 394 00:21:55.119 --> 00:21:58.480 know what causes them. Fibroids usually show up on a 395 00:21:58.519 --> 00:22:02.319 pelvic ultrasound, but you can also get an MRI or 396 00:22:02.480 --> 00:22:05.000 something called a hysteroscopy, which is a little camera that 397 00:22:05.039 --> 00:22:07.039 goes up into the uterus. They might need to do 398 00:22:07.079 --> 00:22:09.359 different kinds of imaging to get a good picture of it. 399 00:22:09.720 --> 00:22:13.759 EC topic pregnancy Okay, this one usually doesn't cause painful 400 00:22:13.880 --> 00:22:17.160 period cramps because you don't get your period because you're pregnant, 401 00:22:17.240 --> 00:22:20.240