Periods Pain Is Not Normal

Endometriosis is where cells similar to lining of uterus grow at an extra-uterine unusual site such as ovaries, pelvic peritoneum, fallopian tubes. Actually, it can grow anywhere. In the past it was believed that this disease affects only older women, but we now know that it is common for a teen or a young woman to get endometriosis says Dr Vimee Bindra - Fertility Enhancing Surgery Specialist. This young girl may think that the incapacitating symptoms are the norm and she has to live with it and this feeling and misconception is deepened further by ill-informed people who tell her that "period pain is normal", "exercise will make it better", "don't behave like a kid, its your period", "your mother and grand-mother had the same pain so don't worry".

If pain does not subside and she is taken to doctor and in all probability, she may be told that there is no problem. Everything is fine with you, no need to complain so much. If pain is pretty bad, she will be introduced to the world of analgesics (painkillers). If this also doesn't work, contraceptive pills come to rescue, and she starts functioning under the influence of hormones. And if it is due to endometriosis the disease progression continues and after years of suffering, she may be diagnosed when she undergoes laparoscopy.

Endometriosis symptoms in teens

Most women when asked tell that their period pain started in their teens or early 20s. around 40% of women start experiencing period pain before the age of 15 years.

Evaluation of period pain

Mild discomfort on the first 1-2 days of a period is common but it needs further evaluation if it causes distress or inability to do routine activities, missing school, sports activities and doesn't get better when treatments like simple painkillers are taken.

Which teens are at greater risk

Endometriosis runs in families, so young girls whose relatives have endometriosis have a higher chance of having endometriosis. Girls who start periods early, have low BMI run a higher risk of endometriosis.

These girls may develop some other symptoms such as

• Heavy bleeding,

• Bloating,

• Lower back pain,

• Muscle spasm,

• Irritable bowel,

• Painful overactive bladder

• fatigue.

If teenager girls is not responding to medical pain management and if laparoscopy is done, almost 67-70 % of them will have endometriosis.

Diagnosis of endometriosis in teenage girls

Ultrasound and MRI can detect ovarian cysts quite well but in teenage girls these lesions are rare and peritoneal lesions are more common. These lesions are small and are clear or white or red and can be picked up on laparoscopy only. To identify these lesions properly endo excision expert should be involved for diagnosis and treatment.

How parents can deal with their teenage suffering with pain

• Get good information about the pelvic pain.

• Do help them cope up with pain and its effects on their emotional thought process which might leave them thinking they have to suffer like this whole life

• Help them develop a support team of gynecologists, physiotherapists, pain management specialists, dieticians, counsellors, friends, teachers and school nurse.

• Try to shift the focus away from pain

• Help your adolescent develop a plan to deal with bad pain day

What adolescents can do with pain to manage their symptoms

• Keeping active which will reduce their muscle spasm. Gentle exercise such as walking and stretching helps.

• Physiotherapists can help relaxing pelvic muscles as tightening the pelvic muscles increases pain.

• Improve diet, include anti-inflammatory diet and avoid constipation, drink plenty of water.

• Involving yourself in a hobby helps distracting from symptoms. Meditation and breathing exercises also focus the mind away from pain symptoms and help in pain management.

• Acupuncture and alternative therapies can improve pain symptoms for some young women.

What's best we can and should offer

Make the diagnosis early. If pain is severe, endometriosis should be considered a possible diagnosis and believe the patient and don't tell them it happens, its normal, you are over-reacting. If its endometriosis, it can be corrected surgically, and she can lead a pain free life.

Simple Surgery to be relieved

Trained excision surgeons who can completely recognize the disease and remove it, can reduce the recurrence rates of disease. This can be a day care surgery and patient can go home same day. If complete excision is done, post-operative pain relief is miraculous. Menstrual cramps and ovulatory pain may persist. When these young girls are free form chronic pelvic pain, their healthy state of mind returns and their productivity increases. They can themselves value their worth.