Nurture Article | The Portland Hospital Parenting Magazine
Autumn/Winter Issue 2014 | Solving Teenagers Period Problems
Teenagers suffer gynaecological problems just like older women but they can get overlooked or not taken seriously.
Periods are just another part of puberty for teenage girls, but some suffer more than others with pain and heavy bleeding or experience irregular cycles,particularly in the first three years of menstruation.
Australian research,published in 2010,suggests as manyas one in four adolescent girls suffer significant problems with their periods which affect life activities and resultintime off school.
‘Around 95 per cent of problems in the first couple of years after a girl starts her period can be attributed to the body ‘settling down’ and developing a regular hormone cycle. Rarely will it be due to an underlying pathological problem,’ says Professor Sarah Creighton, a Consultant Gynaecologist at The Portland Hospital and Honorary Clinical Professorat University College London Hospitals.
‘But that’s not to say we can’t give treatments to ease their symptoms while we wait for Nature to settle down.
‘If girls and young women are experiencing heavy bleeding, clotting and flooding, pain or their cycle isn’t improving
and they are missing school for instance or,in rarer cases,developing anaemia and tiredness, then it is worth considering treatments that can help.’
Sometimes, all that’s needed is reassurance that what they are experiencing is normal and in most cases will settle down, she says.
‘I advise them not to wait for period pain to start but to take painkillers such as ibuprofen or paracetamol as soon as the period starts as a preventative treatment.
‘It’s also important they get enough sleep, avoid constipation, take enough exercise and eat healthily,’ explains Professor Creighton.
‘I find not all young girls have had access to this type of information – they may have touched on it in a biology lesson, but that will just be the biological facts and not the useful stuff about how to cope with period problems, and some are too embarrassed to ask friends or family members.’
Apart from painkillers to treat menstrual pain, there are also drugs available to make problem symptoms more bearable.
‘One of the commonest treatments for heavy periods is an oral progestogen pill such as norethisterone(NET). This has to be taken for 3 out of 4 week seach cycle and can make periods regular, less painful and lighter. One study on NET showed it reduced blood loss by 83 percent,’ explains Professor Creighton.
‘For older girls, the contraceptive pill can beavery effective treatment. Some studies have shown it reduces blood loss by 43 per cent and cramping by more than 50 per cent.’ Girls can also be prescribed iron tablets for anaemia, medication called tranexamic acid for very heavy blooding and non- steroidal anti-inflammatory drugs (NSAIDs) to relieve pain.
This term describes ovaries that contain many small cysts (about twice as many as in normal overies). The condition affects one in five adult women. Symptoms include irregular, less frequent periods or a complete lack of periods, oily skin and acne, weight problems, depression or mood changes and unwanted facial or body hair. ‘We don’t know how many teenage girls may have PCOS as there is very little research on this condition in teenagers,’ says Professor Creighton. ‘But it’s important to stress that acne, mood changes and irregular periods are common in the teenage years and that doesn’t always mean you have PCOS.
‘Blood tests and scans can confirm a diagnosis and then the condition can be managed – there is no cure. A combination of diet and lifestyle advice and sometimes prescription of the contraceptive pill can symptoms.’
Other causes of period problems
When girls don’t respond to these treatments, there may be an underlying cause which requires specialist investigation. These conditions include:
Blood clotting disorders such as von Willebrand’s disorder, where individuals have either low levels or a complete absence of von Willebrand’s factor (a protein needed for healthy blood clotting), platelet disorders and haemophilia carriers, are rare, but can cause heavy periods. They may need treatment by a haematologist.
This is a condition where endometrial cells lining the womb migrate to other parts of the body, causing painful heavy periods. Each month these cells react to the menstrual cycle and also bleed. However, the blood cannot escape and causes inflammation, pain and the formation of adhesions (scar tissue).
‘We used to believe that teenage girls didn’t get endometriosis but now we know they can. At The Portland I would refer suspected cases for laparoscopic (keyhole) investigation and treatment to remove endometrosis’ says Professor Creighton.
Very rarely girls can be born with gynaceological abnormalities such as a blocked or absent uterus or vagina. This may not become apparent until puberty and some of these conditions may require surgery,’ says Professor Creighton.