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Q&A with Australian Health Practitioners
Could painful periods indicate endemetriosis?
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My 15 yr old daughter has had extremely painful periods from the start. Vomiting etc and days off school. It's now at the point where she has pain for at least 3 days prior to her period then increasing pain once the period arrives for the next three days.
During this time she is taking nurofen round the clock plus parametrial/codeine when needed….even with all this she is not pain free.
Last year we trialled Yaz for 5 months and she seemed to have less pain…still used nurofen. However she became very teary and anxious and so we stopped the pill.
She is quite a highly strung intelligent girl anyway so I was concerned about using a hormonal treatment.
After stopping the pill it took about 4-5 months for her period to return. We have tried alternative natural therapies for the last 8 mths but her periods are getting worse.
Our GP suspects Endo plus prostaglandin pain is occurring but wants to trial loette.
Should I be taking her to a gynaecologist? -
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Thanks
Dr Joseph Jabbour
Gynaecologist, Gynaecologist - Infertility (IVF) Specialist, Obstetrician
Dr Joseph Jabbour is a specialist Obstetrician & Gynaecologist and Fertility Specialist with Monash IVF situated in Sunnybank (Brisbane Southside). Dr Jabbour has had the … View Profile
Hi there,
There are studies that show 50% of teenagers undergoing laparoscopy (key-hole) surgery for chronic pelvic pain or severe period pain have evidence of endometriosis.
It is certainly abnormal for a woman regardless of age to suffer from such severe period pains. Taking time off from studies, vomiting, inability to control pain with simple analgesia and the improvement with Yaz all strongly point to the possibility of endometriosis as the cause. Although an initial conservative approach is fine, a referral to a gynaecologist with advanced laparoscopic skills would be warranted. The options are the following:
1- Simple analgesia such as Nonsteroidal anti-inflammatories and paracetamol can be used (Ponstan)- Tried in your case with little success.
2- Restart the COCP and take it continuously with a break every 3-5 months is generally a good approach - This did control the pain and is certainly an option to go back on.
3- A referral to a gynaecologist who can offer laparoscopic (key-hole) surgery. This is a relatively low risk procedure in the hands of an experienced surgeon. Laparoscopy is both diagnostic and therapeutic. Treating the endometriosis (preferrably with excision) followed by medical management would optimize the success of treatment. I would recommend insertion of a mirena IUD at the time of laparoscopic surgery as it has been shown to reduce the recurrence of symptoms of the endometriosis. If the mirena is not an option, the patient can recommence the COCP or start on dienogest.
Such a clinical case as your daughter's, especially after failed medical therapy, would definitely benefit from the input of a gynaecologist.
All the best.
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