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 and I 100% agree with pig
We have to trial treatment in primary care initially and think about what we are trying to achieve with a referral. If we referred everyone at first presentation of a symptom to the appropriate speciality, the NHS would be in even more trouble than it is already.
I really hope she gets sorted OP. Good luck

DoinIt
Has your DD tried the contraceptive pill yet?

You say that she has both period pain and ovulation pain so I would be really surprised if the contraceptive Pill didn't help with both of her problems.

You don't mention it very much in your posts so I am wondering if there is a reason why she hasn't tried it or she is trying to avoid trying It?

@RandomMess some women who take cerazette (a mini pill) will get no periods but others will get irregular bleeding. combined pill is a more sure thing to make periods light and short and you can run 2-3 packets together to only get a period every 6-9 weeks.

(this isn't individual medical advice, if the GMC is watching!)

A couple of my girls suffer similarly. For one the implant has been transformational. It’s important to get it controlled before public exams. Our GPs were always excellent and as said above, you can’t be moving towards referral outside of guidelines or before first line options have been tried. Period pain in young girls is often cervical spasm and symptom control is a reasonable way forward. We had Naproxen, codeine, metoclopromide and hot water bottlers but there was still breakthrough pain and the codeine meant two days a month curled up on sofa.
The pill for one and implant for the other has reduced the number of periods and alleviated some of the pain. They can now manage without too much disruption on the Naproxen.

I had very painful periods as a teen and taking the contraceptive pill helped me. A lot of girls take the pill to help with period problems, it really is worth a try. I really don't see why you wouldn't try that first.

The implant can be great - 20% of those who use it will find their periods stop and another 60% will have ok periods or some irreg bleeding. 20% will have very problematic heavy bleeding, so it doesn't work for everyone.

@pigshavecurlytails thanks, I wasn't sure if the pros and cons of having more or fewer hormones pumped through the body! Neither types override my cycle so I'm thinking combined likely to be more successful and those exams are fast approaching!

DD was the same - crawling into my bedroom at 3 am to ask me to get her painkillers for ovulation pain, because she could not stand up; and crawling round the house, unable to move without vomiting, and on the floor with period pain! She was given it all by GPs - the pill, mefenamic acid, painkillers....The pill worked for 6 months, then the problems returned, while GPs told her all women suffer period pain....

She suffered pain on sex - was told it was psychological! She started with loss of appetite, nausea and vomiting all month - was told it was anxiety!

First appointment with consultant gynaecologist five years later, he told her she had the classic symptoms of pelvic endometriosis - which he dealt with in the laparoscopy, along with the adhesions. He told her to have children in her 20s, not to leave it until her 30s! She was devastated after being fobbed off by GPs for 5 years, who made out she was being a wimp!

Sex was better after that, she said and her periods are nowhere as bad now (with the pill)! However, at least she can make the decision to try for children in her 20s, rather than maybe leave it until it's too late for her!

The whole family has lost all faith in GPs!

I have endometriosis which took 10 years to be diagnosed which is about average (and unacceptable in my opinion). The problem is that if it is endo, the pill may well help improve the symptoms, but it’s not going to resolve the actual problem. It may help stop it from spreading, but not entirely (or maybe at all). So if the pill helps, that doesn’t mean there isn’t a bigger issue sadly. Unfortunately in the current climate most cases are only diagnosed if the patient is constantly in and out of hospital in agony (as was the case with me) or they’re being investigated for fertility issues. Basically if you have endo that can be controlled by thepill, there’s a good chance you’ll never know and will miss out on far more effective treatments.

The important thing to remember is that very severe period pain is not normal. It shouldn’t be something we put up with. I hope the GP can help

@Checklist that's somewhat of a different scenario from the OP. I have already said that if initial treatment with the pill failed then gynae referral would be totally appropriate. Ditto with pain on sex. The OP's daughter hasn't yet tried anything prescribed so is much earlier on her journey than your daughter.

It's highly likely my eldest has endo and I keep telling her she needs to be persistent. The first implant she had was great, the 2nd stopped being effective after 22 months, the third got infected when fitted!!! It's not been effective had to take the pill as well and is now passing large black clots

She did tell me sex was painful but we've not revisited that conversation! She too has been fobbed off "so long as the implant is working we won't investigate further" she is semi aware that having DC may be difficult but at 21 it's very young to do much about it!

That makes me really angry - even if the implant does seem to be working, why do they think she’s having those symptoms in the first place? And then down the line if she does struggle to conceive when it could have been prevented by early diagnosis and excision surgery...

