GP - treatment offers for period/ovulation pain 16 yo

[DoinItForTheKids]

Hi

And by GP I mean General Practitioner, not grandparents!

My DD has two ills each month one being her period which can be really painful, and the other is ovulation pain in the middle of the cycle - enough to double her up at its worst. She has lost numerous school days from either one and we've certainly waited a considerable time to see if it would all calm down - it hasn't.

We have a GP appointment on Monday to discuss this whole topic and I wanted advice from others who've had DDs with this, to find out how your request for help was taken by the GP, what treatment/solutions were offered, and how well did they work?

Be helpful to see how this issue was addressed with others and might give me a bit of a steer to offer ideas to DD about which option(s) offered she might want to research ahead of the appointment.

Thank you.

I'm a GP. I'd offer painkillers or the contraceptive pill, assuming no medical reason why she can't use it. Those are really the only two options.

Ps should have said after of course taking a full history to make sure nothing serious going on.

Thanks pigs .

We went when dd was around 14 and were offered mefanemic acid (sp?)

We're going back next week to discuss other options because it isn't really enough any more.

Dd has awful periods with sickness and diarrhoea as well as cramps. Ovulation pain is bad enough that she's aware she's ovulating but not doubled up with pain so not on the level of your dd.

She copes ok with period pain with a hot water bottle but it wipes her out each month and so she'd like to go on the pill for her exams and long summer holidays.

I'd be interested to know what your gp offers.

I shall feed back afterwards. We're past the 'take a painkiller' option but I will look at the mefanemic acid and find out what that's all about in case it's one of the options put forward.

I take mefenamic acid for painful heavy periods. It's one tablet three times a day and it does help with the pain and also reduces the flow a bit.
It's not doing the job for me anymore as other stuff going on and my periods have now reached epic proportions but it can be very helpful.
Good luck

Personally I have endo which has some of the symptoms you describe. I was fobbed off by many GP's over a period of 14 years.

I had been very clear when giving my history about the extent of the blood loss (Max absorbency towel AND tampon needed changed hourly, periods lasting 10 days to fortnight), pain (bad enough to cause me to pass out regularly and I'm quite stoic),

Pain around ovulation, diarrhoea, visiting, migraine, many school days and later work days lost.

First put me on the pill which helped a little but not enough. Other GP's simply changed what pill I was on. (I moved around a lot due to dad being army)

In all that time I was NEVER referred to a specialist.

The endo was finally diagnosed when I was overseas (therefore not by nhs) following my second mc.

Partly it was a relief to finally get recognition, treatment and a diagnosis. Partly I was very angry and felt betrayed that it had taken all that and losing 3 babies before getting a diagnosis.

I do have a point...

I have a dd. After my own experience I swore to myself she would NEVER go through that so I discreetly monitored/monitor her sanitary product usage and any symptoms she mentions. I've also had discussions with her about my experience.

If I were you I would want a referral to a gynae. This is not normal and is not acceptable and merely treating the symptoms is not acceptable either.

Sorry pigs I know you will disagree but I really think that's a major issue that is a false economy AND does patients a disservice - treating without KNOWING the cause.

Yes some conditions are hard to diagnose but most gynae ones are fairly visible with scans etc

Vomiting not visiting

Dd has pcos and would go for 5 months with no period then bam!! Period from hell. She got an implant which far from regulating her periods gave her a 3 month period! She now is on mercilon pill (as well as implant) which has dramatically improved her pain and cyst situation.

I also don't want to offend pigs but I do think women, in general, are often just fobbed off with symptom control and very little actual diagnosis - which bearing in mind we can also fall victim to serious stuff like ovarian cancer with no symptoms at all, has always felt a bit silly and a false economy as you say graphista.

DDs period aren't really heavy actually. The ovulation symptoms have been quite variable (hence we've given it quite a lot of time to enable the building of a picture of whether it was going to settle down or whether it was always going to be an issue every month). It's still not the exact same replicable issues each month but it is enough to knock her off being able to go to school, and not least since if it's a day where she has sport (she's a sports student too) then she doubly doesn't feel up to it.

There's also issues like ovarian cysts which can be hugely painful and as you say, masking the symptoms isn't necessarily the right thing to do and I totally get your point.

I think for the moment something to stop the ovulation will be enough and probably sensible in view of the looming exam period, and review it again after that (because let's be honest there's risks to being on oral contraceptives).

What we would do if we were told 'it's endometriosis', I'm not sure though.

I do wonder if she needs diagnosing for an ovarian cyst though.

This is what always concerns me (with going to the GP) for anything really.

I don't go dashing to the GP as soon as there's a problem. Not least because I know the first thing they're going to say is "let's leave it a while and see if it improves" - so why go straight away, do that first, give it time. Then the next thing is "oh just try painkillers" - so again, why not try that first, see if tablets and hot water bottles is enough, don't go to the GP straight away. Maybe tack on trying other remedies (herbs, whatever) to see if they help - all to avoid burdening over burdened GPs. But then when you go and say well we've been tackling this for 1.5 years, I don't know what it is, but it seems to almost count against you! I've done the waiting, I've done the first line treatments, I've tried other treatments, none of that's worked so I'm coming to you now for the actual formalised treatment that is clearly needed - and it's almost as though because you've not repeatedly gone to the GP loads of times, you've not built up a history of the issue with them and they don't always seem to trust or be happy to give you treatment - which seems to fly in the face of what they tell us about not seeking NHS treatments unless we really need them. Sometimes feel you can't win. So part of my asking is that I always go into a GP appointment with the expectation of being buffed back out the door again! When I do actually need treatment.

