Painful Period in a Teenager: Part 2

Why Are My Periods So Painful?

This is the continued conversation with a teenage patient about her painful periods. To catch up on the first part of the conversation click here.

In part one of this article, I was speaking with a patient who was brought in by her mother because her pediatrician had suggested she see a gynecologist about her painful periods.

Having heard Hope’s story I have made the diagnosis of primary dysmenorrhea and I have asked Hope’s mom to come back into the exam room so I can explain the diagnosis and treatment options to both of them.

Doctor: “ From the conversation I had with Hope I have been able to make the diagnosis of primary dysmenorrhea. This diagnosis is based on history and at this point there is no need for a pelvic exam or any additional testing.”

Hope’s mom: “ That must be a relief for you, Hope!”

Hope: “ Absolutely.”

Hope’s mom: “ Is there anything you can do to help her?”

Doctor: “ Yes, definitely. Let’s start by talking about non-medical interventions that can help reduce her symptoms.  As I told Hope, an important thing she can do is to continue to exercise. Aerobic exercise on a regular basis has been shown to reduce painful periods.  

There are also some dietary changes that have been shown to help. She should try and eat more foods rich in omega -3 fatty acids such as salmon, walnuts and avocados.  Also foods rich in Vitamin B have been shown to help reduce menstrual cramping. If you eat a well balanced diet you are likely getting enough Vitamin B.

But often teens don’t have the best diet so taking a Vitamin B complex supplement can be helpful. “

Hope: “ I think I have a really good diet and I love avocados and salmon.”

Hope’s mom: “ Yes, I agree with Hope she eats really healthy foods and she is very active but she still has really bad periods.”

Doctor: “ I am really glad to hear she has such a healthy lifestyle and I can tell you that her periods would be much worse if she didn’t. I am saying this mostly to be sure she continues with these things.”

Hope: “ So what else can I do?”

Doctor: “ As I explained before it is the natural chemicals called prostaglandins that are produced in the lining of the uterus which are responsible for the symptoms of primary dysmenorrhea.  The goal of medical management is to decrease the production of prostaglandins in the lining of your uterus.  We can do this by using two different medications, non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptive medications.”

Hope’s mom: “ Ibuprofen is a NSAIDs right?”

Doctor: “ Yes that is one type of a NSAID.”

Hope: “ Well I use ibuprofen like candy and it doesn’t help at all.”

Doctor: “ Sometimes you need to use a different or a stronger NSAID to block the prostaglandins. But, you have to be really careful when you use NSAIDs because they can cause damage to the lining of your stomach that can lead to gastritis and gastric ulcers. You should never take a NSAID on an empty stomach.”

Hope: “ Great, but I can’t eat during on the first day of my period because I am so nauseous.”

Doctor: “ That’s why I think that using a form of hormonal contraception that will thin out the lining of your uterus and by doing so reduce  prostaglandin production will be the most effective treatment for your painful periods.”

Hope’s mom: “ By hormonal contraception do you mean birth control? If you do, Hope’s father will never agree to her using it. He thinks that once a teenager starts birth control it makes her want to have sex.”

Hope: “ Mom, that’s ridiculous!”

Doctor: “ I have to agree with Hope there is no data to support that. I can tell you in my clinical experience I have never seen that happen.

I really believe that starting Hope on hormonal contraception will reduce if not eliminate her painful periods. She no longer will lose three days every month to the pain of her periods.”

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