We’re thrilled to share a powerful piece from Kate Helen Downey, host and creator of the CRAMPED podcast.
Kate Helen Downey is the host & creator of the CRAMPED podcast, where she attempts to get to the bottom of her own “mysterious” severe period pain. She’s gone 22 years without a diagnosis or effective treatment for her “death cramps”, which can be so painful they lead to hours of vomiting, passing out, and going to the emergency room. On CRAMPED she interviews doctors, researchers, and other people experiencing severe period pain to finally understand what’s happening inside her own body, how many other people are out there experiencing the same thing, and what we can do about it. Because having a microphone gets you more answers than having a uterus.
In this Substack post, Kate digs into the slippery, often dismissive way the word “normal” gets used in medical settings, especially around gynecological health. She unpacks how “normal” can be both a comfort and a dead-end, reminding us that what’s average on a chart isn’t always reflective of our lived experiences.
Her writing is sharp, relatable, and rooted in the same determination that drives CRAMPED: refusing to settle for dismissal and pushing for real understanding of our bodies. We’re so happy to feature it here because conversations like these are how we shift what “normal” in healthcare really means.
This is a Substack post she published July 2025.
Since I started releasing episodes of the CRAMPED podcast in February of this year, a lot of people have sent me questions. And, as I start off every podcast episode saying, I am not a doctor! I am just a person with a uterus and a microphone who has gotten really good at reading medical studies and finding experts to talk to in order to get answers to my own questions about my body, what the hell it’s doing to me, and why it’s so hard to get help from the people who are supposed to help me.
I get a LOT questions like this:
“What do I do if my test result comes back ‘normal’ but I’m still in pain?”
“Why do doctors say everything is ‘normal’?”
“Why do I keep getting told something is ‘normal’ when it’s messing up my life??”
So today is all about the word “normal” in the mouths of doctors.
Usually, the term “normal” in a medical setting is a relief to hear: My glucose levels are normal? Awesome, no pre-diabetes! The mole on my shoulder is “normal”? I’ve escaped melanoma for another day!
But as anyone with a uterus knows, hearing the term “normal” at a gynecologist appointment sometimes can effectively mean “go away” or “end of the line” or “*shrug* I can’t help you”.
Oh my period pain is “normal”, so you’re not going to give me any options to help treat it.
My ultrasound is “normal”, so you’re not going to refer me to a specialist to figure out what might be causing my symptoms.
My hormone levels are “normal”, so you don’t think my symptoms are real.
I’ve gotten so used to “normal” meaning “you’re on your own”.
So what do doctors THINK they’re saying to us when they say our test results or our symptoms are “normal”?
I got a big-picture insight on this from biological anthropologist Kate Clancy’s excellent book PERIOD.
I’ll quote Kate Clancy here:
“…the individualistic, authoritarian model of medicine somewhat gave way to standardization: of calculating averages and probabilities in order to determine best practices. This is not all bad. Yet the shift from art to standardization is also when the field of medicine started to equate certain statistical calculations, like normality, with health. Normal eventually came to be associated with the normal distribution, in particular the data that cluster in the middle, or the average. This definition of normality impacts how we understand menstrual cycles and their variability. A lot of factors relevant to the menstrual cycle are, guess what, not normally distributed. There is no cluster in the middle, so any calculation of average is not an actual calculation of normal.”
A good example of this is the length of a menstrual cycle - the most common question someone gets when they go to the gyno is “how many days is your cycle?”, and often the “correct” answer is as close to 28 days as possible. But menstrual cycle length is not, on its own, an indication that anything is wrong (unless it’s shorter than 23 days or longer than 36). Within that LARGE span, it’s not “healthier” to be closer to 28 days. What’s more important is the question “has the length of your cycle changed recently?” - because if you USED to have totally chill 35 day cycles, and now you have 28 day cycles and painful cramps or other symptoms, something’s clearly wrong, even though your cycle is closer to the “normal” 28 days. But that is not often how doctors contextualize this information.
With any kind of test result, there is a “normal range” that the doctor is looking for your result to fall within. As long as you’re within that rage, nothing is medically wrong. But again, these normal ranges are calculated with averages, and what the result means for YOU might mean something different.
For example: I’m 5’ 2”. If my big toes suddenly grew to be 3 1/2 inches long, and I went to see a podiatrist, because what the hell, none of my shoes fit anymore, walking is hard, and a 36 year old shouldn’t suddenly experience toe growth, right?? And that podiatrist measured my toes and said “great news, 3 1/2 inches is within the normal range of big toe length!” That’d be pretty f*cked up, right? Because while a 3 1/2 inch big toe might be normal for a 6’ 2” man, it' s definitely not normal for a 5’ 2” woman. Plus, the fact that they just suddenly grew longer after 20 years of being like 1 1/2 inches must mean SOMETHING, right??
This seems stupidly exaggerated, but change out “big toe” for “uterus”, or “ovary”, and suddenly EXACTLY this thing has happened to SO MANY of us. Talk to anyone who has had a 3 1/2 inch ovarian cyst and been told it’s “normal” - until a cyst is literally 4 inches (or 10 cm), most doctors will not recommend any action, no matter what horrific symptoms or pain the cyst is causing. And these are cysts on an ovary that’s only 3-5 cm long!!
If you’re trying to figure out what’s causing symptoms that are disrupting your life and causing you pain, you get back a test result in the “normal” range, and your doctor is considering the matter resolved, you simply have to NOT LET THEM. Most of the time we’re getting test results delivered to an online portal that we go and review, and maybe your doctor leaves a little note in the portal that says “results are normal, ruling out _____ condition”. And that means it’s on us to follow up with our doctor and say “Saw that test result come in normal - I’m still experiencing this symptom and I still want to figure out why and how to treat it. So what’s our next step? Is there another test, or another condition that might be causing it?”
It also might mean doing research on your own to figure out what that specific result means for YOU, and your specific context and situation, and following up with the doctor with specific questions.
Which is…A LOT OF WORK. It’s taken me 22 years to resign myself to this work, and realize that my doctor is not really there to take care of me - my doctor is there to provide an expert opinion (on the things they are educated or interested in - and it might surprise you how narrow that knowledge actually is), and prescriptions and referrals. It’s up to me to understand my own experiences, test results, conditions, and plan for care. In our medical system, doctors are generally very siloed, and are focused on identifying and treating potentially life-threatening conditions. Which is great - but if what you need is someone to be a detective with you, and figure out what’s causing symptoms that are making your life miserable but not likely to kill you, you might need another kind of health provider.
So while, to a doctor, your “normal” result might mean “we’re done here”, you’re not going to let them off that easy. Because you read/listen to CRAMPED!
