Common Is Not Always Normal: An OB/GYN’s Reflection on Women’s Pain and the Silence We Inherit

By Busra Ozkaya, MD

There is a sentence many girls hear from the time of their first menstrual period:

“This is normal. It is just part of being a woman.”

Most of the time, this sentence is spoken with kindness. It is meant to comfort a young girl, to ease her fear, and to remind her that she is not alone, but over time, the same sentence can become something else: a quiet curtain drawn over pain.

As an obstetrician-gynecologist, I have learned that the word “normal” must be used carefully.

Common is not always normal.
Familiar is not always harmless.
Pain that changes a girl’s or woman’s life deserves more than reassurance alone.

During my OB/GYN training, I met many women who had carried pelvic or menstrual pain for years before giving it a name. Some had missed school, work, family responsibilities, or important moments in their lives because of symptoms they had been taught to tolerate. Others began their stories with an apology:

“I know this is probably normal, but…”

That apology stayed with me.

Why should a woman feel the need to apologize before describing her pain?

During my training in Turkey, I saw how culture, family expectations, and quiet endurance could shape the way women described pain. Some patients did not only describe symptoms; they described years of adjusting their lives around those symptoms. They had learned to function through pain before anyone had asked whether that pain deserved closer attention.

A heating pad, an analgesic, or comforting words may help some patients, and sometimes they truly do. They should never replace the deeper clinical questions: Is this pain interfering with her life? Is this pattern changing? Has she been heard before? What diagnosis might we be missing because the symptom sounds familiar?

This question matters deeply in conditions such as endometriosis, where years of normalized dysmenorrhea can delay recognition, diagnosis, and treatment. Of course, not every painful period means endometriosis. Every patient whose pain interferes with daily life deserves to be heard carefully, evaluated thoughtfully, and taken seriously.

Beyond any single diagnosis, this issue reflects a broader pattern in women’s health. Too often, women are praised for tolerating pain before they are supported in understanding it. They are told to be strong before they are asked what they are actually carrying.

In clinical practice, the way women speak about pain can be shaped by culture, upbringing, fear, access to care, prior dismissal, family responsibilities, and the exhaustion of not being believed. Some patients describe their symptoms only after years of silence. Others have learned to make their pain sound smaller because they do not want to be perceived as dramatic, difficult, or weak.

Silence should never be mistaken for absence of suffering.

As obstetrician-gynecologists and surgeons, we are trained to listen carefully. We ask about timing, severity, associated symptoms, patterns, and the effect on daily life. We think about the possibilities behind pain. We try not to miss the important diagnosis hiding beneath a common complaint.

That is why listening is not a soft skill.

It is a clinical skill.

Listening shapes the history we take, the differential diagnosis we build, the referrals we make, the urgency we feel, and the trust we earn. Sometimes, healing begins before a diagnosis is made. Sometimes, it begins when a patient realizes that her pain has been heard without judgment.

When I later began rebuilding my professional path in the United States, I found myself listening in a different way. Starting again in a new system made me more attentive to pauses, hesitations, and the small ways people communicate uncertainty. It reminded me that listening is not only about understanding words; sometimes it is about recognizing what a person has been taught not to say.

This lesson has become especially meaningful to me as an obstetrician-gynecologist trained in Turkey and continuing my professional journey in the United States. Across different cultures and healthcare systems, I have seen that women may describe pain in different languages, but the need to be believed is universal.

Some women speak loudly because they have waited too long.
Some speak softly because they have been dismissed before.
Some do not yet have the words for what they are carrying.

Our responsibility is not to decide how much suffering sounds convincing enough. Our responsibility is to ask better questions before silence becomes part of the disease.

For me, this is why women’s health advocacy begins before treatment. It begins in the moment we decide that a woman’s pain does not need to be dramatic, perfectly explained, or long endured before it deserves our attention.

As women’s health advocates, we have an opportunity to help change this message. We can remind girls and women that pain should not be dismissed simply because it is familiar. We can create clinical spaces where patients do not feel the need to apologize for their symptoms. We can listen earlier, validate more carefully, and remember that compassion is not separate from clinical care.

Common is not always normal.

Pain should not have to become unbearable before it is taken seriously.
A voice should not have to become louder before it is heard.
No woman’s pain should have to become silence before it matters.

Busra Ozkaya, MD, is an obstetrician-gynecologist trained in Turkey who is continuing her clinical and academic journey in the United States. Her interests include women’s health, gynecologic surgery, patient-centered care, and global collaboration. Through clinical work, research, and advocacy, she is committed to advancing compassionate, evidence-based care that begins with listening.