Painful Period in a Teenager: Part 1

Why Are My Periods So Painful?

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As an OB/GYN I see many teenagers in my practice with painful periods. I want to share a typical conversation to explain the diagnosis of primary dysmenorrhea.

Hope was 14 years old when she shyly came into my office with her mother. Her mother told me that they were sent by Hope's pediatrician to talk to me about her periods. I asked Hope and her mom if it would be OK if I spoke with Hope alone. I explained that I have found that most teens have an easier time answering some of my questions when their moms aren't there.

They agreed and Hope's mom left the exam room. I asked Hope several questions about her periods. She told me that her periods started when she was almost thirteen years old and that they have always been really bad! 

Doctor: "Are your periods coming every month?"

Hope: "Yes."

Doctor: " You said they have always been painful. Is the pain getting worse?"

Hope: " Yes, they have been painful from the beginning, but over the last six months they have gotten worse and that's why I am here."

Doctor: " You say your periods are bad, can you explain?"

Hope: " Well, I can't get out of bed for two days!"

Doctor: "When are those two days? At the beginning or end of your period?"

Hope: " It's like I know when my bleeding is going to start because the day before I bleed the pain starts. I literally like get in bed and don't get out until the end of my second day of bleeding."

Doctor: " Can you describe the pain for me?"

Hope: " It's awful. Do you know those metal pokers you use in a fire place? Well it feels like a red hot one is stuck in my belly and it is being twisted around. The pain even goes down into my upper legs and it's like a throbbing feeling. Oh, and the best part, I throw up at least twice on my first day of bleeding and I usually have some diarrhea."

Doctor: " That sounds awful."

Hope: " It's really bad. I keep missing two or three days of school every month. I am going into high school this fall and I am really afraid of falling behind in my classes."

Doctor: " That is stressful."

Hope: " I also really want to play sports but I know the coaches will get really mad if I have to miss practices or games because I am out 'sick'!"

Doctor: " I am glad you are athletic, exercise is really good for you and actually it helps with your painful periods. They might be worse if you didn't exercise."

Hope: " I couldn't stand it if they were any worse!"

Doctor: “ I am going to ask you one more question that might seem a bit random but is important to your gynecologic health. Have you ever had sex or are you sexually active?

Hope: “ No.”

Doctor: “Ok. We will save the safe sex and contraception talk for another day. Also based on what you are telling me there isn’t any reason for me to do a pelvic exam today.”

Hope: “ Oh, good! That’s a relief!”

Doctor: “ Pelvic exams aren’t that bad, and they are important when they are indicated but at this point you do not need one.

I can make the diagnosis based just on the information you have told me. You have a condition we call, primary dysmenorrhea.”

Hope: “ What causes that.”

Doctor: “ The lining of your uterus produces natural chemicals called prostaglandins. Some of these prostaglandins cause the muscle and the blood vessels in your uterus to contract and this causes pain. They can also cause nausea, vomiting and diarrhea. The amount of these chemicals is highest the day before and during the first day or two of your period. That is why these are the worst days for you.”

Hope: “ Ok, so can you do something to help me?”

Doctor: “ Yes, I am sure I can help you feel a lot better. Let’s ask your mom to come in so we can discuss this with her.

Hope: “OK.”

Please see part two of this article to learn about the treatment options for primary dysmenorrhea. 

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