How Meftal Redefined the Cultural Relationship Between Pain and Femininity
The first and only time I sought a doctor’s advice for menstrual cramps, I was told that it would subside with marriage and childbirth. I was asked not to worry until then. What I didn’t have the opportunity to say was that I was not worried, I was in pain.
The “pain myth,” a common experience of menstruation, goes like this: as someone who menstruates, any pain or discomfort associated with it is “worth” the greater good – giving birth. When it comes to periods, personhood is sacrificed at the altar of motherhood; and pain is an essential part of the process.
But while the pain myth persists, pain, itself, no longer needs to. A nifty little over-the-counter painkiller by the name Meftal Spas mediated the relationship between period pain – or dysmenorrhea – and an amorphous idea of womanhood in India. Meftal is short for mefenamic acid, which in turn is short for dimethylphenylaminobenzoic acid. It is an analgesic, non-steroidal anti-inflammatory drug (NSAID). Studies have found NSAIDs to be more effective than paracetamol for treating dysmenorrhea, with limited side effects like nausea or headaches in 2 to 3 out of 100 women.
Its entry into the Indian menstruation lexicon was fairly recent; older generations of women relied on paracetamol, ibuprofen – that is, if they relied on any medication at all. For many Indians who grew up as girls, bearing the pain was and continues to be a rite of passage as a woman – the notion of “tolerating” pain without complaint was a measure of resilience and femininity.
“I’m sick of this pain being almost romanticized – I’ve been told stories of how my mum and her mum had the same pain,” says Anuja, 32.
Rashmi, 25, who describes her period pain as so unbearable that it withers her down into a fit of screaming and crying, says that she was initially discouraged from taking painkillers like Meftal for relief. “They [relatives] have been conditioned to think that, as a woman, one should just tolerate the pain because it happens to everyone and we are some sort of ultimate strong creatures who should bear it all,” she said.
Meftal thus became the locus of several complicated feelings about pain in menstruation, including seeking an “unnatural” remedy for a “natural” phenomenon. “It took me a very long time to be okay with taking it, because of the notion your cycle is supposed to be ‘naturally’ handled – when I was in school, even if I had bad cramps I wouldn’t take it because I thought you were supposed to go through that,” says Aishwarya, 23.
“The lack of conversation made me think that it was just something that everyone bared… when I moved to hostel I was quite proud of the fact that I didn’t use it… taking something to alleviate the pain was in fact unnatural,” she adds.
It’s why many women take to Meftal for pain relief with a sense of shame overlaying the act of seeking painlessness. And often, it’s as a last resort – after crossing a certain threshold of pain. “When the pain reaches to a point that my abdomen feels on fire, that’s when I take Meftal,” says Anannya, 27.
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There’s also a common misconception that “if you do take medications to reduce or suppress the pain, you may have difficulty conceiving, or during childbirth… those are the taboos. I see so many women not taking it and suffering with pain,” says Dr. Sujatha Rajnikanth, a Chennai-based gynecologist. Many girls, as young as 12 or 13, try to tolerate pain under the assumption that painkillers may affect a potential pregnancy 10-15 years later.
Usually, women aren’t prescribed Meftal by a doctor; a family member or a friend recommends it themselves. For many, the beginning of their period made them a link in a long, generational chain of women with painful periods. This normalization of pain leads to misconceptions around the medicine and its interference with reproductive health persisting.
And while Meftal gives Rashmi and others like her some control over how much pain they want to tolerate, doctors express concern that not consulting doctors due to the normalization of period pain could mean that problematic period pain goes undiagnosed.
Dr. Renuka Dangare, a gynecologist with Proactive For Her, explains that Meftal is a harmless painkiller that can be a powerful tool for reclaiming the agency that people who menstruate lose in pain that they cannot help. But there is a difference between primary and secondary dysmenorrhea; the latter caused by underlying medical problems that need to be addressed.
Dr. Sujatha Rajnikanth also explains that secondary dysmenorrhea leads to pain before menstruation. There is a definite pathology, she says, that can be treated with surgery or medication. But “either way, a mefenamic acid is simply a painkiller. It’s just to suppress pain, it’s not going to treat the cause.”
