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Even Morphine Doesn't Help My Horrific Period Pain
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"It felt like being stabbed, I'd be on my hands and knees in pain."
Emily Handstock, 25 has struggled with period pain for 10 years and has documented the agony she has gone through on TikTok.
"I was admitted to hospital and the morphine barely touched the sides," she said.
She wants other women and girls to take part in severe period pain research which could help shape education and healthcare and improve the lives of women in the future.
Emily, who lives in Aberdare, Rhondda Cynon Taf, has felt the agonising effects of her period since she was 15.
"It was horrendous bleeding, I'd have to leave school and go home and change – I'd bleed through tampons and pads," she said.
At times, she felt like she would pass out because of the pain, but felt society had "normalised" what she was going through.
"Throughout my teenage years I was told, 'you're just experiencing a painful period. You're fine. Just have some ibuprofen and suck it up'," she said.
"The mental toll is also awful, you feel like people won't believe you and worry about being well enough for school or work."
Emily works as a sales manager and said her company had been very supportive and accommodating when she struggled.
"I'm really lucky that I can work from home to help accommodate the pain, to make sure I'm as comfortable as I can be," she said.
However, the impact of needing time off work has been a concern.
"I have savings, it's something I've always done in the knowledge this could financially impact me by taking time off, I think that's a real worry for lots of people who suffer that they may run out of sick days."
NHS Confederation research reported that the economic cost of taking time off due to issues such as severe period pain or ovarian cysts is estimated to be nearly £11bn a year in England alone.
Dysmenorrhea is the medical term for moderate to severe pain that occurs during menstruation
It is usually felt in the lower abdomen or pelvis and can also cause cramping
Other symptoms can include nausea, vomiting, fatigue, diarrhoea, headaches and weakness
Severe Period Pain is when it affects your daily habits like sleeping or going to work
Emily says it also has an impact on her husband Marcus who has had to watch her "screaming in agony" [EMILY HANDSTOCK]
Emily is sharing her story as a Westminster report by MPs warned women experiencing painful health conditions, including heavy periods, were being dismissed when they asked for help.
It stated that medical misogyny was leaving women in pain for years and disrupted all aspects of daily life.
Last week, the Welsh government announced the first women's health plan, following similar strategies in England and Scotland.
It includes a focus on menstrual health, including endometriosis - something Emily has welcomed.
Last month, after seven years of tests and scans, Emily had surgery for stage four endometriosis, but had to "fight to be taken seriously".
Dr Robyn Jackowich says it is an exciting and important time in women's health research [BBC]
Emily is encouraging those who experience severe period pain to share their experiences as part of a study based at Cardiff University, which she said was "a validating experience to be heard".
Dr Robyn Jackowich is one of the researchers running the two-year Health and Care Research Wales Project.
It will create a list of recommendations to both education and healthcare providers.
"There's certainly a need for it, given both how common it is and what an incredible impact it has on the people who experience it," she said.
Dr Jackowich said severe period pain was something that can be experienced on its own or linked to other conditions, such as endometriosis or uterine fibroids.
She added that severe period pain where it becomes difficult to carry out day-to-day activities was estimated it affects up to 29% of those with periods, making it hard for people to "focus, move, sleep or miss school or work".
The study, which is about halfway through, is looking to speak to more people, including parents, teachers and community pharmacists as they "play a big role in young people's education and access to healthcare".
Morphine Sulfate
Morphine Sulfate Generic Name & Formulations General DescriptionMorphine sulfate 15mg, 30mg; scored tabs.
Pharmacological ClassOpioid agonist.
Mechanism of ActionMorphine is a full opioid agonist and is relatively selective for the mu receptor, although it can bind to other opioid receptors at higher doses. The principal therapeutic action of morphine is analgesia. The precise mechanism of action is not known but the effects are thought to be mediated through opioid-specific receptors located in the CNS.
Morphine Sulfate Indications IndicationsManagement of: adults with acute and chronic pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate; or pediatrics (≥50kg) with acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.
Limitations of UseDue to risks of addiction, abuse, and misuse with opioids (can occur at any dosage or duration), reserve for use in patients for whom alternative treatment options (eg, non-opioid analgesics, opioid combination products) are not tolerated or inadequate to provide analgesia. Should not be used for an extended period of time unless the pain remains severe enough to require an opioid analgesic and for which alternative treatment options continue to be inadequate.
Morphine Sulfate Dosage and Administration AdultUse lowest effective dose for shortest duration. Individualize. Opioid-naive or opioid non-tolerant: initially 15–30mg every 4hrs as needed. Conversion to and from other morphine formulations or other opioids: see full labeling. Withdraw gradually (esp. If opioid-dependent), taper by ≤10–25% every 2–4 weeks.