But hey, so many women have endometriosis, they can’t be expected to diagnose and treat everyone, right? It’s a fucking joke. I know so many women whose lives have been destroyed by this illness. Men wouldn’t put up with this shit - although if it affected men, maybe there’d actually be some research funding!

There are two completely different issues being discussed here. One is that there is no doubt that diagnosis of endometriosis is often delayed. As a GP with a particular interest in women's health I often pick up patients who arguably should have been referred some time ago, so @TamnySwansonTwo and others, you'll get no argument from me that it probably isn't taken seriously enough.

But this thread is about a 16 year old girl who has not yet been to the GP and suggesting that her mother push for a referral which would have the intention of leading to surgery that is probably unnecessary at this point and can itself have complications, is also not appropriate.

@pigshavecurlytails I completely agree with what you are saying.

I think the frustration is that many GPs do have a poor attitude to painful periods and historically women with endo have received sub standard treatment and their fertility compromised because of it. I think posters need to vent and also want to raise the profile of endo which I totally get.

@DoinItForTheKids I hope you get some results in for your DD, I have to say the first implant did wonders for my eldest- she lived with her Dad at the time so I hadn't been aware of how badly she'd been suffering.

"The problem is that if it is endo, the pill may well help improve the symptoms, but it’s not going to resolve the actual problem."

Exactly - true of other conditions too AND it means that women with these problems are also not checked or told it can lead to trouble conceiving or miscarriages.

If even ONE GP had taken me seriously and referred me to a gynae before I got pregnant maybe I could have avoided not only the heartache but the treatment needed following the miscarriages (which I'm sure overall was more expensive than it would have been to diagnose and treat the aftermath. The treatment I received overseas because I was there as an army wife would have been paid for by uk taxpayers)

"The OP's daughter hasn't yet tried anything prescribed so is much earlier on her journey than your daughter." Yea wait until she has a shit sex life or suffers a mc first

"And then down the line if she does struggle to conceive when it could have been prevented by early diagnosis and excision surgery..." Exactly - let her go through hell first eh!

"As a GP with a particular interest in women's health I often pick up patients who arguably should have been referred some time ago" that's extremely worrying and disappointing given your other comments and lack of knowledge on endo.

Yes,but this was practically every GP in two practices, as she was under Uni Student Health too! I had to go with her to get the referral to the gynaecologist! Even after that but before the appointment, the GP supposedly specialising in gynae problems told her:

"I don't think it's endometriosis; I think it's a bit of IBS!"

Hi Persiancatlady - no, no reason actually, we've just been seeing if it was something that was going to keep on bothering her, or she'd just get the odd month and have some months in between that were perfectly alright. It's turned out one or t'other of the symptoms are pretty regular and with the fact it's causing her to keep missing school, in combination that's been the triggers to go and do something about it.

That's very useful to learn welsh about the ablasion vs excision of endomitrial tissue - it's a good thing to know that you can actually have good results (where that is the cause) with a surgeon skilled in that technique. Least you'd have a chance of being able to cast around and find one that fit the bill when you know that excision is the right way to remove it.

I understand the anger about girls/women who are left to suffer undiagnosed with treatment going on for years that serves to address symptoms but not cause. We're not at that point yet in our case although I fully totally acknowledge that it doesn't mean she hasn't got endometriosis. The current goal is medium term to get the pill (probably) working in time for the exam period which is not that far off (exam period ha ha!) and we'll see how it goes over the next year on that scenario. I have to agree with pigs in this scenario that learning she had endometriosis might not be of too much value at this point simply because sending her off for surgery (laparoscopic or otherwise) isn't something we want to leap into quite yet. And, if they were likely even after that to say oh well it's not too bad, hot water bottles, painkillers and the pill for the next 5 years, there'd have been no point (that's not the right approach but I'm guessing it's what could happen).

When it comes to women and woman-related pain/problems we're told to grin and bear it (a LOT) in general. It's not our fault we are born with ovaries and fallopian tubes and uteruses - if those bodily parts go wrong we should bloody well get treated for the underlying cause, not just the symptoms. I have no doubt if a man kept having pain in his penis he'd be whisked off to the appropriate consultant at the drop of a hat (in comparison). Whilst I understand that there are parameters for when people can be referred I often think it's a bit short-sighted (of the NHS) in terms of their approach - if they were diagnosed early, and treated early (for the actual causal issue, not the symptoms), then the person would have less health problems, less repeat visits to the GP, a better quality of life (oh yeah, that!), less fertility problems - I've never understand the attitude of 'let's leave it until it gets really really bad and the person's been suffering for years'. I just think that's inherently wrong. Anyway, that's a whole 'nother thing.