This pain being so inextricable from the experience and narrative around periods makes it hard to dissect it further and identify red flags. Questions that are missing from self-assessment are: What kind of pain? When? How much is too much?
“There is a good amount of pain I can tolerate. However if I have to attend to work it’s hard when menstrual pain hampers day to day activities. So I take it only when I really need it,” says Y*, 16. Many others reiterate more or less the same, using some variant of the words “excruciating,” “intolerable,” and “unbearable,” as the threshold they wait for before they take a tablet.
“Waiting till the threshold is definitely a norm; [but] once it is at the threshold it is not going to come down to zero anytime soon. And you are going to have pain,” explains Dr. Rajnikanth.
For Akshita, 20, hearing statements like “seh lo thoda kya jaroorat hai do tablets lene ki” [just bear it, what is the need for two tablets] reinforces this dichotomy between cultural tolerance and medical tolerance.
Further, unlike most other medications, very little concrete knowledge about what Meftal is adds to fears around medicine in general. “I wasn’t informed of what it does, except that it was ‘period medicine.’ It’s only recently when I did my own research that I realized it was a generic painkiller and anti-inflammatory medicine… My reservation about painkillers [was] probably due to the bias I’ve internalized towards western medicine because a lot of my family members keep saying that taking too much of those will ‘reduce my immunity’,” says Gowri, 20.
Another source of distrust is in how sometimes, Meftal reduces bleeding. With the cultural associations of menstrual bleeding as a cleansing process, many users experience panic when they first notice this. “They have this concept that menstrual blood is a packet of ‘bad blood’ that is discarded from the body. And if you don’t discard this happy, good amount of blood, all the bad blood is getting accumulated in your body and is going to cause problems,” Dr. Rajnikanth says. It is just as well that she was able to clarify this with her own patients – but many others stop relying on Meftal altogether due to not having consulted a doctor with their questions.
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Dr. Rajnikanth adds that there are studies cautioning against the risks of mefenamic acid to ovulation – but this is in the event of overusing the pill. But the medical definition and the common cultural perception of “overuse” are vastly different. Medically, taking several Meftals every single day, especially during ovulation, can have unintended effects on the body – but not if it’s taken during the actual menstrual cycle.
Medically, both doctors maintain that it is a myth that mefenamic acid usage can lead to tolerance or resistance over time. “One possibility is they take the tablet very late,” says Dr. Rajnikanth. The right time to take it is when the pain is at a 3 or a 4, on a scale of 10 – and this scale looks different for different people, which means that the “woman has to be the judge of how to take and how much to take.”
“It boils down to each individuals’ understanding of whether their period is healthy or not,” says Dr. Renuka, on the relationship between Meftal and pain. Which is to say, not many treat pain with the gravity it often deserves, but people have begun to take steps to alleviate it.
Meftal thus remains one of the very few easily accessible sources of pain relief. Not only that – it presents a challenge to the pain myth that for so long has constrained the lives of women. Just as many women keep extra sanitary napkins to share with others, many also carry strips of Meftal – “spreading the lack of pain,” as Aishwarya, 27, puts it. This is how a lot of people were even introduced to Meftal: in hostels, at work, or in school, when a friend or even a stranger happened to have it and, in quiet solidarity, shared their lack of pain.
The effect it had on transforming women’s relationships with their pain cannot be overstated. Many began to take it preventively, and use it to reorient their relationship with work and rest. “In general, the doctors I had been to, believed I should go for school/work after taking these but I’ve never been able to,” says Sowmya, 30. She isn’t the only one who was prescribed pain relief only as a way to be productive. But realizing how effective Meftal was, many gradually took it as a means to alleviate pain not only for work, but for rest and leisure.
A tiny little pill, taken unobtrusively a few times a month, thus led to small acts of resisting the paradigm of pain and work imposed upon women: it allowed them to seek true rest. In a culture where women are conditioned to not listen to their bodies, Meftal lent an ear. It beckoned to them in moments of disrupted leisure.
And in a country with pervasive menstrual taboo, this alone was enough to mark it as a harbinger of a largely silent resistance against needless pain and, in the process, allowing many to negotiate their relationship with their bodies and femininity.