By Dr Tania Burgess – General Practitioner (with a special interest in adolescent health)

 

Hi!  My name is Tania and I’m a General Practitioner with a special interest in adolescent medicine.  I’ve been a GP for just over 15 years, and over that time, I’ve developed a real passion for seeing this age group.  What do I love about teenagers?  Teenagers are awesome to work with.  Of course, they can often seem difficult, or incomprehensible and impulsive (and being a Mum of 3 teenagers and a tween I see all of this).  But they are also fun and interesting, and they have so much potential.  I see practicing in adolescent medicine as an opportunity to make a real difference in their lives and help shape their future by setting them up with good habits and sound information, particularly when it comes to their health. 

I am delighted to have been asked to contribute to Adolescent Month. 

One of the common problems I see in my practice, is teenage girls suffering with period pain.   It can sometimes be tricky to know what is normal and what is abnormal, and the internet can be a tricky place to find reliable information.  I hope you find this article helpful. 

How to help your teenager manage period pain 

Painful, crampy lower abdominal pain which occurs during menstruation is a very common problem for teenage girls.  Period pain can range from mild and annoying to painful and debilitating, and it can interfere with daily activities like school and sport.  Period pain can have a significant impact on the quality of life of adolescent girls, and seeking timely medical care is very important.  

What makes periods painful? 

During periods, the body makes chemicals called “prostaglandins”. These chemicals cause the uterus to contract or tighten, similar to the type of contraction which happens during childbirth.  Sometimes this is accompanied by nausea, vomiting or loose bowel motions, as well as a heavy feeling or ache in the back or legs. 

Some medical conditions make period pain worse. The most common is a condition called endometriosis.  Endometriosis could be a whole other blog post, but to suffice for now, this can be a debilitating condition for which early diagnosis and treatment is very important. 

 

 What can teenage girls do on their own to feel better? 

 There are some simple things teenage girls can try if they are experiencing painful periods.    

1. Take anti-inflammatory pain medication (NSAIDs) such as ibuprofen [nurofen] or naproxen [Naprosyn] – but remember, these can cause stomach irritation, so they should be taken with food.   It is very important to start these the day before the bleeding commences, or at least at the very onset and keep taking them regularly for 2-3 days.  One pattern I commonly see as a GP, is teenage girls not starting medication until the pain has set in.  Unfortunately, the prostaglandins are well on their way to causing pain by then.  Pain medication works best for period pain if it is taken early, so if girls are experiencing painful periods, it is a good idea to be prepared and have anti-inflammatories close at hand.  Paracetamol does not work as well, due to its mechanism of action but is an option for girls who cannot take anti-inflammatories. 
2. Try using a heating pad or hot water bottle (carefully!) to help relax abdominal and back muscles. 
3. Do some exercise. This might seem counter-intuitive, but there is some evidence that exercising might help with pain, probably by releasing endorphins (our natural feel-good chemicals).  

 

When to see the GP? 

 People often ask me “what is normal?” when it comes to period pain.  Normal period pain only lasts 1-2 days at the start of the period, it responds to simple anti-inflammatory medication and it doesn’t interfere with normal activities.  If period pain is so bad that it interferes with daily life, or if it happens at other times of the month, it is important to see your GP.  The majority of young women with moderate to severe period pain never seek medical help, perhaps because they think it is a common problem which just needs to be tolerated. Only a small minority receive the medical care they need. 

 

What can I expect at the GP? 

 Before your teenager heads into her appointment with the GP, it can be helpful to have an idea what the GP will do.  Talking to a GP about periods might seem embarrassing or difficult, but this is an important problem, so don’t be worried about seeking help.  Here are the things to expect: 

• Your GP will take a history, asking questions about the problem 
• Your GP may do a physical examination, depending on a girls’ age and individual situation.  An examination is usual deferred in adolescents who are non-sexually active. 
• Your GP may test for infections that can be caught during sex, if this is indicated. 
• Your GP may order an ultrasound, which is a test that uses sound waves to make a picture of the uterus, ovaries and vagina 

• Your GP will discuss treatment options, such as using the oral contraceptive pill or other treatment possibilities.      
• If needed, your GP may suggest a specialist gynaecology referral.  This might include consideration of a surgical procedure called a laparoscopy to investigate the possibility of endometriosis.  Again, endometriosis is a very important diagnosis to consider especially if the pain is very severe, if it doesn’t respond to usual treatments like anti-inflammatory medication (used properly) or the contraceptive pill, and if the pain is interfering with daily activities. 

 

Summary 

 When it comes to period pain in teenage girls, my take home message would be that if you have tried the simple strategies I have outlined, and this doesn’t help enough, please don’t feel periods are too embarrassing to talk with a doctor about, or that period pain is just “part of life”.   Find a GP you feel like you can talk with about the problem.  

Here are some helpful resources 

• JeanHailes.org is a terrific website for independent, evidence-based health information for girls and women. 
• The Women’s and Children’s Health Network is another good site for health information for girls and women 
• Girls Stuff by Kaz Cooke is a terrific book for teenage girls, covering a myriad of issues 

 

Sources: 

Primary Dysmenorrhoea in Adolescents by Chantay Banikarim 28 August 2017 www.uptodate.com 

Prevalence and severity of dysmenorrhoea and management options reported by young Australian women Volume 45 No. 11 November 2016 Pages 829-834 by A. Subasinghe et al. 

Primary Dysmenorrhoea in Adolescents: Prevalence, Impact and Recent Knowledge Paediatric Endocrinology Review 2015 Dec; 13(2) Pages 512-520 V. De Sanctis et al.  

Diagnosis and Initial Management of Dysmenorrhoea American Family Physician 2014 March; 18 (5) Pages 341-346 A. Osayande and S. Mehulic