How much pain is too much?

Holly Crawford was no stranger to pain. In her long career as a halfpipe snowboarder – she was a world champion and a four-time Olympian – she had endured the pain of broken wrists and ribs, as well as the reconstruction of a knee and shoulder.

But the abdominal cramps she experienced shortly after she retired from professional sport in 2018 were a whole new world of pain. She couldn’t work and even struggled to get out of bed.

“When you don’t know what’s causing the pain, it’s scary,” she explains. “I had a remarkable pain threshold because of my training. I had learnt to push through pain, but this was different.”

A short time later, Holly was diagnosed with endometriosis, a chronic condition that affects 10% of women of reproductive age. Symptoms are wide-ranging but can include pelvic pain, painful periods, fatigue and nausea. It’s a complex condition and, unlike Holly who was diagnosed within months, many women put up with the pain for years before they are given a diagnosis.

“Far too many women endure their pain alone or have gone to doctors who have dismissed their pain as ‘normal’,” says Jean Hailes gynaecologist Dr Pav Nanayakkara. “That’s not acceptable.”

How do you know when pain is too much?

While Dr Nanayakkara believes that each woman’s experience of pain is different, she recommends any pain that’s making life miserable be checked out. “The key message is that women should not suffer in silence,” she says.

For example, any one of these scenarios warrants a discussion with your doctor:

• Your pain is stopping you from doing daily activities – going to work or school, being physically active, sleeping or socialising.
• Your pain cannot be managed with over-the-counter painkillers (e.g. paracetamol or ibuprofen) or other means such as heat packs.
• Your pain is becoming more severe or becoming more frequent.
• You’re not sure if your level of pain is normal.

How to talk to your doctor about pain

Jean Hailes GP Dr Tessa King says it can be difficult for women to describe pain to their doctors. “This is especially so with pelvic pain because it can be hard for women to localise the pain to a particular spot. But that’s okay – there’s no expectation that you should be able to describe it accurately. However the more information you can provide, the better.”

Both Dr King and Dr Nanayakkara suggest keeping a pain diary. “It’s good to take a note of pain frequency, how long it lasts and how severe it is on a scale of one to 10,” advises Dr King. “Also mention if it affects your ability to do something that day. Describe how it affects your ability to function.

“When it comes to pain in the pelvic region, it’s also helpful to mark when you have your period on the calendar. Does the pain happen before your period or is it unrelated to your menstrual cycle?”

“Take note of anything that might have triggered it, such as food or movement,” adds Dr Nanayakkara.

What’s the next step if women feel their doctor isn’t listening to them? Dr King says, “A lot of women have that experience of talking about severe period pain and being told it’s normal. These women can seek a second opinion or seek out a doctor who specialises in women’s health.”

What’s that pain?

Whether it’s to do with female hormones, body parts or for reasons unknown, some chronic pain conditions are seen more frequently in women than men. Here are some of the more common ones:

• Pelvic pain: Learn about the different causes of pelvic pain and when to seek help.
  
• Fibromyalgia: A chronic condition that causes pain and muscle stiffness in many parts of the body.
• Rheumatoid arthritis: An inflammatory condition caused when the body’s immune system attacks its own tissues, usually the joints.
  
• Migraine: The vast majority of people who experience migraine are women.
  
• Painful bladder syndrome: Also known as ‘interstitial cystitis’, there is irritation of the bladder wall but no infection.
  
• Vulvodynia: A complex pain syndrome of the vulva.
  

The power of sharing

Holly’s diagnosis of endometriosis was only the beginning of her health journey. Surgery revealed that her disease was well advanced. “It was attacking my bowel,” she recalls. “It was everywhere. I ended up in hospital for 10 days because they were worried my bowel had been injured. It was quite traumatic.”

Nearly four years later, Holly still sometimes struggles to manage her pain. “I had to begin rebuilding my body,” she says. “On really bad days, I try to be kinder to myself. I’m now better emotionally and mentally in dealing with it, and that’s part of the journey. But there are days when I just can’t get up.

“Having a support system around you is important. There is never any one solution medically for everyone. And that’s why it’s important for women to share their stories.”