passing out while on period?

[bloodyunicorns]

DD has now passed out twice while she has her period, through pain.

She's going to ring the GP, but what can she do to prevent this? She already takes Feminax as soon as her period starts, and keeps on top of pain meds.

Does anyone else pass out with pain, and what helps you?

Solpadeine Max (Paracetamol and codeine) or nurofen plus (Ibuprofen and codeine) are the only things that worked for me as they have the highest OTC codeine amount available. I managed to get it prescribed eventually but GPs are rightly reluctant to do this. She can always combine Solpadeine Max with normal ibuprofen, or Nurofen Plus with normal paracetamol. Could the copper IUD be contributing? I know they make periods heavier but my knowledge isn't up to date re. their effect on pain.

I had this throughout my periods. I lost a tooth passing out in the Coop car park. The only thing that stopped it, was getting ahead of it by taking 2 Neurofen as soon as you know your period is starting. Now of course its just ibuprofen.
It wasn't caused by the pain - that didn't kick in really til after I'd fainted. It's another reason to do with the lining peeling away. Can't remember the medical term.
I've never had endometriosis or any other problem. And had the easiest menopause ever. So at least it's not automatically tied to other problems later on.
All my sympathies to her. It's an absolute nightmare.

I had this until I went on the pill at 15 and it sorted it out.

I have past out a couple of times since but it has been when I've not been on the pill for a while.

I had this as a teen and it was an early indicator of endo. The biggest challenge you face is firstly getting a GP to take it seriously and then getting a referral. I think the current average for diagnosis is around 8 yrs.

However don't rule out the IUD - its also a possibility. It may well be that if it the problem isn't endo then the minipill is the right solution for her. I agree with PPs that starting pain relief the day before she is due might help.

Don't be dismissed either by the "its a woman's lot" response - seek out further investigations, she shouldn't be in that much pain every month without it being better managed at least.

Boots sell it, as do most pharmacies but it's just (expensive) ibuprofen now. The old school formula was much better!

I've been told they've stopped selling it. 🤷🏼‍♀️

I did when I was about 15/16. The pill was the only thing that worked for me, none of the painkillers worked for me.

OP can I ask why DD is using a copper IUD as opposed to a Mirena or other brand? Copper IUD will make already bad periods (which need thorough investigation) much worse.

Hope you get it resolved via the GP. I don’t think dosing up on lots of painkillers is a long term solution women should accept.

She didn't want a hormonal IUD.

I have endo op and this was me at her age.

Please help her to get a referral to gynae and not be fobbed off by gp prescribing pain meds, pill and blood loss reduction meds which only treat the symptoms and mask whatever may be wrong.

Took me 14 years to get a dx by which point I had lost 3 babies and had an ovarian torsion likely due to the endo (though Drs tend to be non committal on such things)

I'm now on the mini pill meaning no periods, but I've had surgery, Prostap and other treatments for the endo so that hopefully I don't have additional health issues as a result

GPS are notoriously crap on such matters so be prepared to fight for her

Is her dad around? Cos unfortunately her fighting her corner may mean it's taken more seriously - medical misogyny abounds

@JigglyPuffster, @DjoChateaux , @Spudlet , @LetitiaLeghorn , do you mind sharing what investigations you had to rule out endometriosis?

I ask because when I looked into it, it seemed to me that the evidence that severe dysmenorrhea commonly exists with no underlying cause is weaker than you'd think. There's a lot repeated about it online, but when you actually drill down into the underlying research studies, all the ones I found were astonishingly poor-quality and contained obvious major flaws. I haven't revisited that topic more recently but if there are any modern, high-quality studies on primary dysmenorrhea that adequately exclude for secondary dysmenorrhea, I'd be really interested to see them.

What I did find was a number of higher-quality studies suggesting that, when adequate investigation is performed, endometriosis is often found. Unfortunately it's easy to miss it with inadequate investigation, or even with laparoscopy - general surgeons and non-specialist gynaecologists can fail to recognise it, either because they're not familiar with some types of lesion, particularly atypical ones and the clear type that can be found in teenagers and younger women, or because they don't look in the right places - they may assume if the uterus/ovaries are fine, there's nothing more to find and they don't check the pouch of Douglas, for example. So a laparoscopy performed by the wrong person isn't necessarily a reliable guide - and so far as I'm aware, there's still considerable variation in the standard of service offered to endometriosis patients in different UK hospitals, even now that the BSGE is working to even things up a bit.

This isn't to suggest that every single case of pain is an undiagnosed case of endometriosis - but a lot of patients are under the mistaken impression that they've been adequately evaluated if they've had an ultrasound scan, an MRI, a hysteroscopy, a colonoscopy.... It very rarely shows up on ultrasound/colonoscopy and often not on MRI, yet GPs even nowadays often tell patients that a clear scan means they can set their minds at rest and the pain doesn't have a cause.

