From hormones to endo to PCOS, we’re blowing up everything you thought you knew about your cycle
— and why it’s time to start listening to your body.
Let’s be real — periods are a huge part of life for millions of us, but we’re still taught to suffer through the pain, stay quiet about the discomfort, and not ask too many questions. In today’s episode, I’m joined by Kate Helen Downey, host of the incredible podcast CRAMPED, who is on a mission to change that. We’re getting into everything you should have been taught about your body but probably weren’t –– the truth about hormones, the reality of living with endometriosis (endo) and PCOS, why the system isn’t built for menstruating bodies, and how period pain is affecting our wallets, careers, and overall health.
If you’ve ever wondered whether your pain is “normal” (hint: if it’s wrecking your day, it’s not!), or felt dismissed by doctors when you tried to get answers, this conversation will make you feel seen. We’re breaking down the phases of your hormonal cycle, what debilitating period symptoms might be telling you, and why advocating for your health — even when the system is stacked against you — is an act of radical self-care.
Key takeaways:
Severe period pain is NOT normal — and it’s way more common than you think.
Kate shares that up to 30% of menstruating people worldwide experience debilitating period pain, yet society normalizes this suffering. Severe cramps, nausea, fainting, and vomiting during periods are serious signs that something deeper, like endometriosis, could be happening — not something to be brushed off as “just bad cramps.”
Our world is designed for male hormonal cycles, not menstrual cycles.
Tori and Kate break down the four phases of the menstrual cycle — menstrual, follicular, ovulatory, and luteal — and reveal how each phase affects your mood, energy, and physical performance. Unlike men’s 24-hour hormonal cycles, people who menstruate experience significant shifts throughout a 28-day cycle, yet society expects consistent productivity every day.
Diagnosis delays and medical gaslighting are major barriers to care.
Kate spent 22 years suffering without a proper diagnosis because many doctors dismiss women’s pain or lack education on conditions like endometriosis and PCOS. It took having a microphone — not a uterus — to finally get access to real experts and useful information. Patients are frequently told “everything is normal” after basic tests like ultrasounds, even when serious conditions are missed.
Severe period symptoms warrant better medical advocacy — and a different approach when speaking to doctors.
Kate emphasizes that describing symptoms in terms of functionality (what you can’t physically do because of the pain) rather than just emotional suffering can help you get taken more seriously by doctors. She also encourages persistence: if a provider dismisses you, seek another opinion, even if it means paying out of pocket.
Managing period pain comes at a steep financial and emotional cost
Kate revealed she spent over $14,000 in one year on health insurance premiums, specialist visits, physical therapy, supplements, and treatments to manage her endometriosis. Beyond personal costs, period pain also costs the economy billions each year in lost productivity, with many menstruators forced to work through debilitating pain without support.
Bodily autonomy is often a privilege — but it shouldn’t be.
Ultimately, Kate shares that access to proper healthcare, answers, and treatment gave her a sense of bodily autonomy — something she believes everyone deserves but that often requires money, privilege, and persistence in a deeply broken system.
Notable quotes
“A normal amount of pain is ideally none. If it hurts really badly, something is wrong.”
“Our hormones run everything in our bodies and lives, and yet we live in a world that is not built for us.”
“More than anything, what my money got me was bodily autonomy — and that is both empowering and heartbreaking.”
Episode-at-a-glance
≫ 02:25 Kate’s Personal Experience with Severe Period Pain
≫ 08:32 Societal Misunderstanding of Menstruation
≫ 16:12 Normal vs. Abnormal Period Symptoms
≫ 25:14 The Hormonal Cycle Explained
≫ 36:49 The Financial Cost of Periods
≫ 39:57 Challenges with Insurance and Diagnosis
≫ 45:13 Understanding Endometriosis and PCOS
≫ 58:53 Mental Health Impact of Period Pain
≫ 01:01:14 Economic Impact of Period Pain
≫ 01:08:08 Remedies and Self-Care Tips
Kate’s Links:
Website: https://www.katehelendowney.com/
CRAMPED podcast: https://www.katehelendowney.com/cramped
Instagram: https://www.instagram.com/katehelendowney/
TikTok: https://www.tiktok.com/@kateiscramped
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Meet Kate
Kate Helen Downey is the host and creator of CRAMPED, a podcast investigating why we know so little about period pain. Previously, she’s worked on shows like Pushkin’s Revisionist History, Wondery’s Scamfluencers and Diss And Tell, and Glamorous Trash. Specializing in creating entertainment out of information, she is the cofounder of Caveat NYC, and used to give renegade tours of the Metropolitan Museum of Art with Museum Hack and assistant direct operas at New York City Opera.
Transcript:
Tori Dunlap:
Periods are a monthly part of our lives, so why do we know so little about them and why is our pain not taken seriously? Let’s get into it.
Hi, financial feminists, welcome back to the show. I am so excited to see you as always, my name is Tori. I’m a New York Times bestselling author. I’m a money expert. I’ve helped over 5 million women be better with money, and I host this show, which is the number one money podcast for women in the world. So if you’re joining me, you’re in very good company and I appreciate your support as always. I’m just going to plug it right off the top. Please share this episode. Please share this podcast. Self-promotion is always a little weird. It’s always a little weird to come on here and be like, “Share the shit that I do, share the shit that I produce.”
But I’m here to tell you that running a feminist company is really hard. It’s hard on a good day. It’s especially hard right now, and there’s a lot of noise in the podcast base from a lot of bros with microphones who shouldn’t have microphones. We just appreciate you sharing this show. It’s free for you. We have almost 250 episodes at this point. And there is so much valuable stuff that you can use to not only change your money, but change your relationships, change your health, change your entire life. If you’ve ever gotten an ounce of value from this show, please share it. It’s the easiest way to keep making this show available and accessible to you and to everybody listening.
This is expensive for us to produce, but free for you all. And we really appreciate you sharing feminist media always, but especially right now. It’s the easiest thing you can do. It doesn’t cost you any money to share the show with somebody you think might love it. So we really appreciate it. This episode is very fun and it’s back to our roots at Financial Feminist, which is not just talking about the financial, but talking about the feminist. Kate Helen Downey is the host and creator of CRAMPED, a podcast investigating why we know so little about period pain. Previously, she worked on shows like Pushkin, Revisionist History, Wondery’s Scamfluencers and Diss and Tell and Glamorous Trash.
Specializing in creating entertainment out of information, she’s the co-founder of Caveat New York City and used to give renegade tours of the Metropolitan Museum of Art with Museum Hack, and she’s an assistant director in New York City Opera. Today we are talking about Kate’s journey from having what she calls death cramps to finally getting an endometriosis diagnosis and everything she learned along that journey. I learned more in this episode than I learned in decades of being somebody who menstruates. We get into how our hormonal cycle works, how the world isn’t built to accommodate that cycle, and the broad effect on our time and our wallets. This is something that will single-handedly change your life.
I learned this a couple of years ago that basically every single day of your menstrual cycle will cause you to have different energy levels, different bandwidth, different workout or diet needs. But of course, we live in a patriarchal world and a calendar and a timeline that is built based on men’s bodies. A content warning. We are talking about some bodily functions that often accompany periods and bodies in general. This is very refreshing and open, but we want to be transparent about that. So I don’t think there’s any reason to not have children around, but if you want to do some education first, great. Amazing. This is a really powerful episode, especially to share it with the women and the people who menstruate in your life.
This is a perfect conversation starter about period pain, about endometriosis, about PCOS, about anything that’s going on for you and your reproductive system. So let’s get into it. But first a word from our sponsors. I will probably yell, knowing the topic of this conversation is going to piss me off.
Kate Helen Downey:
It will. I promise. [inaudible 00:04:03]
Tori Dunlap:
Kate, I’m so excited to have you. Welcome to the show. Can you tell me why you do the work that you do and why it’s so important?
