Period Pain & Young Women

What to do when period pain is getting in the way of living your best life.

by Dr Peta Wright

As an adolescent gynaecologist, I see many young women with painful periods that are interfering with their ability to go to school, play sport, hang out with friends and family and generally can make them feel pretty miserable. By the time I see them, often it has been going on for a long time and the longer it goes on, the worse it tends to get.

Often young women are told it’s normal to have period pain and to just suck it up, but for girls with debilitating period pain this is impossible and these kinds of sentiments only make it worse.

I am often asked what IS normal and what symptoms should I look out for that may indicate something else is going on. I am also asked what are the first steps to help address pain and what are the steps I can take to help to make things better.

Most women get some period pain due to prostaglandin (an inflammatory compound that is released as the lining of the uterus sheds with a period) but this pain should only last for the first one or two days before and one or two days of your period. If the pain persists all throughout your period or between cycles this could be a sign of endometriosis.

‘Normal period pain’ is usually relieved by simple measures such as:

• Medications like ibuprofen and paracetomol taken regularly. These medications are anti-prostaglandins and help to mop up inflammatory prostaglandins before they can cause pain.

• If periods are heavy, using tranexamic acid plus ibuprofen during periods is found to be as effective at reducing pain and bleeding as the pill. 

• Ginger 500mg three times a day has been shown in numerous studies to be as effective as ibuprofen for period pain.

• Supplements such as zinc 30mg and magnesium 300mg can also help to decrease prostaglandin production when taken every day.

• Many young women find that eliminating dairy from their diet for 6 weeks to 3 months can help to decrease period pain. This may be due to the inflammatory A2 casein found in cow’s dairy. 

If your pain is not helped by these strategies, it is a red flag that something is wrong and should be investigated further.

Other symptoms around your period like migraines, nausea, spotting before your period and painful sex are also symptoms that could make endometriosis more likely.

The biggest thing to take note of is the effect of the pain on your ability to live your life the way you want! If you are consistently missing days of school, not able to play sport or enjoy life, then your period pain is NOT normal and you should seek further advice to get your pain under control.

If simple things like using heat packs, Nurofen and Panadol and the measures described above, are not effective you may want to see a gynaecologist to discuss further treatments.

Many young women are put on the pill without addressing possible causes or implementing diet, lifestyle, and supplements, and while the pill may be helpful for many girls, it’s important to understand exactly how it works, and potential side effects and risks. 

Hormone treatments commonly include the pill, or the Mirena IUD. If taking the pill, many girls with debilitating periods may find it beneficial to skip the sugar tablets and only have a withdrawal bleed every few months. The hormones in the pill keep the lining of the uterus thin but support it so it does not need to shed. Without shedding, the lining does not bleed and release the inflammatory prostaglandins leading to reduced pain. 

The Mirena is an intrauterine device that contains a progestin that also acts to keep the lining of the uterus thin. Most girls who have a Mirena have no periods after 12 months.

If you try hormone treatment for three to six months and get little relief, I would recommend requesting a referral to a specialist who deals with pelvic pain and endometriosis. 

It is important to stress that you don’t always need an operation if we suspect endometriosis. If hormone treatment works to relieve pain, you are not troubled by side effects, you are well informed about how it works and it enables you to live a brilliant life then you may not need a laparoscopy. However, if the hormone treatment is not working, a laparoscopy may be the next step.

Some young women prefer to have a diagnosis before starting hormone therapy and I think this is reasonable also. It is commonly felt that laparoscopy is only warranted after hormone treatment fails – but I think that young women should be properly informed of all the facts, risks, side effects of hormones and surgery and be guided to make their own informed decision as currently it is not known whether early laparoscopy over going straight to hormone therapy leads to improved outcomes. 

Laparoscopy is a key hole surgery to diagnose and remove endometriosis. If endometriosis is diagnosed and removed it is still important to suppress periods with hormones to prevent it growing back – this can be with oral progesterone, the pill, Visanne or with the Mirena IUD. Diet and lifestyle and addressing underlying inflammation are also a big part of ongoing treatment. Read all about this in my diet and endometriosis blog. 

Many girls think that an operation will be the fix when it comes to endometriosis and painful periods, but for most women it is just the beginning. While surgery can diagnose and remove endometriosis, it can’t fix other factors that may contribute to your overall pain, such as pain nerves that have become sensitised and pelvic floor muscles that have become too tight and tense over time. When it comes to surgery with endometriosis, excisional surgery, where the endometriosis is completely removed is thought to be best. This removes inflamed tissue from the pelvis and reduces the inflammatory burden in the body. Make sure you see a specialist who is skilled in this kind of surgery and who also addresses the other factors involved in pain and endometriosis. 

If pain does persist after surgery, it’s important to remember these things and treat them early. Therapies like specialist physiotherapy, pelvic floor relaxation, nerve desensitising medications, mindfulness and a healthy diet are often just as important as surgery in getting better and staying better.

Organisations like QEndo, Endometriosis Australia and the Pelvic Pain Foundation of Australia have excellent information and resources on their websites. They also provide a platform to be able to communicate with other young women about their experiences. This sense of community around pelvic pain and endometriosis is growing and means that young women can be well supported and empowered with information that will help you to take charge of your own body and find the best people to help you get back to living your best life. 

If pelvic pain is interfering with your life and happiness, your ability to go to school or work, then please know that there is help available. While there is much we don’t know for sure about endometriosis, we do know that early discussion, recognition and properly informed intervention improves the lives of young women and helps to prevent the development of chronic pain and other problems later on. 

If you are struggling with period and pelvic pain please reach out!