Every time this type of thread appears - and there have been a lot of them over the years - a lot of posters pop up to say they've had horrendous pain for years and it definitely isn't endometriosis. And while some of them may be correct, both statistics and evidence on current diagnostic practice suggest that at least a proportion of these women have been misinformed about the value of the investigations they've been given and the certainty with which the disease has been excluded.

Apologies for the hijack, but this is a topic which I feel strongly about. I'd welcome better studies, better-quality data, better access to good-quality assessment for symptomatic patients, and better all-round awareness and education.

OP, sorry for the hijack, but I hope it's been of some use to you.

@ElnoraComstock totally agree scans are not diagnostically rigid for endo or even fibroids always my endo was dx by a gynae surgeon I'd had surgery for other things before that and the other surgeons failed to dx

@ElnoraComstock it was a vaginal ultrasound wand scan that they said ruled out endo. I had my doubts but conceived two kids very easily and I didn’t go back on the pill, and the fainting and puking did not return, so I stopped worrying about it. I’ve got a friend with endo who has struggled to get it diagnosed for years and has just had a second operation to remove it, so I agree, it is very underdiagnosed and badly managed. (Have you read Hilary Mantel on how badly managed her endometriosis was. Amazing read. www.lrb.co.uk/the-paper/v25/n02/hilary-mantel/little-miss-neverwell)
However just to add - for me as a teenager, the pill sorted it out straightaway and I was fine on it, no side effects It was a relief.

I used to faint as a teenager during my periods, not because of pain, maybe it was low iron or something to do with blood sugar, I did have painful v heavy periods. This was the late 80s/early 90s. I used to take painkillers but sadly in those days nothing else helpful was suggested.

@ElnoraComstock I had a dilation and laparoscopy under GA. I had no trouble conceiving and my pains are now totally manageable after having had a baby, so I’m fairly confident that it isn’t endometriosis. Who knows though?

@ElnoraComstock I never had any symptoms of endometriosis so never had investigations for that. In fact I don't think I had investigations for anything. My mum suffered from bad period pains too with no endometriosis so I think it was just put down to one of those things. I did have a scan once for something - I think it turned out to be a cervical erosion. Later when I'd gone through the menopause, I suddenly bled a bit. So I was sent to the gynae who did an internal scan (one tiny fibroid) and a colposcopy (right word?). No signs of anything wrong, no endometriosis. They put it down to a release of hormones. Nothing uncommon or suspicious. It never happened again. So I think it's safe to say, definitely no endometriosis. Bear in mind I started my periods back in the 70s. If you think doctors aren't interested in women's issues now, you should have seen what it was like then!

I always had normal periods lasting about 5 days on a cycle of 28 to 31 days - never spot on. Until the menopause where they became a bit more unpredictable and occasionally heavier. Then they stopped, I had a couple of hot flushes and it was all over. (Strangely, same for my mum.) Honestly, I reckoned I was owed that for all the fainting and pain I'd had to put up with. Like everything, though, you learn how to deal with things and as long as I was timely with a couple of Neurofen, I was fine.

Can I say, you have shown more interest in my pain than the entire NHS! Lol. Thank you.

@LetitiaLeghorn , bad period pains are the primary symptom! An internal scan and a colposcopy would be very unlikely to show endometriosis. It rarely shows up on ultrasound scans and a colposcopy is looking in the wrong place! So no, I don't think it's at all safe to say there was none!

@JigglyPuffster , a vaginal scan is unlikely to show up most cases of endometriosis, even when it's severe.

@ElnoraComstock Id love to know out of curiosity, but do you think there’s any point pursuing a diagnosis if it’s not bothering me? Given it’s not bothering me, I wouldn’t want an operation.

I had this as a teen. Excruciating period pains, heavy blood loss and I nearly fainted twice and would regularly vomit from the pain (once in the school dining hall, despite me telling the teacher it was imminent) and once on the school bus. It stopped when I went on the pill at 17 and my periods were lighter and less painful even I'd stopped taking it.

I have stage 4 endometriosis and adenomyosis (amongst many other things).
In my experience, in terms of concrete diagnosis you need a laparoscopy and a good endometriosis surgeon to find it (some legions are very hidden and hard to spot) and a lab to confirm it.
sometimes endometriosis is able to be seen on an MRI if it is quite severe - mine showed due to nodules, fibrosis and anatomical distortion from 25 years of not being listened too 🤦🏼‍♀️
ultrasounds generally don’t show endometriosis but can show adenomyosis.
if it is endometriosis, you then need an excellent surgeon who will remove it with excision surgery. Sadly it can and does grow back although in my experience no where near as bad as I was pre-surgery when I was housebound for most the month. Read more at Nancy Nook on Facebook or there’s a website.

Sorry, @ElnoraComstock , I had a hysteroscopy. It was a camera into the womb and they pumped in water and air so it felt like minor period pains. I had to take ibuprofen beforehand. Nothing changes. Lol.