Kate Helen Downey:
I mean, the short answer is I do the work that I do right now because I suffered alone for 22 years, and I don’t want anyone else to feel that way.
Tori Dunlap:
We of course want people to listen to the episode, but you open your own podcast with this story of a particularly bad period and what you call death cramps. Can you share an abbreviated version of that story? And it sounds like maybe this was the impetus for realizing, “Oh, this isn’t normal.”
Kate Helen Downey:
I had definitely realized it wasn’t normal before this. I’ll take you through this because I feel like this was the most egregious time that this happened. So I was working at a restaurant, I was a waitress in my early twenties while I was in college. I was working at a fancy restaurant, the fanciest place I’d ever worked at. Not a whiskey bar, not a seafood shack, but a fancy restaurant.
Tori Dunlap:
An Applebee’s.
Kate Helen Downey:
A fancy restaurant in Boston, and you have to wear the crisp white shirt, the fun tie, multi-course servings. So I was working a lunch rush, I was so caught up in getting everything right, pleasing the chef, making sure I wasn’t screwing up any orders, and all of a sudden I realized, “Oh, fuck, I have cramps.” And for me personally, that realization is never just like, “Damn, that sucks.” It’s like, “This is an emergency. I might be in real trouble here.” What makes me realize I have cramps, and they might get really bad, is my whole body breaks out in a sweat like it does right before you throw up with the nausea. My back hurts very badly. It’s not just in my stomach or in my lower belly.
It is a full body experience. So I realized, I have to get to a bathroom right now. I grab a waiter who has been nice to me even though, it’s because he wants to sleep with me, but whatever. I’ll take the niceness. I tell him, “I am having an emergency, I have to go. Can you please cover my tables? Here’s a bunch of information about the tables that…” And he’s like, “What? What’s happening?” I go to the employee bathroom. There’s one employee bathroom. It’s the only one. I lock myself in. I take off my white button down because I know it’s going to get drenched in sweat if I don’t take it off. I kneel down at the toilet and I say, “All right, here we go. Let’s see what happens here.”
An unknown amount of time later, I wake up on the bathroom floor because what happens when I have horrible cramps is I throw up every 10 minutes until there’s just bile coming out. It doesn’t stop because it isn’t about what’s in my stomach. It’s about the amount of pain that my body is in. My stomach just gets rid of anything, just in case it might help. I have diarrhea alternating with the throwing up, which is so fun. And the waves of pain that go through my body are so intense that I often pass out. And that’s actually great because when I pass out, it kind of short circuits the whole process, and when I finally wake up, I am no longer in pain. So I pray to pass out, I pray.
So after I wake up on the floor of the employee bathroom at this fancy restaurant, I sit up, I wake up because someone is knocking hard on the door and yelling my name. There’s no windows. I don’t have my phone on me. I don’t know how many hours it’s been that I’ve been locked in this bathroom. I turn around and there is a outline of my body in sweat. That’s how much the sweat pours off of me when this happens to me. I get my shirt back on and I kind of stumble out. The lunch rush is over. Everyone thinks I’ve been doing drugs in there. I have to tell my manager, “Really sorry that this happened. This is a medical thing that happens to me sometimes.” And I get my ass home.
So that’s just one time that this has happened to me. One of the worst timings, one of the worst places that it has happened, but that is not an unusual experience for me when I get my period.
Tori Dunlap:
Kate, was that every month? Was that every month’s experience?
Kate Helen Downey:
No. No, it’s intermittent. In psychology, it’s like the intermittent reinforcement is the most powerful. So it doesn’t happen every single month, but it does happen every three or four months.
Tori Dunlap:
I’m not usually this speechless this soon into the episode. So broader conversation from that story, because we’re going to talk about period pain, we’re going to talk about all of that, but we live in a society that, one, does not understand women’s bodies. Two, does not care about women’s bodies or menstruating people’s bodies and three-
Kate Helen Downey:
Or quality of life.
Tori Dunlap:
Or quality of life. And three, misunderstands it to the point where you are passed out on the floor after basement and attic situations here.
Kate Helen Downey:
I like that terminology.
Tori Dunlap:
That’s what my mom, when one of us has food poisoning. She’s like, “Basement, attic, or both?”
Kate Helen Downey:
I’m using that.
Tori Dunlap:
Great. And yet, you were doing drugs in the bathroom. So can we talk about what at a societal level is going on when menstruating people have their periods and sometimes they’re debilitating or at the very least they’re uncomfortable for five to seven days? Society does not understand that.
Kate Helen Downey:
No, and part of it is that we don’t talk about it. It’s a chicken egg situation that I don’t know which came first, but society can’t understand and be empathetic to something that they don’t know exists and they have no context for. I’ll give you some numbers because I think without these numbers, it can be very much like, “Well, everybody’s got a weird medical thing. Everybody’s dealing with some weird pain.” So when you’re talking about menstruating people, people who are ovulating, people who are menstruating. 95% of menstruating people experience some kind of pain with menstruation. And so that can range a lot.
That can be just your “average” period cramps, which what is that? We don’t know what is normal because we don’t talk about it, but just some discomfort, a little bit of aching, something that is not going to screw up your day, but you’re just going to kind of go, “This sucks. Maybe take an ibuprofen. You’re fine.” 95% of menstruating people are experiencing that kind of pain. Up to 30%, and this is a number that has been reached through… I can talk about later why this research is bad, why this data is not great, but at least 30% of menstruating people experience debilitating period pain, severe period pain.
Period pain that keeps them from doing their day-to-day activities. So they may not be throwing up and having diarrhea and passing out, but it stops them from going to work, from taking care of the people that they take care of, from taking care of themselves. 30% of menstruating people worldwide is something like 355 million people. And so that’s the scale we’re talking about here. And I like to bring up those numbers because when we say, “Oh, severe period pain.” I think a lot of people think like, “Oh, this happens to 2% of the population. This happens to just a few people.” It’s so many people, and it’s not once a year.
It’s sometimes 12 times a year, once a month. And yet we have no representation of this kind of anywhere in media. We have some representation of periods, just periods, that recognition that they occur. We’re still fighting for that. Stories about that. Period pain and severe period pain, we have no cultural reference point for that.
Tori Dunlap:
The thing I think about all the time is, so if 95% of people are experiencing some sort of discomfort and then at least 30% are experiencing intense physical symptoms, this is on top of you’re just bleeding. You’re bleeding for typically five-ish, give or take, days. And I just think about all of the time that for us as menstruating people, we have to walk through our lives picking up children at school, giving presentations at work. I remember giving… I was literally speaking at the Forbes 30 under 30 conference having cramps. And I’m like, “Oh my God.”
So there’s one part of me that is like, “This is so fucked and this is so crazy that this does not get discussed and is not given the space and the understanding that it needs.” And on the other hand, I’m like, “How fucking badass are we though that our bodies are in constant flux and change? And how strong are we that we live our lives anyway?” So can we maybe talk about when we’re thinking about periods, you have this great sentence in your bio that you sent, “because having a microphone gives you more answers than having a uterus.” What’s going on in that quote for you where you’re like, “Microphone’s giving you more answers than just being someone in existence.”
Kate Helen Downey:
That statement came out of my frustration and rage of going 22 years without getting real help or a diagnosis. And part of the reason I made the podcast was this frustration and this rage. So I’ve had this pain since I was 14. Intermittently, obviously I’ve been to doctors, I ask doctors about it. I’ve been to so many doctors and ask them, what is going on? Why do I have this pain? And I’ve experienced everything from total dismissal, just like, “Oh, it’s cramps. What are you… This is not that big a deal.”
Tori Dunlap:
Slap a heating pad on it. You’re fine.
Kate Helen Downey:
Have you heard of ibuprofen?
Tori Dunlap:
No, I’m throwing up the ibuprofen, guys.
