Of course there is no such thing as what actually *was* causing the pain, because this is a fictional story and answers to such questions are in no 'answer book'. So there is no way to *know* what the pain caused. There is just our interpretation of it, and our arguments for our interpretation.
For me, the abdominal pain is definitely menstrual in nature. That is because I regard it as a symbol, or analogy, of the intimate pains and stress that Rosetta needs to endure in her life. She is alone, lonely, and has to deal with all psychological and physical worries life brings her. In a normal family life, daughters can communicate with their parents about what is bothering them, receive advice etc. Particularly with their mother about problems that come with womanhood.
But Rosetta shuts off such essential, intimate communication with her mother, because she feels her mother is unable to support her. Even about menstrual pains, which are in any way a natural part of life (not diseases), Rosetta cannot talk with her mother. For me that underlines her tragedy. And her mother's tragedy, too.
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