Children<50kg: not recommended. Use lowest effective dose for shortest duration. Individualize. ≥50kg (Opioid-naive or opioid non-tolerant; able to swallow tabs): initially 15mg every 4hrs as needed; max 30mg. If unable to swallow tabs: use other forms. Conversion to and from other morphine formulations or other opioids: see full labeling. Withdraw gradually (esp. If opioid-dependent), taper by ≤10–25% every 2–4 weeks.
Morphine Sulfate Contraindications ContraindicationsSignificant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. During or within 14 days of MAOIs. Known or suspected GI obstruction, including paralytic ileus.
Morphine Sulfate Boxed Warnings Boxed WarningSerious and life-threatening risks from use of Morphine Sulfate: Addiction, abuse, and misuse; Life-threatening respiratory depression; Accidental ingestion; Risks from concomitant use with benzodiazepines or other CNS depressants; Neonatal opioid withdrawal syndrome; Opioid analgesic risk evaluation and mitigation strategy (REMS).
Morphine Sulfate Warnings/Precautions Warnings/PrecautionsAssess the potential need for access to naloxone when initiating and renewing therapy. Consider prescribing naloxone based on risk factors for overdose (eg, history of opioid use disorder, prior opioid overdose, household members or other close contacts at risk for accidental ingestion or overdose). Abuse potential (monitor). Life-threatening respiratory depression esp. During initiation or following dose increases. Accidental exposure may cause fatal overdose (esp. In children). Sleep-related breathing disorders (including central sleep apnea (CSA), sleep-related hypoxemia); consider dose reduction if CSA develops. Opioid-induced hyperalgesia (OIH) and allodynia; consider decreasing dose of current opioid or opioid rotation if OIH is suspected. COPD, cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression; monitor and consider non-opioid analgesics. Adrenal insufficiency. Monitor for signs of hypotension when initiating or titrating dose. Head injury. Increased intracranial pressure, brain tumors; monitor. Seizure disorders. CNS depression. Impaired consciousness, coma, shock; avoid. Biliary tract disease. Acute pancreatitis. Drug abusers. Renal or hepatic impairment; initiate lower doses and titrate slowly. Reevaluate periodically. Avoid abrupt cessation. Elderly. Cachectic. Debilitated. Pregnancy; potential neonatal opioid withdrawal syndrome during prolonged use. Labor & delivery: not recommended. Nursing mothers: monitor infants.
Morphine Sulfate Pharmacokinetics AbsorptionOral bioavailability: <40%. Maximum analgesic effect occurs 60 minutes post-administration.
DistributionVolume of distribution: ~1–6 L/kg. Plasma protein bound: 20–35%.
EliminationRenal (primary), fecal (7–10%). Half-life: ~2 hours (after IV admin). Plasma clearance: ~20–30 mL/min/kg (adult).
Morphine Sulfate Interactions InteractionsSee Contraindications. Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); reserve concomitant use in those for whom alternative options are inadequate; limit dosages/durations to minimum required; monitor closely; consider prescribing naloxone if concomitant use is warranted. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT3 antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. Avoid concomitant mixed agonist/antagonist opioids (eg, butorphanol, nalbuphine, pentazocine) or partial agonist (eg, buprenorphine); may reduce effects and/or precipitate withdrawal symptoms. May antagonize diuretics; monitor. Paralytic ileus may occur with anticholinergics. May be potentiated by cimetidine, P-gp inhibitors; monitor. May delay the effects of oral P2Y12 inhibitors (eg, clopidogrel, prasugrel, ticagrelor); consider IV form instead. May increase serum amylase.
Morphine Sulfate Adverse Reactions Adverse ReactionsConstipation, nausea, somnolence, lightheadedness, dizziness, sedation, vomiting, sweating; respiratory depression, orthostatic hypotension, syncope, OIH and allodynia.
Morphine Sulfate Clinical TrialsSee Literature
Morphine Sulfate NoteNot Applicable
Morphine Sulfate Patient CounselingSee Literature
Morphine Sulfate Oral Solution
Morphine Sulfate Oral Solution Generic Name & Formulations General DescriptionMorphine sulfate 100mg/5mL (20mg/mL).
Pharmacological ClassOpioid agonist.
Mechanism of ActionMorphine is a full opioid agonist and is relatively selective for the mu receptor, although it can bind to other opioid receptors at higher doses. The principal therapeutic action of morphine is analgesia. The precise mechanism of action is not known but the effects are thought to be mediated through opioid-specific receptors located in the CNS.