Kate Helen Downey:
And that’s a whole other section of the process. That is what my friend Sydney calls her pill window is the amount of time you have between when you start being in pain to when you’re throwing up at so much you can’t keep meds down, and it’s like you got decisions to make in that pill window. So I’ve heard everything from total dismissal to, “Look, we don’t know what it is, and you’re just going to have to figure it out.” So I also heard the first doctor I ever went to for this when I was 14 told me, “Some women have bad periods and it usually goes away when you have your first kid.”
And it’s like, “What am I supposed to do with that as a 14-year-old?” Which also the research does not back that up. There are some people whose cramps get worse after they have a kid. There are some people whose cramps get better after they have a kid. It is entirely individual.
Tori Dunlap:
But again, that is the solution, which is like, “Oh, just wait however long, maybe forever if you don’t have children.” That is such bullshit.
Kate Helen Downey:
Yes. To answer your actual question, I didn’t find real answers to what I was experiencing, how to help myself, what my diagnosis was until I literally got a microphone, started making this podcast, and sat down with doctors and experts to interview them. And it was so infuriating to me that as a patient, as just a person with a uterus experiencing pain, I did not rate well, good enough care or enough curiosity to get information about this and to have something to go on. But as a podcast host with a microphone interviewing someone, I was able to get in contact with those experts, ask them the questions that I needed answered personally and get those answered. And that to me is so upsetting.
Tori Dunlap:
So when we’re talking about the symptoms and even maybe pulling from the research you’ve done or the conversations you’ve had, what is a “normal” symptom versus something that is not normal and probably something more serious is going on?
Kate Helen Downey:
A huge part of this problem is we don’t culturally or as patients have information about what is normal and what is not normal. I remember in fourth grade having a sex ed class where they told us about what was going to happen to our bodies. I remember getting sample deodorant. I don’t remember being told, “Hey, if you feel anything more than this amount of pain or these symptoms, talk to somebody.” I think that would go a long way. But that is not the focus quality of life. Not being in pain is not the focus of that education. The focus of that education is making the people around you more comfortable by giving you deodorant, telling you to shower more, telling you to use menstrual products so that you don’t make anyone else uncomfortable.
So a normal amount of pain is ideally none. This is a normal bodily function. So just like if it hurts really bad when you take a shit, it shouldn’t hurt really bad when you have your period. The process of having your period involves having a muscular organ, your uterus squeeze, and so you might feel discomfort, you might feel a little aching. The squeezing of your uterus can be involved with your abdominal muscles and the muscles in your lower back. And so a lot of people feel a little bit of achiness or soreness in their lower back as well, sometimes even down into your hips because those tiny pelvic floor muscles are deeply involved with all of the muscles of the uterus.
And so beyond that, also, you might get hungry, you might get cranky. Those are all things-
Tori Dunlap:
Period poops too, that’s pretty common. Your poops getting a little crazy.
Kate Helen Downey:
Period poops are related to cramps. The same prostaglandins, which are little hormonal messengers that cause your uterus to cramp also cause your colon and your intestines to cramp the same way. And so that’s why period poops happen. And so that’s normal. That’s part of the hormonal messaging that’s happening. You might have cravings for different foods, you might notice changes in your emotional receptivity, but those things should not in any way interfere with your life. They should not be making it difficult for you to do the things you have to do.
That is the baseline, if any symptom, whether it’s emotional, whether it’s physical, whether it’s pain, if anything is making it so that you are having a much harder time showing up in your life the way you want to, that’s a problem. And that’s something that your health provider should be able to help you with. And that is just not what happens most of the time.
Tori Dunlap:
I know for me, it’s definitely… I feel like I’ve faucet for five days or it’s like the faucet’s just on. And I jokingly… My periods were a lot more manageable when I was on hormonal birth control. And then I got off of it about two years ago and day two and three of my periods are full murder scenes. They are just murder. I am changing ultra tampon every two and a half hours. And for the most part, other than the general discomfort, I have one bad period a year. I actually just had it last week and-
Kate Helen Downey:
I’m so sorry.
Tori Dunlap:
It’s okay. It’s not throwing up. It’s really bad cramps and a lot of discomfort. But I’m lucky where I have a pretty normal period. And it sounds like for folks listening, a little bit of cramping, feeling like a faucet, period poops, I’m sensitive on a good day, yet along the days before my period, oh my gosh, anything sets me off. So I think that’s all normal. But for people listening, if it is pain that you’re like, “I should be taken seriously with this pain or any sort of discomfort.” That’s when you should talk to somebody. Is that right?
Kate Helen Downey:
Yes. And if you talk to somebody and they don’t have anything for you, if they don’t run any tests. If they run a test and it comes back normal and they say, “Well, that’s the end of the road. Go talk to somebody else, go find somebody else.” And that’s easy to say and hard to do. And I know it puts all of the work on us, and that shouldn’t be the case, but we have to go get the help we need and we have to be educated about it because it’s not out there for us a lot of the time. So there are doctors out there who will take you seriously, who will help you. There are so many people I could recommend to follow on Instagram or TikTok. Dr. Karen Tang is an amazing resource.
She posts all of these videos about people will ask about their symptoms and she will run down, “It could be this, ask for this test. It could be this, ask for this test. If this comes back normal, make sure they run this test.” So she almost gives you a playbook to go into the doctor with, which is so incredibly helpful. And we need that because a lot of the time we are dismissed or we’re told go on birth control because birth control can help people’s symptoms depending on what the underlying cause is. The other kind of galaxy brain thing that I will say and try not to get too deep into because it honestly has broken my brain completely.
Our hormones run everything in our bodies and our lives. We are living in a world that is not built for us. We are living in a world that is constantly telling our bodies that we’re in danger and we’re in an emergency, and that affects our hormones in such a way that our periods can be way worse. One doctor I talked to calls periods the fifth vital sign. It’s like your blood pressure, it’s like your heart rate. It’s a really important measure of your overall health, but it is not treated that way. We don’t gather data on it that way. We are asked, “Do you have normal periods?” And we say, They’re regular. They’re the same every time.”
But we’re not asked, “How much are you bleeding?” We don’t have an easy way to measure how much we’re bleeding. If you’re bleeding, if you’re filling up a super tampon in two hours, you’re probably bleeding too much. You’re probably low on iron. That could be causing or caused by a thyroid issue. And then we get into a whole world that is very scammy and weird of hormone balancing. And yes, that is so full of bland minds, and yet our hormones are very real and they affect our quality of life so much. Even if your hormones are tested and they come back “normal” within normal ranges, that doesn’t mean that you are not feeling legitimate pain or suffering because of an issue with your hormones.
Tori Dunlap:
I have thyroid issue symptoms on another tab open, so we’re going to-
Kate Helen Downey:
And be careful. That’s also a rabbit hole to dive down, but-
Tori Dunlap:
I’m fatigued. I feel tired. Weight gain. Who knows? Bloating or swelling in the face. I mean, maybe.
Kate Helen Downey:
And wow, if you Google it, if you look it up on TikTok, you’re going to find 9,000 people who want to sell you supplements to fix it that will do absolutely nothing.
Tori Dunlap:
Truly. And then they’re like, “Is your cortisol high? Do you have a cortisol face?”
Kate Helen Downey:
I have literally a whole episode coming up where I’m like, “Is my cortisol high? Is that what’s been causing all these problems? Will a supplement from TikTok fix me?”
Tori Dunlap:
Definitely not.
Kate Helen Downey:
And we talk to-
Tori Dunlap:
Definitely not, but Donald Trump is president. I think all of our cortisol is too high.
Kate Helen Downey:
Exactly. Exactly.
Tori Dunlap:
I’m sorry. This is the world we live in once in a lifetime. I would like precedented times, please.
Kate Helen Downey:
Exactly. Exactly. This is so frustrating, but the thing that fixes cortisol imbalance and… Because it’s true, if your cortisol is too high, progesterone makes cortisol and progesterone is what we need for easier, better periods. And so if you are using up cortisol, you don’t have enough progesterone. The fix is to not be stressed out and to rest more. And it’s like-
Tori Dunlap:
Go take a walk.
