Why Don't We Know What Causes Period Cramps?

by Pamela J. Hobart

Having an approximately monthly period is normal for human females during their reproductive years, and this cycle is often accompanied by unpleasant to excruciating cramps. Unfortunately, what causes period cramps is still basically a mystery and sexism might be part of the reason why. Just because period cramps (and other menstrual and premenstrual symptoms) are common doesn't mean that women must enjoy bearing their "natural" burden. It's time for science to divert a little much-deserved attention towards this scourge on women.

The vast majority of women (around 90 percent) routinely experience at least one symptom of premenstrual syndrome (PMS), including swollen breasts, bloating, joint and muscle pain, headaches, and skin problems. PMS rises to the level of premenstrual dysphoric disorder (PMDD) when it also involves psychological symptoms, such as despair, anxiety, panic attacks, and even suicidal thoughts.

Treatment for PMS is usually limited to over-the-counter painkillers or diuretic combos (Midol, anybody?) or minor relief measures like heating pads, and PMDD can sometimes be treated with antidepressants. You may be offered a birth control prescription for either PMS or PMDD control, but these definitely don't work for everyone (and may come with side effects of their own).

According to ResearchGate, more than 40% of women with PMS do not respond to the available treatments, though, and not much is being done to help them. A search of ResearchGate materials shows that there are way more studies about erectile dysfunction than about PMS, more than five times as many, despite the fact that erectile dysfunction is fairly uncommon (less than 20 percent of men will experience ED during their lifetimes). Now, that's not to say that erectile dysfunction isn't important too. But can you imagine if researchers had come up with the Viagra of PMS by now? Women everywhere would be joyfully taking weeks and months of their lives back.

It's not just bad luck that women's health problems have gotten the short end of the stick, research-wise. Some evidence indicates that bias against PMS-related research is systemic. For instance, psychologist Kathleen Lustyk of the University of Washington has had a grant application on the subject of PMS rejected because (according to her reviewer) PMS is "merely a product of our society or culture that has painted a natural process in a negative light and that, given its monthly predictability, leads to suffering through anticipation."

This naturalistic fallacy of the reviewer's could have directly caused Lustyk not to receive grant money that would have furthered knowledge of PMS. Of course, we all already know that period cramps are "natural." And, of course, "natural"-ness doesn't mean something is good or desirable. Erectile dysfunction can be a natural and predictable symptom of aging, but you don't see men writing off their own ED-related suffering.

This lack of curiosity regarding PMS within the scientific community is especially disappointing, given that scientists currently don't understand anything about period cramps and other PMS symptoms. As a reproductive endocrinologist told The Guardian last year, PMSing women actually show normal levels of various hormones, so what's truly causing their symptoms remains completely unknown.

On top of just being a humane thing to do, solving the problem of PMS makes good economic sense, too. Though the financial costs of menstruation on our economy is obviously difficult to quantify, one 2005 study took a stab at it. About one third of the reproductive (and working) aged women in the study group were diagnosed with PMS, and a PMS diagnosis was associated with $59 of direct costs and $4,333 of indirect costs per year. The direct costs of medical care for PMS were probably low because there's not much doctors can do for you if you report having PMS, while those steep indirect costs are a result of additional time off work, and reduced productivity while at work, due to PMS.

If there were more treatments for PMS and the related period cramps, the direct medical costs for PMS patients would increase from providing them, but the indirect costs could fall dramatically. Even if a PMS drug cost $100 per month, that could still mean around $3,000 of annual savings for employers (not to mention the avoided pain and suffering for PMS sufferers themselves). Period cramps are not imaginary or inevitable, they are a physical symptom of a physical condition. Women joke about their PMS to add a little levity to a bad situation, but they constitute a huge and eager market for solutions. Ignoring this medical condition is a bad way to treat women, and it's bad science too.

Images: Giphy(4)