Underrecognition of Dysmenorrhea Is an Iatrogenic Harm

Abstract

Many patients face years of recurrent and debilitating menstrual pain that affects their ability to work and study. Patients often normalize their severe pain as an expected part of menses. Both underrecognition and lack of awareness of available therapies for this remediable condition serve as a quintessential example of hermeneutic injustice. Hermeneutic injustice describes a structural lack of access to epistemic resources, such as shared concepts and knowledge. Pervasive menstrual stigma further discourages people with dysmenorrhea from discussing their symptoms and seeking health care. A lack of respect for women's experiences of pain in clinical encounters acts to worsen these issues and should be considered a source of iatrogenic harm. Health care workers can promote hermeneutic justice by preemptively destigmatizing discussions about menstruation and validating patients' concerns. On a systemic level, there should be greater awareness of dysmenorrhea and the various treatments available for it.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. CaseWhile taking a contraceptive history in clinic, Dr G's 55-year-old patient, JJ, remarks, "I wish I could have had an IUD when I menstruated." Dr G then uncovers a long history of JJ's painful menses with severe nausea, crippling cramps, and occasional fainting. JJ regularly missed at least a day of school or work each month."Did you see a physician when you had pain?" asks Dr G."No," said JJ. "Women didn't see physicians for that. I thought every woman had pain like me." CommentaryCountless people who menstruate have spent many days of their lives curled in bed unable to partake in their normal activities while they unnecessarily suffer from a

More than Cramps in Scrubs: Exploring Dysmenorrhea among Women Healthcare Workers

“…Gender bias could be a potential contributing factor as to why dysmenorrhea remains understudied, as it is considered "the tax" that women must pay, instead of a pressing medical disorder. 21 This lack of consciousness is 750 in fact another impediment to effectively diagnosing and managing dysmenorrhea, as the main sources of menstrual information are family, friends, and teachers, accounting for 63%, 52%, and 23% of informational sources, respectively. 3 The consideration of menstrual pain as "normal" is only exacerbated due to its association with family history.…”