Kate Helen Downey:
We’re either privileged enough to be able to change our lives to be able to do that or we’re not. And if we’re not, we can’t do it.
Tori Dunlap:
Oh boy. Kate’s story is just getting started. When we come back, we are talking about the hormone cycle of our periods and why it’s important for us to know this information about our bodies as well as the truly astounding cost of just having a period generally. Stay tuned. One of the things that I’ve learned in the past couple of years that blew my mind that I’m like, “Why didn’t somebody teach me this?” Is that it’s not just your five-ish days of a menstrual cycle.
Your cycle is happening in phases and those phases impact your mood and your hormones and your energy levels and your pain. So can we talk about those four phases, what’s happening in our bodies throughout our whole menstrual cycle, not just the days we’re bleeding?
Kate Helen Downey:
Absolutely. And I’ll preface with I am not a doctor. There are people who know way more about this, but I’m happy to give just a top level overview. So we start in your menstrual phase, which is… That’s what’s counted as day one. It’s a cycle, so it doesn’t really matter what day you start counting, but for medical stuff, you start counting day one of your period when you are bleeding. So that is what some holistic practitioners call the body’s winter. So that’s when kind of a lot of hormone levels are low. Your uterus is getting rid of the endometrial lining that it built up to potentially house a baby, to nourish a baby, and it’s scrapping that for the month and saying, “We got to start over.”
So you are bleeding. You are probably lower energy while you’re bleeding. It’s typically thought of as not a time you should be out being social. Not that you can’t, of course you can, but your body and your hormones are craving rest, craving downtime. After that, whenever you are finished bleeding, we move into a cycle called follicular and it’s called follicular because it’s referring to the follicles in your ovary. Every month you have multiple follicles that might… Of course you have all the eggs that you’re ever going to have. And a crazy fact is that you are born with all the eggs you’re ever going to have.
But because you are born with all the eggs you’re ever going to have… If I have a kid, my kid was in my ovary when I was in my mom’s ovary, which is crazy. But anyway, the follicles are the potential eggs in your reserve that are maybe going to get released this cycle. And they fight for domination. Multiple follicles start maturing every cycle, and they get selected by a very cool process. So one follicle rules them all at the end of the day. At the end of the follicular phase, you release an egg, you ovulate. During the follicular phase, that’s sort of the body’s spring. So things are getting a little… Things are warming up, you’re getting a little bit more energy.
You are feeling probably, getting towards higher energy, more social, more active. When you ovulate, a bunch of things are happening with your hormones. In your follicular phase, the lining of your uterus has been thickening and regrowing in preparation to maybe house a fetus. And when you ovulate, you get this spike in luteinizing hormone and then a spike in estrogen, and this causes a release of the egg. So then you’re in your ovulatory phase. This is the highest energy. This is when you want to do your big workouts, your run your marathon. This is when you have the most energy, you’re the most social.
A hormone expert that I talked to, it was really interesting to hear her perspective on this. When we have a lot of estrogen flowing around in our system, we tend to be more social, more outgoing, even more verbal. And when we have more progesterone, higher progesterone in our system, that is more of a nesting thing. That is rest, that is stay home for the night. That is when you want to rot in bed. And so not only do those hormones affect your behavior, but your behavior can affect those hormones. And as a yapper myself, I’m like, “Wow. Maybe I have high estrogen.” Not just that I have it and it makes me talk, but I talk and it makes me have higher estrogen, maybe.
Well, regardless after ovulation, we get into the luteal phase. So the luteal phase is when all the crappy stuff happens, it’s the body’s autumn. Progesterone is building this whole time and estrogen is dropping. The progesterone building is what thickens that endometrial lining. What it’s waiting for is did this egg get fertilized? The progesterone comes from a little thing on the ovary after the egg released called the corpus luteum. It’s also called the yellow body. It produces progesterone, which makes the lining of your uterus build even more. And if the egg is not fertilized, that corpus luteum breaks down and leads to a very quick drop in progesterone.
That drop affects things like serotonin, but it also releases prostaglandins, which signal to the uterus to cramp, which starts your period. And then we’re back at the beginning of the cycle. But the luteal phase is where people often feel PMS. If you notice that you’re PMS, you’re cranky, your food cravings, your energy is really low, that all happens usually in the lead up to your period. And once you get your period, those symptoms ease pretty quickly. And that’s because what you’re feeling, what’s giving you those symptoms is this progesterone, this higher progesterone. Everybody reacts differently to that higher progesterone.
Everybody’s processes are different, but once that progesterone drops, we usually feel a lot better.
Tori Dunlap:
I want to blow up my entire life in the luteal phase.
Kate Helen Downey:
And that’s what I’m talking about when I say nothing in this world is built for us. We have these 24 to 30 day cycles where our energy is vastly different week to week. Area of the cycle to area of the cycle, our lives, our entire structures are built around men’s hormonal cycles, which are 24 hours. It’s why we have a nine to five. It’s why we work during the day and we have fun at night and then go to sleep. That is based on men’s hormonal cycles.
The fact that we are supposed to be consistent, there’s this expectation we don’t even think about, that from week to week we’re supposed to get the same amount of work done. We’re supposed to work out the same amount. That’s just not realistic for our bodies and expecting us to live that way is what is putting stress on our hormonal systems.
Tori Dunlap:
I think for anybody listening where you’ve never heard this before, please do more research and we’ll actually have future guests to talk about it because it is something that changed my life. And I do think about it, and I’m really glad you brought the seasons up because that’s how I think about it. And correct me if I’m wrong, I believe spring and fall are the longest, with winter and summer being the shortest. So your menstruation is shorter, but also your fun sexy time, summer, is also short. The spring, the buildup to summer, is long. The buildup to menstruation is long.
So when I start realizing that, and again, not everybody has this luxury, but there are certain things I try to do during phases that I know are going to be supportive of that. I have not fully gotten to the point where I’ve had my team be like, “We’re only recording podcast episodes when I am in summer.” But something to reach for, but I have realized even at the gym, that one’s the very, the one I can see a ton because I lift weights. I can see I lift a lot more weights. I can lift a lot more and it feels easier when I am not either menstruating. I actually don’t typically lift weights at all when I’m menstruating because of low back stuff.
I’m nervous about that. But also during luteal, it’s so interesting. So spring and summer is where I do a lot more of my literal heavy lifting.
Kate Helen Downey:
We have to learn how to think about this so differently because like you said, we are programmed to think like, “Oh, we have being on our period and not being on our period.” And those are the two phases of our lives. And it’s the same way with exercise. Like you’re talking about, that is something so obviously physical, it’s easy to notice the difference. I have struggled a lot because in my mind for a long time I was either working out, which meant really intense HIT classes or going for long runs or half-marathons and achieving things physically or not doing that at all. Those were the two modes for me.
And I have had to totally change how I think about taking care of myself, how I think about exercising. When I am able to exercise and move my body, even if that’s super gentle yoga in the luteal phase or just taking a walk. My symptoms are way better. And if I overdo it, if I go on a really hard run in my luteal phase, I pay for it. I suffer. That is not what my body needs. And so we have to stop letting external expectations run how we take care of ourselves.
Tori Dunlap:
I mean what we talk about all the time on this show that an act of protest is getting money or an act of protest really more broadly is stop believing that you have to conform to a system, to your point. And I wrote about it in my book, that has not been built by or for you. So if you can slow down and understand and actually ask yourself, what do I feel like doing today? Not what I should do or not what society wants from me, but what is my actual energy levels? What do I actually feel like doing? And we live under capitalism, so you can’t just fuck off and play around sometimes.
But if it is just, “I am going to not push myself and not go to my crazy gym where I’m going to lift heavy weights and I just need to walk today.” Great. Or if it means, “I need to take some time off and work from home today.” There’s some flexibility that we can have.