Yes I had the ibs nonsense too.

In my opinion GP's are Jack of all trades and masters of none. Fine for diagnosing and treating uti's, chest infections etc but often reluctant to admit when they're out of their depth and refer to specialists.

I’m 23 now, but I had and still to some extent have this.

I was given tramadol eventually as it’s the only drug that helps. I was referred to a gynaecologist who suspected possible endometriosis but they were reluctant to do a laparoscopy at my age at the time.

I had a baby a few years later and it improved for a short period of time, however it returned a few months later. Scans are now showing what looks like a damaged tube and they’re seriously considering endo again.

Please don’t let them fob you off. I’ve had early losses that they think might be down to the endo, she needs referring to a gynaecologist.

pigs - I am not advocating surgery at 16, but it would be better if GPs said to some young women that it could be endometriosis; but a gynaecologist would expect them to try painkillers, the pill, etc first before a referral - rather than making out it is all normal period pain, and everything else is due to anxiety! Imo, the ignorance among the GPs she saw, was staggering! DD was an IVF baby and I saw countless women myself in an infertility clinic in their 30s and 40s, there because it had taken 10 - 15 years for endometriosis to be diagnosed. Things don't seem to have moved on in 22 years!

Actually if she were diagnosed by a gynae, they probably would suggest painkillers and the pill in the short term. That’s pretty much first line treatment. Most aren’t able to do excision and ablation is almost pointless for most sufferers. I guess the difference is that I’ve had access to other treatments which I wouldn’t have had access to without diagnosis, my damaged tube was sorted out before I had an ectopic and I’ve had surgeries every few years to keep my symptoms as under control as possible.

Yes checklist, and how much does that cost the NHS - it's got to be more than if you referred early for diagnostics and excision treatment (where appropriate)!

We do have a right to be enraged, I really agree with that and have no issue at all with you being that angry. I have no issue with saying to DD that this could be masking endometriosis, that she could find sex painful or that if she did decide she wanted children that she could have trouble conceiving or suffer miscarriages, or that the treatment now may not continue to work and could mask the underlying issue. The fact that this is NOT told to women when they are offered symptom relief (which may be the appropriate course of action at that time depending on your viewpoint), is incredibly wrong.

What's the motivation for it is my question. Buff the person out of the surgery and back out the door a. because they don't currently meet the requirements of long suffering and trying of multiple symptom-relieving solutions that would qualify them for a referral and/or b. because surgeries that did lots of referrals for 'women's problems' would get their wrists slapped by the CCG? Me thinks this might be partly why the coil is pushed so much (and it is) onto women - by gad we're going to alleviate those symptoms in the cheapest* and most likely to be successful in the long run so we don't have to open these women up, admit there's an actual cause, and then treat the defect surgically.

• = Assumed to be the cheapest, probably isn't in the long run

I think that thing to remember here is the sheer number of YEARS of suffering these women are forced to endure - it's not like within 12 months you've had your diagnosis, you've had your treatment. It's bloody years and years of pain, of agony in many cases, every four weeks of your life, sometimes near total debilitation.

That's just the primary part. Then you might be having problems conceiving, then getting pregnant but miscarrying, and then that can go on again, for YEARS.

It is totally unacceptable.

It's ingrained sexism and viewing women as little more than bloody cows, to be herded down a particular route, kept docile (that's partly what thalidomide was prescribed for, not just for morning sickness), and left to suffer. If it was a male internal problem it would not happen.

To be honest, I’d gladly take every four weeks. I have constant pain, every day (thanks to the addition of adenomyosis and nerve damage which my specialist tells me is common when you’ve had untreated and unmanaged Pain for years).

They do it because most women who go in with these symptoms will take the pill, have a slight improvement and live with the remainder until they physically can’t any more - never mind their longer term health or their fertility. They think it’s normal. Usually they’re not encouraged to go back if things don’t improve, they’re told that periods hurt and that’s how it is. I was honestly 25 before I found out that period blood is supposed to be red, not the black sludge I’d been losing for the previous 13 years (up to 21 days a month). It was only after my first excision surgery that I had a red period - I rushed to the doctor thinking I was bleeding to death! You couldn’t make it up.

In my area there used to be a pathway which said that women with pelvic pain should be referred for an US, and if that was clear, for counselling / mental health assessment. Mind boggling.