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Teenagers are more likely than older women to have painful periods, and doctors need to be on the lookout to give them the right advice about managing discomfort, gynecologists said Tuesday.
While period pain is common, it’s usually not serious, the American College of Obstetricians and Gynecologists said in new guidance to its members.
“We know that teenage girls suffer a lot with painful periods and we wanted to heighten awareness,” said Dr. Geri Hewitt of Natiobnwide Children’s Hospital and Ohio State University, who wrote the opinion.
“Dysmenorrhea, or menstrual pain, is the most common menstrual symptom among adolescent girls and young women,” the new guidance reads. Up to 90 percent of teen girls suffer painful periods.
Symptoms of dysmenorrhea include nausea, vomiting, diarrhea, headaches, and muscle cramps. It also can make it hard to sleep. And it is a very common reason that teenaged girls miss school.
"No matter the cause of dysmenorrhea, it has a profound effect on our patients' lives, especially adolescent patients," Hewitt said.
“By quickly identifying and diagnosing dysmenorrhea, ob-gyns can help relieve patients' pain and enable them to resume normal order in their lives."
See gynecologist by age 15
ACOG recommends that teenage girls see a gynecologist by the time they are 15. These visits do not usually involve a pelvic exam but are a good opportunity for a specialist to advise girls about their menstrual cycles, vaccinations, tampon use, safe sex, nutrition and other matters.
Treatment for painful periods usually includes non-steroidal anti-inflammatory drugs such as ibuprofen, as well as hot pads. Hormonal contraception pills can also help lighten and regulate painful periods and relieve painful symptoms. Teens should not get narcotics for period pain, the guidelines stress.
“The vast majority of the time when girls have painful periods, it’s not because they have an underlying medical condition, but rather the lining of the uterus, called the endothelium, is making too many chemicals call prostaglandins that result in increased pain,” Hewitt said. It’s not known, she said, why this happens among teens.
NSAIDs treat the underlying cause of the pain.
Symptoms of endometriosis
Sometimes it is more serious.
“Secondary dysmenorrhea refers to painful menses due to pelvic pathology or a recognized medical condition,” the guidelines read. “The most common cause of secondary dysmenorrhea is endometriosis.”
Teens who are still in pain after treatment with NSAIDs or contraceptives may need an ultrasound and perhaps a pelvic exam to see if they have endometriosis. This requires a trained specialist to diagnose.
“The appearance of endometriosis may be different in an adolescent than in an adult woman,” the guidance reads.
“In adolescents, endometriotic lesions are typically clear or red and can be difficult to identify for gynecologists unfamiliar with endometriosis in adolescents.”
Even though period pain is common and needs treatment, teenagers may have trouble getting proper medical care, the guidelines note. They may also have to wait as long as five years to get a diagnosis and medical advice.