Kate Helen Downey:
And a lot of this is also in social obligations too. And this was something as a yapper, as an extrovert, I struggled with a ton because there were times when I had social things that I had committed to. I had people who were expecting me to show up somewhere, and I was, if not in pain, I had nothing to give. I was not in a place to be able to show up and be social, and I did not want to say no, and I forced myself to do it, and I paid for it. And so part of that too has been… And that requires being in a social support network that understands, “Hey, I can’t come to your birthday party tonight. I’m really sorry. Let’s get lunch next week and I will treat you to lunch. We will celebrate you, but I do not have this in me.”
And I think being in my thirties has really helped with managing that, making decisions about how my energy and my social time is spent. But that’s really hard. And as women, we are socialized to show up for other people to our own detriment. And we have to not only think of our work and our money that way, I’m sure you’ve talked about this before on the podcast, but thinking of your time not as money, but the same way you think of your money. Your time and your energy of, “I have limited energy. I have limited wellness. How am I going to spend that? What aligns with my values and what do I have to say?”
Sorry. No, you don’t get my energy today.
Tori Dunlap:
To switch gears a little bit, can we talk about the actual cost of periods, the financial costs? Because let me check my notes. You said you spent $14,622 on cramp treatment in 2024. Tell me where did that money go? And also how much are we spending as people who menstruate at the individual level? And we’ll talk about the societal level in a second, but how much money are we spending trying to manage our pain?
Kate Helen Downey:
And mine is an extreme case, and I want to preface this in that you don’t have to spend $14,000 to properly manage your pain. I’ll go on average first and then come back to exactly what I spent my money on. But on average, menstruating people spend about $20 per cycle on menstrual products. So the average ovulating person has about 450 periods in their lifetime, which ends up being about $9,000 you’re spending on menstrual products over the course of your life. Which again, we have 12 periods a year. We are like, “That doesn’t sound like a lot, but it sure adds up.” And that changes depending on what state you’re in, what the taxes are like.
The most expensive place to have a period right now is New York State, partly because of the taxes. One of the cheapest places is Ohio. And literally, it’s $20 on average in New York, and it’s $12 on average in Ohio. So this varies a lot. Some of this is a pink tax thing. Some of this is just a regular taxes are higher in New York thing, but that’s a lot of money. And that’s just for people whose menstruation is no problem. That’s for anyone who has a period managing their period in a healthy way. When we get into having period pain and how you manage that… I’ll do a really quick breakdown of what I spent this money on.
About 4,800 of that was just what I pay in health insurance premiums. I pay $400 a month in health insurance, and I did not go through my health insurance to get my period pain treated and diagnosed. And I can get into why I didn’t later, but I was paying that in case I got hit by a bus or got strep throat or something while I paid out of pocket for my period pain treatment and diagnosis. And so the rest of that, roughly $10,000 was spent on specialists, pelvic floor physical therapy, an integrative nutritionist, supplements, medications and tools to help with my pain. And that was over the course of a year.
Tori Dunlap:
Oh god.
Kate Helen Downey:
I don’t have a lot of money. The reason… This is savings that I would’ve loved to spend on something else. Will I ever be able to buy a house? Probably not. But I did not save this $10,000 to spend on period pain.
Tori Dunlap:
And that is the cost unfortunately, of managing it, but also getting good healthcare. So very briefly, can we talk about why did you have to go to somewhere else? Why did you have to go out of network in order to get the care you needed?
Kate Helen Downey:
So I’ll preface this with, I probably could have gotten some treatment for this pain through my network. I did a lot of research and heard a lot of stories. I spent a lot of time on subreddits for period pain on other communities where people were talking about their journey to get a diagnosis and to get treatment. And what I learned through this and through talking to some specialists was that when you go through insurance, you are only getting the care that your insurance provider thinks you should have. And when it comes to things like period pain and the conditions that most often cause severe period pain, like endometriosis, PCOS, fibroids.
Very often the insurance companies do not have the most up-to-date information or there simply isn’t enough information or research done for them to be able to cover the appropriate treatment. So using my own case as an example, based on my symptoms and pain specialist I talked to, I was told, “You probably have endometriosis, you should go see a specialist.” If I had gone to my gynecologist through my health insurance, what probably would’ve happened is they would’ve said in their little seven minutes that they’re allowed to spend with me, “Well, to figure out if…” Well, here’s what they had done in the past is they had sent me for an ultrasound.
My ultrasounds, every time I got them, came back normal. And that would always be the end of the road. That would be, “We got an ultrasound. There’s nothing weird about doing the physical exam. Nothing was weird. Nothing was weird in the ultrasound, we didn’t see anything. So what you’re feeling is normal, nothing is wrong.” And I was told that for 22 years and I knew something was wrong. I knew what was happening to me was not okay, not normal. Something was wrong. And so it took going to an endometriosis specialist here in LA, which caused over $800 just for the initial appointment and exam.
But in that initial appointment exam, she went through and reviewed all of my previous imaging, all of my previous medical records, sat with me, and asked me lots of questions about my experience, my quality of life, my symptoms, did an exam and told me at the end of this hour she spent with me, “I’m 95% sure that you have endometriosis.” Technically, endometriosis is not diagnosable without laparoscopic surgery, which is where it’s a minimally invasive surgery where they cut four, five little holes in your belly and send in cameras and equipment and fill your belly up with gas so they can see what’s going on.
They take little samples of where they think endometriosis might be, send them to a lab, and the lab confirms if those cells are the same kinds of cells that are inside the lining of your uterus. So that’s how you get diagnosed, is fucking surgery. It’s not efficient. There are lots of research projects being done right now to try to find a better way, a less invasive way to diagnose. Because when you go through insurance, obviously they’re not going to cover anything that isn’t confirmed diagnosed. If you go through insurance, you might end up with subpar surgery because, and again, we talk about this is overarching over every aspect of our healthcare system, of our culture, of our society is not informed, is not interested or curious in improving this.
And they do not know about this. So gynecologists might not get a lot of information on endometriosis despite the fact that one in 10 people with uteruses has endometriosis. It is the number one cause of painful periods. And yet gynecologists are generally not trained on this. And if they are trained on this, they are not trained well enough to know that most of the time you can’t see it on an ultrasound, which is what happened to me. So many people are turned away, are told there’s no way they have endometriosis. I was told there was no way I had endometriosis because I have light periods. I don’t bleed heavily. And so I was told, “There’s no way you have it.”
Over and over and over again. Go see a specialist. They’re like, “No, that as nothing to do with it.”
Tori Dunlap:
I’d be so curious to know if you’re listening on Spotify, leave a comment and let us know how much you think you spend on period products a year. When we come back, we’re talking more about endometriosis, PCOS, and how to get our doctors to listen to us and take us fucking seriously. We’ll be right back. I think the conversation is changing a lot because you’re right, I didn’t hear the word endometriosis 10 years ago or PCOS. But I feel like a lot, probably because of social media, the democratization of this information, many of my close friends now have endo or PCOS diagnosis or treatment plans.
Can we talk a bit more about if you do know the difference between both of these and what kind of symptoms someone listening might go, “Oh, maybe I should look into this more?”
Kate Helen Downey:
Yes, absolutely. So to get to the basics, endometriosis and adenomyosis are caused basically by the same thing. And again, not a doctor, you should talk your doctor if you think you might have this. But the lining of your uterus, your endometrial lining is made of cells that react to hormones like estrogen and progesterone to thicken to house a baby. They don’t know why but for one in 10 people, these cells end up in places outside the lining of the uterus. And that’s endometriosis. So if you have endometriosis, you have cells, and this can be one or two cells, this can be a big group of cells.
They are living somewhere they’re implanted somewhere in your body that is not the lining of the uterus where they’re supposed to be. That means that wherever they are, most often it’s on the ovaries or the bladder or the intestines. But there have been confirmed cases of it in people’s lungs, in their brains, in their noses. Wherever these cells are in your body, they react to hormones the same way the cells that are inside your uterus do where they thicken based on the progesterone and they bleed based on the drop in progesterone. And so that means if you have endometriosis, you have spots in your body that are bleeding, you’re bleeding internally every time you get your period.