Would that pick up endometriosis? I don't know. I've looked up the symptoms and I only ever had the one symptom of bad period pain. And that was only til the painkiller kicked in. No heavy bleeding. No pain over sex, no blood or pain with urine or bowels. I've read about women suffering ftom it and I can't really relate to any of what they've gone through. However, I'm always happy to add an illness to my collection so that I can tell family, oh how I've suffered! 😉😁 So I'm taking what you're saying on board.

Nurse and gynae patient here, I have fibroids and adenomyosis. Feminax appears to just be ibuprofen. Mefenamic acid is a non-steroidal (same family as ibuprofen) but is a prostaglandin inhibitor. Prostaglandin is the hormone that causes the cramping. I've also found that reducing other inflammation in my body helps, I have a mild dairy intolerance and am quite sensitive to sugar so if I limit that it really helps with my pain. Don't rule out paracetamol as well, I can mostly manage my pain with Mefenamic acid and paracetamol.

I noticed a previous poster suggested naproxen and feminax - this is NOT advisable.

I went on the pill at 14 and after investigations for endo was told I had primary dysmenorrhoea. I would recommend the pill as it also made my periods lighter.

I do think evening primrose oil helped a bit too.

I was convinced I would have trouble conceiving but actually I fell pregnant very easily and had easy pregnancies and births, so even if your poor dd is in agony every month there may not be anything wrong.

A helpful gynaecologist said soluble aspirin was the best thing for period pain.

Some of the more helpful GPs I have seen have been men, you'd think women would be more sympathetic really.

I was told the pain would be better after having children. This wasn't helpful to a teenager and also not especially true, I wish they'd stop saying this to young women.

Jigglypuffster, it all depends. (Disclaimer - I'm not a doctor. This is based on a lot of reading, an understanding of stats and on personal experience).
If you really have no symptoms currently, I think you'd have difficulty getting a GP to refer you, though you could try and if you're ever at all worried I think you should ask them. If you did manage to get referred, I'm not sure a surgeon would agree that the benefits of laparoscopy in a non-symptomatic patient would outweigh the risks.
But it would be worth flagging up if it does start to cause you problems again. I don't just mean gynaecological symptoms - in its more advanced stages it can give all sorts of problems that aren't obviously gynaeclogical in nature and that can occur in the absence of any gynaecological symptoms at all. Patients can end up being sent round gastroenterology, urology and other departments with nobody joining the dots, so the wrong investigations get done. So if you get any persistent bowel/bladder/abdominal problems, or even leg and back pain, it's worth flagging it up - don't assume that somebody appropriately qualified will make the connection or ask the right questions.

The other thing that might make a difference is your age, which I don't think you mention. I think there do seem to be patients who have endometriosis for a long time and it doesn't in the end cause them any serious problem apart from pain, which is distressing but on its own, not a serious risk to health. If you're past a certain age and it hasn't caused a major problem already, the risk of its becoming so later seems to decrease a bit (disclaimer - I don't have a reference for this so if anyone disagrees, please point me to a source). In younger patients (teenage and 20s) I feel strongly that symptoms should be thoroughly investigated - it's potentially a serious illness in some cases, and diagnosis is the first step in risk assessment. Teenagers/younger women are often too young to know whether they might be in the proportion of patients who are much more seriously affected and who would, retrospectively, have benefitted greatly from earlier treatment. There also does seem to be a small proportion of endometriosis patients who get diagnosed in their late 20s or 30s when they hit serious complications - such as kidney failure. So far as I'm aware, this particular risk peaks during your 30s and decreases afterwards.

So I think the upshot is, if you're still younger, keep an eye on your health and act promptly if you get any pain/bowel/bladder symptoms. Discuss it with your GP if you feel at all worried. If you're over 40, it becomes less of a concern but it's still worth flagging up if you get any odd symptoms.

I haven't read the article you linked but have read Hilary Mantel's memoir. The shocking thing to me really is that things have moved on a little since then, but not nearly enough, given the time that has passed.

Letitia, no it likely wouldn't unless possibly you had adenomyosis, and probably not even then, and I think it would be very unlikely to pick anything up that's on the outer side of the uterus wall, which is most types of endometriosis. It's not a given that you have the other types of pain, though they are common. So, yes, I doubt you will ever know. I'm glad you've got through menopause!

@Caramac555 and the others who are suggesting successful pregnancies indicate there wasn't a problem - I'd be wary of suggesting this, because actually the proportion of endometriosis patients who experience fertility problems is less than half (25-50% depending on estimate but I think a good proportion of these do go on to have children), so ease of becoming pregnant isn't really an indicator of anything. Also, for patients with really extensive disease, the big concern often isn't actually fertility, it's damage to various essential organs and nerves.

I can only echo the excellent posts by ElnoraComstock and urge you to support your DD in getting this pain properly investigated. This level of pain isn’t normal.

Unfortunately there is a lack of knowledge and understanding of conditions like endometriosis, even by doctors. I presented with symptoms for over 15 years before diagnosis, by which point I had extensive disease and was infertile. I wish my younger self had been diagnosed and received treatment years earlier.