urgent gynae advise needed for teenager please

[Crackalac]

life's been a bit chaotic and I just can't think straight, so this might be obvious

dd13 started with what we thought was severe menstrual cramps on Saturday. this is normal for her but this was more extreme.... vomiting and fainted. but me and other dd experience bad periods so horrid but didn't worry too much

it has improved since but she is still getting waves of pain where she can't walk, peeing hurts, keeping her awake etc etc

it occurred to us that she has not long finished a period and so we went to OOH last night. they ruled out appendicitis and urine infection, and do think it's gynae. they didn't have access to a CT scanner and told us to see GP today.

I have been trying to contact GP anyway since yesterday and have received a text message saying phone lines are down, should get a response in 2 days

I think she needs a scan. I don't think she should wait 6 months for GP to refer her to gynae. but currently she isn't in extreme pain so I don't feel like we can go to AnE. she fell asleep about 6am so is currently settled

Did the nurse she saw know she has a fever? If this is new info this is a good reason to escalate.

yes, the nurse took her temperature and commented on low grade fever

Get the tranexamic acid prescription. Get her taking that if you haven't already.

If it is gynae one possibility is a burst ovarian cyst.

This is when a cyst on the ovaries bursts and the abdominal cavity is flooded with nasty pus etc etc.

It happened to me - the pain was something else.

If she is still in pain after the tranexamic acid take her to an and e because although it might be gynae that kind of thing can kick off infections etc.

Regardless if the cause if she is in massive amounts of pain she needs pain relief and if the tranexamic acid isn't cutting it then an and e will help. Or if you can actually get a gp appt get one.

Tranexamic acid is in the ibuprofen class of drugs (nsaids) so you can use paracetamol and codeine (co-codamol) in between. Co-codamol is available at pharmacists but you need to ask for it.

The nurse cannot possibly confirm that the pain is “gynae” just from palpating the abdomen. I’ve never met the woman but I know she’s not that good, even the most experienced gynaecologists/general surgeons in the world aren’t that good, and they’d tell you that themselves. Unless she’s got magic ct scanning fingers she can only be suspicious that the pain is gynae.

well, when she pressed on her uterus, it was painful

you are thinking of mefenamic acid, which is NSAID. Tranexamic acid is to reduce bleeding

I think you need to push to get that scan either through the GP or A&E ASAP. It could be so many things that getting a proper investigation is so important. When I had severe pain and vomiting, that resulted in emergency gynae surgery, the consultant in A&E suspected gynae but absolutely refused to rule out things like appendicitis before a CT scan.

Sorry just to clarify? I may have mis -read your post
your daughter has a coil fitted?

And if so has someone checked its position?
Is it a mirena or copper coil?
Seems a bit unusual to fit a coil for painful periods in a non sexually active child

Severe intermittent abdo pain, vomiting, fever, not currently menstruating...she needs a review by a doctor today!

I would ring GP and ask to be seen today. If they can't fit her in then ring 111, I would be amazed if they say anything other than go to A&E.

I'm in Ireland where we aren't experiencing the severe difficulties in seeing a GP as you are in the UK, so I'd first go to the GP, then A&E.

The nurse you saw cannot possibly tell you it's 'gynae', whatever that means.

I had something similar. Woke up, the pain indescribable. Passing out if I lifted my head, had to army crawl for help. Mesenteric adenitis. Only after A&E and surgery insisted it must be an ectopic pregnancy (despite 5 negative pregnancy tests and my informing them it was immaculate conception if it was!). Every new person I met insisted it had to be that and ordered another pregnancy test. Ignored the sky high white cell markers and swollen lymph nodes elsewhere.

I'd take her to. And e, potential cyst

Hi OP, many cases of pelvic inflammatory disease are caused by a sexually transmitted infection, such as chlamydia or gonorrhoea. I wonder if she has cysts. I had a similar experience at your daughter’s age and it turned out that I have PCOS. If you can afford, maybe opt for a private ultrasound scan. Ultrasound scans are generally a lot cheaper than other scans.

sorry, that was my eldest child...she had it fitted age 16. it's not unusual to have a coil to control heavy periods. I had one too

GP has given her an appointment for 17th May 🤣 We are on our way to AnE

thanks for everyone's support , info, suggestions

The only way to press on the uterus is to do a bimanual examination - internal and external at the same time. Otherwise you generally can't feel it (unless enlarged) as it sits behind the pelvic bone.
There are lots of things in a female that can also cause pain (ovaries, appendix etc) in the same lower abdominal area.
There is also no way to exclude appendicitis just by feeling someone's abdomen. Certainly some things make it more likely, but the only way to exclude is for certain is scan/surgery.

With this much pain, take her to A&E, she needs a proper examination and assessment.

I've had PID, if I can help.

I don't know what infection caused it but it wasn't sexually transmitted. So it can be from other causes.

I had been getting heavier periods for a couple of months, but I hadn't thought anything of it. They were also quite far apart, but again didn't think anything of it.

I started off with a very sore neck, actually. I thought I'd wrenched it. It was painful enough that I went to A&E (I was away from home so called 111 and they sent me in), but A&E sent me home.

I then started getting a low fever, along with low abdomen cramps. It felt like a combination between bad period pain and a UTI.

I was getting stinging when I was going to the loo, as well as trouble passing urine.

The cramps then got worse and worse over the space of about a week-ish. It became increasingly painful to walk. I also got a raging temperature. It was well over 40 by the end.

By that point, the pain I was in was excruciating, I couldn't pass any urine at all, and I was finally blue lighted to hospital.

If there's anything else you might be interested in, please let me know.

Campylobacter infection gives very similar symptoms to those you describe. Waves of pain, nausea and vomiting and sometimes bloody diarrhoea. May explain low grade fever.
As an endo sufferer I would say campylobacter is marginally worse than a flare up of endo ( mine was stage 4 so pretty debilitating).
The cramping is very similar to contractions.

A&E with ongoing pain and fever sounds completely the right thing to do. Like other people have said the nurse can’t palpate a uterus and be confident like that. Same reason you can’t feel a pregnancy externally for months as it’s so low down. Not that I think she’s pregnant, just there is bowel and other issues going on and appendix is one possibility

frigging hell, that sounds goddamn awful 💐

if you would like to place your bets, I will let you know later 👍

My hope is mesenteric adenitis as it doesn't require surgery etc and often passes fairly quickly on its own if its a viral infection. I was much better after 24 hours. Fingers crossed isn't something more serious like a cyst, ovarian torsion, appendicitis etc.

Fingers crossed she feels better soon and you get to bottom of it x

It was horrendous!!

Fingers crossed it's not that for your DD 🌺