That in itself is a problem. That shouldn’t happen. That blood has nowhere to go. It creates a lot of irritation and inflammation wherever it is. Your body doesn’t have a way to deal with other than something is wrong. “White blood cells, go get it, figure it out, protect it.” And so what you end up with is a lot of scar tissue called adhesions that basically glue your organs together. So if you have, say some endometrial cells on your bladder and your bladder, the organs in your body, they’re all next to each other. There’s no space between them. So if you have endometrial cells on your bladder that are bleeding and getting inflamed every month for years and years.
The scar tissue that forms ends up basically gluing your bladder to maybe your uterus or maybe your intestine or maybe the side wall of your pelvis. And so that causes problems with whatever organ it’s attached to. The problem is this endometriosis can be anywhere and it causes different symptoms depending on where it is. So the biggest symptom to look out for is period pain. Although if you have endometriosis, that doesn’t mean you always have period pain. I highly suspect because my sister also has horrible periods, has never gotten a diagnosis, I now have the diagnosis of endometriosis. I suspect she does. Our mom has never had painful periods.
That doesn’t mean she doesn’t have endometriosis because it is highly genetic. So a big, big symptom is period pain. There’s an estimation that 70% of severe period pain is caused by undiagnosed endometriosis. My doctor thought it was even higher, probably closer to 90% of severe period pain caused by undiagnosed endometriosis. So that’s a huge one.
Tori Dunlap:
Is PCOS similar symptoms? Severe period pain, maybe heavy bleeding. What is a telltale sign, typically, of PCOS?
Kate Helen Downey:
So PCOS is different. It does not have anything to do with the lining of your uterus or the cells being somewhere else. PCOS is a condition where your hormones are really out of whack. It’s really a hormonal disorder, but it leads to having a lot of cysts on your uterus. So polycystic, multiple cysts, but it also can lead to hair growth in places you don’t want hair growth. The big symptom of PCOS other than pain, is really irregular periods.
So people with PCOS may not ovulate or because of those cysts on their ovaries, they may not have a period for months at a time and then have one really bad period where it’s almost like months of period blood coming out at once. And so that’s a different disorder with a different treatment, but it also can cause really bad period pain.
Tori Dunlap:
So basically the big takeaway everybody, is that if you are in severe pain or even pain that is debilitating you or preventing you from being able to do your daily life, it’s time to go see a doctor.
Kate Helen Downey:
Yes. And if that doctor doesn’t have anything to say to you about that, it’s time to see a different doctor, even if you have to pay for it, if you can. Because unfortunately we live in a system where you have to pay for better care.
Tori Dunlap:
Right. What are you saying to the doctor to get them to take you seriously? What is that script?
Kate Helen Downey:
Yes, that’s a great question. The biggest thing that you can say is, “This is affecting my quality of life. These symptoms are making it so that I cannot do the things I usually do in my life.” There have been studies about how women communicate pain and how men communicate pain differently. Men usually communicate pain based on what they can and cannot do. Whether that’s physical movements, like, “My shoulder hurts and so I can’t lift it above here,” or, “Oh, I can’t drive the car,” or whatever. They will talk about it in terms of functionality. Whereas women will often talk about their pain in terms of emotionality. They’ll describe how it hurts and what it feels like.
And they’ll also describe what it is keeping them from doing in terms of social and emotional responsibilities where like, “Oh, I can’t go to my friend’s party. I can’t even listen. It hurts so much. I can’t listen to my friend talk.” Not that this is our fault, but what ends up happening is that doctors tend to prescribe antidepressants and antianxiety to women when they complain of pain and painkillers, when men complain of pain. And look, this is not… I’m not saying we have to act a different way. We have to… But if in order to get appropriate care, we need to change the way we’re describing something, do it.
Tori Dunlap:
I mean, it’s like negotiation, we talk about all the time as you might still be met with, “You should just be grateful.” But there are certain things you can say as a woman, you can play the game without completely giving away your agency. And that’s what we’re talking about is if you can change or subtly alter the way you’re describing things, knowing that the system’s fucked anyway, it might mean you get the care that you deserve. Unfortunately.
Kate Helen Downey:
Yes. And you can play the game knowing it’s a game and knowing why you have to do this and working to change it, but you still have to get care somehow.
Tori Dunlap:
Well, and that was one of the questions I wrote down too, is we’ve discussed a lot on this show, and I’ve done a lot of listening and research about just that we do not take women’s pain seriously. We just never do. And I don’t know if you’ve listened to the Retrieval’s podcast. Have you listened to that?
Kate Helen Downey:
Of course.
Tori Dunlap:
So I’ve brought that up on the show multiple times, but if you guys have not listened to it, basically a nurse at the Yale clinic was stealing fentanyl, so the pain medication, and women were getting egg retrievals done with no pain relief at all. And they would say, “Oh no, I’m in a lot of pain.” They’d bump up the fentanyl.
Kate Helen Downey:
Sorry to interrupt. This is a procedure that involves having a giant needle shoved through your cervix, so you need pain meds.
Tori Dunlap:
And I think it was dozens, maybe, they don’t even know how many women, because it was saline, right? It wasn’t fentanyl. And so dozens, potentially more than dozens of women went through this procedure without any sort of pain management. And I always get to the point in this show where I’m just like, “Everything’s fucked.” But I don’t know if I have a question. Maybe just talk to me about why we don’t take women’s pain seriously, what we can do about it. I don’t know. That’s my official statement is, “I don’t know.” It’s so fucked.
Kate Helen Downey:
It is. I spent the last year deep dive researching into exactly this and being like, “Look, I know this is true. I know that we as a society, we as a medical organization do not take women’s pain seriously. Why in 2025, why?” And the reasons are complicated and many, but ultimately, we as a society are not invested in women’s quality of life. And that really touches everything. The things that would have to happen to change this are pretty massive.
And so at a certain point, you look at inertia, right? Who is benefiting currently? What would have to change and who would it benefit to change? And who is in the positions to make those changes happen? And that is really what it comes down to.
Tori Dunlap:
So you have this quote, “More than anything, what my money got me was bodily autonomy,” which is basically our entire mantra at HOK. So can you break that down for us in this context? Money got me bodily autonomy. What did that mean?
Kate Helen Downey:
So I realized that going… I’ve gone through insurance my whole life. I was lucky enough as a kid, my dad had good insurance through the teacher’s union. And so my family has always been like, “Have insurance, go to the doctor through insurance.” And we’ve generally been pretty healthy, so we haven’t had to explore options outside of that. And when I was in my twenties, I was working in theater. I did not have money to make these kinds of decisions, and I never did. And so suddenly having my first experience of paying for medical care outside of the insurance system was incredible and mind-blowing and so upsetting because it was so good.
It was the first doctor’s appointment I’ve had in my life where I felt like the doctor was actually seeing me as a person, was on my side, was trying to understand exactly what I was experiencing, and then was very invested in explaining to me exactly what was happening in my body and why I was experiencing what I was experiencing and what my options were. It was not prescriptive. It was not, “Hey, take birth control,” or “Don’t bother me with this.” It wasn’t dismissive. It was taking me seriously and giving me options. I left that appointment with a list of other specialists I could call, and this is an appointment with a surgical specialist.
And her answer was not, “Let’s schedule you for surgery. You have endometriosis. What we do for endometriosis is surgery. That’s what it is.” It was, “Surgery is one option, but in my opinion, the best way to treat it is to take down inflammation, which might address all of your symptoms and concerns. And we might not even need to do surgery, but at the very least, we should get your symptoms down and your inflammation down so that if you decide to do surgery, your recovery will be easier and better.”