Thanks for the tip re mercilon @Worldsworstcook - is that specifically good at dealing with cysts??

Mefenamic Acid was a life changer for me, I had period issues until early 30s struggled for about a year then went to the gp and it literally changed my life, I take first tablet when first signs start then take 2-3 that day and no more after that until next month

That's good to know twinny thank you. It's kind of all guesswork as to what will or won't work isn't it, because without undergoing diagnostics which could possibly give a clearer indication of where the problem actually lies you can only try a bit of a scattergun approach by trying different solutions. I'll not take this one off the table then for DD - I wonder if the side effects/potential side effects of this are more palatable than those for being on the pill (when you don't actually need to be on it for the purpose it was designed for that is).

Watching with interest, I have an appointment for my 16 year old next Monday ( didn’t have any in half term) though I will ring every day next week for a cancellation.
I wonder about endometriosis, she has so many of the symptoms. On the teenage website it recommended ibuprofen as opposed to paracetamol, then the pill. She has had a scan after being admitted to hospital in pain a couple of years ago, the ovaries were clear. Hoping the pill will get her through her GCSEs without the fainting from pain etc...

I'm not easily offended! I did say that I would be looking for other causes. The history as given by the OP isn't one of an ovarian cyst and ovarian cancer is vanishingly rare at this age.

The treatment for endometriosis would be to abolish the cycle with, for example, the pill. Gynae would reasonably expect that to have been tried in primary care before referring. I'm not sure of the benefits of referring at this stage as I doubt they would be keen to do a laparoscopy at age 16, which is the only way of diagnosing endometriosis (sometimes you see clues on scan but by no means always.)

Fast forward 3-6 months on the pill with no benefit - yes, gynae referral totally appropriate. Just not now,with the history as given, without any trial of treatment in primary care. .

By the way mefenamic acid is an anti inflammatory which has about the same effectiveness as over the counter ibuprofen.

But what is the point of treating symptoms without a diagnosis pigs?

And it may not be endo, I certainly wouldn't presume that I simply said some of the symptoms match. It could be something that a specialist COULD diagnose with more specialist knowledge and equipment.

As I said as a GENERAL issue I think that if GP can't diagnose to a reasonable level of certainty (I accept there are many conditions a GP can diagnose or can take samples which can be tested etc) they should not be so averse to referring to a specialist.

And yes I think with gynae issues girls and women are often treated dismissively.

I reckon I was told over 20 times that there was nothing wrong with me, that I was just unlucky and some women have "slightly" heavier more painful periods.

When I finally got a good regular gynae in U.K. I outlined my experience to her and she was not impressed (to say the least) but also said it was an experience she had heard of many many times.

And yea, most of the Gp's that fobbed me off were male but the female Drs weren't much better.

The point is that the pill is both the treatment for endometriosis and a treatment for painful periods. To diagnose endometriosis you need to have an operation, which is not without risk and therefore that is largely resolved for when initial treatment doesn't resolve it or if something worrying is seen onscan. Treating endometriosis surgically isnt hugely effective (unless there is e.g. a huge cyst). We always think,will this test/intervention change the management of that patient. If not, and there is a risk to the intervention,it isn't justified.

As I said before, if a trial of the pill didn't work, then I would certainly refer. But no one wants to take a 16 year old to theatre unless it's necessary.

I think you need to learn a lot more about endometriosis.

op I hope your GP listens to the fact you and your dd have done all you can already AND have waited a good amount of time to see if whatever the cause has settled. That they aim for diagnosis before treatment.

Which pill is best for long (at least 7 days of bleeding often heavy) with lots of cramping - mini or combined?

Agree with everything you’ve said OP and Graphista.
I had appalling pain, vomiting and diarrhoea from age 15, so late 80s on. No investigations at all. At uni I was told it would get better once I’d had a baby or got older. And given totally inadequate pain relief.
I hope you get a vastly better response for your DD.

Thanks for all the input and lively discussion - I'll report back.

My dd has recurrent ovarian cysts and got referred to a gynecologist. The only option offered to us was the pill and as she gets neurological migraines only the progesterone only pill. Unfortunately that both made her feel very low and didn't prevent another cyst, so we're back to managing the cysts when they happen with painkillers. Currently waiting for one to burst after three days of maximum ibuprofen which doesn't do enough to let her go to school. She's been told to take codeine, but although that's better for the pain it makes her too woozy to go to school. Life as a teenage girl isn't much fun sometimes.

Thanks Graphista, I'm more than happy with my knowledge on endometriosis and what referrals will be accepted and which ones will be bounced as the appropriate primary care treatment hasn't been tried.

Agree trial of OCP would be a reasonable first step but disagree about surgical treatment of endometriosis being ineffective. Ablation of endo is pretty ineffective but excision of endo, by a skilled excision surgeon (which sadly there aren’t many of in the U.K. but this is improving), cures many women of their endometriosis and can be extremely effective at managing symptoms.