Morphine Sulfate Oral Solution Indications IndicationsManagement of acute and chronic pain in opioid-tolerant patients severe enough to require an opioid analgesic and for which alternative treatments are inadequate.
Limitations of UseDue to risks of addiction, abuse, and misuse with opioids (can occur at any dosage or duration), reserve for use in patients for whom alternative treatment options (eg, non-opioid analgesics, opioid combination products) are not tolerated or inadequate to provide analgesia. Should not be used for an extended period of time unless the pain remains severe enough to require an opioid analgesic and for which alternative treatment options continue to be inadequate.
Morphine Sulfate Oral Solution Dosage and Administration AdultMeasure dose with graduated oral syringe. Use lowest effective dose for shortest duration. Individualize. ≥18yrs: Initially 10–20mg every 4hrs as needed. Conversion to and from other morphine formulations or other opioids: see full labeling. Withdraw gradually (esp. If opioid-dependent), taper by ≤10–25% every 2–4 weeks.
Children<18yrs: not established.
Morphine Sulfate Oral Solution Contraindications ContraindicationsSignificant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. During or within 14 days of MAOIs. Known or suspected GI obstruction, including paralytic ileus.
Morphine Sulfate Oral Solution Boxed Warnings Boxed WarningSerious and life-threatening risks from use of Morphine Sulfate Oral Solution: Risk of medication errors; Addiction, abuse, and misuse; Life-threatening respiratory depression; Accidental ingestion; Risks from concomitant use with benzodiazepines or other CNS depressants; Neonatal opioid withdrawal syndrome; Opioid analgesic risk evaluation and mitigation strategy (REMS).
Morphine Sulfate Oral Solution Warnings/Precautions Warnings/PrecautionsAssess the potential need for access to naloxone when initiating and renewing therapy. Consider prescribing naloxone based on risk factors for overdose (eg, history of opioid use disorder, prior opioid overdose, household members or other close contacts at risk for accidental ingestion or overdose). Abuse potential (monitor). Life-threatening respiratory depression esp. During initiation or following dose increases. Accidental exposure may cause fatal overdose (esp. In children). Sleep-related breathing disorders (including central sleep apnea (CSA), sleep-related hypoxemia); consider dose reduction if CSA develops. Opioid-induced hyperalgesia (OIH) and allodynia; consider decreasing dose of current opioid or opioid rotation if OIH is suspected. COPD, cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression; monitor and consider non-opioid analgesics. Adrenal insufficiency. Monitor for signs of hypotension when initiating or titrating dose. Head injury. Increased intracranial pressure, brain tumors; monitor. Seizure disorders. CNS depression. Impaired consciousness, coma, shock; avoid. Biliary tract disease. Acute pancreatitis. Drug abusers. Renal or hepatic impairment; initiate lower doses and titrate slowly. Reevaluate periodically. Avoid abrupt cessation. Elderly. Cachectic. Debilitated. Pregnancy; potential neonatal opioid withdrawal syndrome during prolonged use. Labor & delivery: not recommended. Nursing mothers: monitor infants.
Morphine Sulfate Oral Solution Pharmacokinetics AbsorptionOral bioavailability: <40%. Maximum analgesic effect occurs 60 minutes post-administration.
DistributionVolume of distribution: ~1–6 L/kg. Plasma protein bound: 20–35%.
EliminationRenal (primary), fecal (7–10%). Half-life: ~2 hours (after IV admin). Plasma clearance: ~20–30 mL/min/kg (adult).
Morphine Sulfate Oral Solution Interactions InteractionsSee Contraindications. Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); reserve concomitant use in those for whom alternative options are inadequate; limit dosages/durations to minimum required; monitor closely; consider prescribing naloxone if concomitant use is warranted. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT3 antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. Avoid concomitant mixed agonist/antagonist opioids (eg, butorphanol, nalbuphine, pentazocine) or partial agonist (eg, buprenorphine); may reduce effects and/or precipitate withdrawal symptoms. May antagonize diuretics; monitor. Paralytic ileus may occur with anticholinergics. May be potentiated by cimetidine, P-gp inhibitors; monitor. May delay the effects of oral P2Y12 inhibitors (eg, clopidogrel, prasugrel, ticagrelor); consider IV form instead. May increase serum amylase.
Morphine Sulfate Oral Solution Adverse Reactions Adverse ReactionsConstipation, nausea, somnolence, lightheadedness, dizziness, sedation, vomiting, sweating; respiratory depression, orthostatic hypotension, syncope, OIH and allodynia.
Morphine Sulfate Oral Solution Clinical TrialsSee Literature
Morphine Sulfate Oral Solution NoteNot Applicable
Morphine Sulfate Oral Solution Patient CounselingSee Literature
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