And having those options, being given resources, and then being told, “It’s up to you. If you want to schedule the surgery tomorrow, we can, but it’s up to you to decide what’s best for you.” And then of course, none of the specialists, none of the pelvic floor physical therapy, the integrative nutritionist, the supplements, none of those further steps I took were covered by my insurance, but they helped me immensely and I was able to make those choices because I was able to pay for it.
Tori Dunlap:
After the break with our sponsors. We’re wrapping up our conversation with Kate, talking about the mental health impacts of fighting for care and being dismissed by doctors, the impact of periods on the economy and our wallets as a whole, and the toolbox Kate has developed to get through her period pain. Stay tuned. Can we talk about the mental health impact of all of this? I imagine… Right? We’re talking about physical pain and that is awful. And then you talk about going decades without any answers or any solutions. And also just navigating all of this, what kind of mental health impact did this have?
Kate Helen Downey:
I actually have an episode of the podcast where I interview my therapist about the mental health impacts of untreated and undiagnosed pain. And it’s one of my favorite episodes. There are so many and the most interesting one that she brought up that I had never thought about was the gaslighting aspect. And this gaslighting is a word is very overused in our parlance now, but when you are having an experience and you go to an authority figure or to someone who is supposed to help you with that and take you seriously, and the message you get over and over again is, “No, that’s not happening to you,” or “What you’re experiencing isn’t real or isn’t important or isn’t legitimate.”
You experience a split in your… Because at that moment, someone you trust, someone who’s there to help you is negating an experience of yours. That creates a split in your perception of there is what I know to be true about my body and my experience. And then there is what I am being told is true by the outside world. And that split… We can talk about big T trauma and little T trauma. Did any of my doctors physically sexually assault me? No, that’s big T trauma. That is a different kind of trauma, but we’re talking about a kind of trauma that affects how you seek help in the future, how you think about your own body and your own experience, how you treat others who have similar experiences.
That stays with you and it causes you to discount a lot of other experiences that you might have that you might know are bad or painful, but other people are telling you, “No, it’s fine. That’s normal. There’s nothing wrong with that.”
Tori Dunlap:
We’re talking a lot about the individual cost, mental health, money, time, energy. Can we talk about… I mean, fuck the GDP at this point, but can we talk about the GDP impact of… I think about it all of the time, both the time we lose as menstruators to period pain and the energy loss. If I’m this powerful already, can I imagine if I wasn’t menstruating? My god. So can we talk at the larger societal impact too, of the impact on the GDP, how period pain really affects all of the outcomes of societal progress?
Kate Helen Downey:
Yes. And first I want to dive into what you just said, which is imagine if I wasn’t menstruating, which is the trap we get stuck in constantly. This is what we get sold is that what our bodies do naturally is there’s something wrong with it because it keeps us from fitting into a structure that-
Tori Dunlap:
No, you’re so right.
Kate Helen Downey:
… we are expected to, and I’m not saying we have to love everything that happens to us when we menstruate. It sucks. It sucks a lot.
Tori Dunlap:
No, but you’re saying imagine if I was a round peg for the round hole as opposed to what if the hole was square because I’m also square.
Kate Helen Downey:
Exactly. Exactly. What if we had options to live in a way where menstruating didn’t create problems, where structures were actually built to hold that. It’s not that we would be more productive if we didn’t menstruate. It’s that we are seen as less productive at the time when we have less capacity for it when we are probably over performing during that summer, during ovulation. But does that get focused on? No. So there’s nothing wrong with you. There’s nothing wrong with menstruating. There’s nothing wrong with your hormones being fucked up because they’re in a fucked up situation.
And so I want to make sure that when we’re thinking about this and we’re talking about this, especially when we get into talking about the GDP, we are not talking about loss of production or loss of value of an employee. The problem is that menstruation is happening. The problem is that we live in a system that is not optimized for that and that is creating friction around this totally normal, natural, crucial thing that our bodies do. With that said, yes, there is a huge effect to period pain on the economy, on an individual level and on a entire economy level. On an individual level, if you are a person who has a part-time job and only gets paid if you show up to work and you have severe period pain, you’re fucked.
You’re fucked if you can’t show up to work. And on an economy level, there is an estimation that it’s something like $4,000 per person per year in productivity is lost because of period pain. And that’s not just people not coming into work, that’s people coming into work but being in so much pain that they can’t do the amount of work that they usually do. That’s called presenteeism. And again, that’s not the person with a period’s fault. That is the fault of a system that doesn’t allow us to rest and care for our bodies. That’s the fault of a system that doesn’t take period pain seriously enough to treat it. So it’s not a problem for that person.
In terms of the entire economy, there’s not a lot of studies about this, but the one that I did find out of Australia and estimated that the cost of period pain to just the Australian economy was about $9.5 billion a year. And so this is what gets a bug up my ass so much is that, we can talk about obviously how much period pain affects menstruating people’s quality of life, but it also affects everyone. It affects shareholders. A mystery I still don’t have an answer to is why don’t pharmaceutical companies want my money? They are profit driven organizations. There is a huge market of people who are in pain.
I clearly would pay anything to not be in this pain and there isn’t anything for me to throw my money at that will solve this problem for me.
Tori Dunlap:
I mean there’s oxycodone, which leads to other problems, right? So there is stuff, but there’s problems with that too.
Kate Helen Downey:
But if you made a pill that made me not throw up when I have my period, I would pay you a thousand dollars a month for that pill. I don’t want to but I would.
Tori Dunlap:
We’ve had a previous guest on the show and we’ve talked about this a bit so I’m not going to get too much into it, but the other part of this is we’ve all heard about developing countries where girls no longer go to school once they get their periods because they don’t have the products they need, they don’t have the support that they need. So we’re talking really, truly first world problems here too. Now, not to discount people’s pain, but there’s also as soon as you get your period when you’re 12, you’re done going to school, you’re done thinking about any sort of life outside of your current lived experience, your education’s done, you’re potentially…
This is your time that you’re now getting married off to someone much older than you.So that’s the other part about this too that I think about all the time is of course the cost of you and I in the United States and anybody listening in a typically a more developed country, but there’s also the folks who will never ever get any sort of healthcare, any sort of access to bigger, better opportunities because they’re menstruators.
Kate Helen Downey:
And I don’t talk a lot about that on my podcast because that is not my lived experience and I don’t have expertise in that area.
Tori Dunlap:
That’s a whole can of worms. I agree.
Kate Helen Downey:
Right, and I think… I believe in what is the biggest thing that’s going to help the most amount of people and change the quality of life for the most amount of people. The podcast I’m making about period pain is probably not the biggest priority for someone who was not able to pursue education or a life that they wanted because of the situation they were in. So there are certainly other priorities, but I also think we as a country like to look at how “bad things” are in other places and focus on that.
Tori Dunlap:
Rather than solving our own problems.
Kate Helen Downey:
Exactly.
Tori Dunlap:
Agreed. So my last question for you before I let you plug away, give us the remedies that have worked for you.
Kate Helen Downey:
Yes.
Tori Dunlap:
Someone’s listening, they’re like, “I need help.”
Kate Helen Downey:
Yes, it is… So I have a toolbox, basically, over the course of the last 22 years that I have had what I call death cramps. I have found lots of things that help some, and if you combine them all together, sometimes they help a lot. So first and foremost, ibuprofen, always the hero. One thing you have to be aware of with ibuprofen is it’s very hard on your stomach. So if you are a person who has stomach ulcers or other stomach issues, ibuprofen might not be the best choice for you. There’s also naproxen sodium, which is sort of an alternative to ibuprofen, does very similar things.
The biggest thing with ibuprofen, which I did not learn until earlier this year, is you have to take it before your cramps start because it is a prostaglandin blocker. What it does, why it is so effective is that it blocks prostaglandins from being connected to the receivers in the uterus or anywhere else in your body. But in order to be maximally effective, you take it before your cramps start.
Tori Dunlap:
Why did no one tell me this? Why?
Kate Helen Downey:
Exactly, exactly. I know. It’s like how much pain could I have avoided if someone had been like, “What if you start taking it before you get your period?”
Tori Dunlap:
It’s preemptive ibuprofen, I guess.
Kate Helen Downey:
Yes, it’s prophylactic. It’s literally… It prevents the cramps before they start. It is annoying because it does mean you have to track your period, and I use a free version of a period tracker. It probably sells my data. I don’t know. That’s not my highest priority. So I use a period tracker and I’m lucky to have very regular periods, so I then put it in my Google calendar. I put a range of days that says period question mark, so that when I hit and I try to make that start two days before my period is actually expected to come. When I get that Google alert, I just stop.
I start popping a couple of ibuprofen and not even every four hours, just a couple of times a day, just get it in my bloodstream, get it going, and then if I start feeling the beginnings of cramps or I start bleeding, I start taking two every four hours. Again, not a medical doctor, this is information that I have heard from other sources and worked out myself. This may help you if you get severe cramps because a huge problem I would have is that pill window, of I would get cramps and then really quickly they would get so severe that I was throwing up and couldn’t keep anything down long enough for it to get into my bloodstream.
So getting the ibuprofen in my system before the cramps even start because a lot of times I get my period in the middle of the night and my cramps start in the middle of the night and I get woken up by having to throw up. Not pleasant. So that was huge for me. Some people can take their ibuprofen once their cramps already start, it still works. It’s just if you have an issue with throwing up, if your cramps get so bad, sometimes there’s a runaway process with prostaglandins, and if you can nip that in the bud by taking it prophylactically, do it. So that’s the number one biggest thing in my toolbox. Similarly, and this sounds a little woo woo, red raspberry leaf tea.
Red raspberry leaf tea is really effective. There have been studies that have shown that it is as effective as ibuprofen if taken before your period. Technically what it does to your uterus is something called toning, which I’m not totally sure what that means. So if someone knows what that means, please contact me and tell me what that means. But pregnant people drink it before labor. It seems to just increase circulation to the uterus and help it be healthier. So that works super well for me. And then once I got into loose-leaf teas, I started adding other stuff that is anti-inflammatory, like chamomile and cinnamon and it’s delicious and it’s so fun to be a little witch with my teas, but I also start drinking red raspberry leaf tea a few days before my period.
The only thing that I have ever found that helps me once my cramps are already bad is Valium. And again, not a doctor, not doing medical advice. I didn’t get prescribed Valium by a medical doctor. I got prescribed Valium by a psychiatrist, but still for cramps because I was on SSRIs. I went in to have a checkup and he was like, “How are you?” And I was like, “Bad. I went to the ER for cramps the other day and it didn’t help.” And he was like, “Oh, do you want me to prescribe you Valium? A lot of my patients who have periods say that it helps them.” And I was like, “Yes.”
So I have a small prescription of Valium that luckily my current doctor believes me when I say it helps me and I get like five pills a month and I hoard them. And if I feel like I might be getting really bad cramps, the ibuprofen hasn’t been working or I didn’t remember to take it or whatever, I’ll take a Valium and that helps. Other people have told me that muscle relaxants are really helpful. Similar to Valium, those are the big items in the toolbox. Otherwise, I have found that addressing my gut issues for endometriosis has really helped.
Anything that causes inflammation that you can address really helps because any pain is going to be worse if you already have a high level of inflammation in your body. Meditating, it sucks. I hate meditating. I really hate that it works. But anything you can do to take your nervous system down a few pegs and help your body, remind your body you are safe, you are cared for, you are okay. Maybe that’s meditating for you. Maybe that’s something else. Taking a bath, whatever and gentle exercise the week before my period. So yoga, walking, moving, but not stressing my body out.
Tori Dunlap:
I’ll also say everything that Kate said throughout this episode, the cycles, understanding when to push yourself physically or emotionally, socially when not to. That is a huge tool that a lot of us don’t have because again, we were never taught it. And so for me the past couple years, learning that is like, “I’m not going to go lift weights because it’s going to aggravate my back and potentially throw it out while I’m menstruating, so I’m not going to do that.” So those are also… It’s really important to understand your energy levels, how you’re feeling at different points in your cycle, and then adjusting your calendar accordingly.
Kate Helen Downey:
That can be so helpful but also thinking of that as a way that you are taking care of yourself and optimizing your energy so that you are able to give more when you are able to give more. And not that it’s a downside or a shitty thing. I avoided taking care of myself for so long because I hated the idea that I couldn’t do everything everybody else could do and changing that point of view to, “I’m doing this so that I can take care of myself better so that I can do all the things I want to do rather than I have to not do a bunch of stuff I want to do to take care of myself.”
Tori Dunlap:
Kate, thank you for your time. Thank you for your expertise. Thank you for sharing your story. I am so sorry your periods are as shitty as they are, but I really appreciate you helping other people who need to navigate this as well. So tell me about CRAMPED. Tell me about where we can find you. Plug away my friend.
Kate Helen Downey:
Thank you and thank you so much for having me. I love this podcast. I have learned so many incredibly useful things from this podcast, so the fact that I get to share something here is really, really meaningful to me.
Tori Dunlap:
That’s very nice. Thank you.
Kate Helen Downey:
So CRAMPED is a limited series podcast, 10 episodes. It is out right now. It goes through my experience and my search for answers to my severe period pain, but it also is a deep dive into why this is an issue in 2025, why this has not been solved, and all of the different factors and areas of our life that we wouldn’t expect it to touch, that it does touch and it affects greatly. You can also find me on Instagram at KateHelenDowney or on TikTok at KateisCRAMPED and I share a lot of things that I have learned from experts, especially on TikTok.
Tori Dunlap:
Amazing. Thank you, Kate.
Kate Helen Downey:
Thank you.
Tori Dunlap:
Thank you so much to Kate for joining us. You can listen to her podcast CRAMPED wherever you’re listening right now, and you can follow her on Instagram at KateHelenDowney, thank you so much as always for being here, Financial Feminists. We appreciate your support and I hope you have a kick-ass day. We’ll talk to you soon. Bye.
Thank you for listening to Financial Feminist, a Her First 100K Podcast. For more information about Financial Feminist, Her First 100K, our guests and episode show notes, visit financialfeministpodcast.com. If you’re confused about your personal finances and you’re wondering where to start, go to herfirst100k.com/quiz for a free personalized money plan.
Financial Feminist is hosted by me, Tori Dunlap. Produced by Kristen Fields and Tamisha Grant. Research by Sarah Sciortino. Audio and video engineering by Alyssa Midcalf. Marketing and Operations by Karina Patel and Amanda Leffew. Special thanks to our team at Her First 100K, Kailyn Sprinkle, Masha Bakhmetyeva, Sasha Bonar, Rae Wong, Elizabeth McCumber, Daryl Ann Ingman, Shelby Duclos, Meghan Walker, and Jess Hawks. Promotional graphics by Mary Stratton, photography by Sarah Wolfe, and theme music by Jonah Cohen Sound. A huge thanks to the entire Her First 100K community for supporting our show.
Tori Dunlap
Tori Dunlap is an internationally-recognized money and career expert. After saving $100,000 at age 25, Tori quit her corporate job in marketing and founded Her First $100K to fight financial inequality by giving women actionable resources to better their money. She has helped over five million women negotiate salaries, pay off debt, build savings, and invest.
Tori’s work has been featured on Good Morning America, the New York Times, BBC, TIME, PEOPLE, CNN, New York Magazine, Forbes, CNBC, BuzzFeed, and more.
With a dedicated following of over 2.1 million on Instagram and 2.4 million on TikTok —and multiple instances of her story going viral—Tori’s unique take on financial advice has made her the go-to voice for ambitious millennial women. CNBC called Tori “the voice of financial confidence for women.”
An honors graduate of the University of Portland, Tori currently lives in Seattle, where she enjoys eating fried chicken, going to barre classes, and attempting to naturally work John Mulaney bits into conversation.
