Tens machine for period pain

[Charliebean]

My daughter suffers from terrible period pain every month. At the moment she is taking feminax and usung a hot water bottle. She is only 16 and not great at taking tablets so hoping not to go down any stronger medication route at the moment. Has anyone used a tens machine for period pain and if so can they recommend a good one ? Thank you so much

My daughter uses Myoovi and it’s been life changing. She is no longer throwing up and missing school or work. She says it feels a bit weird but really helps the pain. It’s best to get it on before the pain kicks in.

Thank you. My daughter is the same. She feels so sick and is in so much pain. I had a look at Myoovi, but unfortunately it is out of stock. I saw on Trustpilot that they are apparently bringing out a later version and it should be back in stock soon so I will keep an eye out. Thanks again

Does she want to find out why her periods are so painful?. This is not something she should be putting up with. Taking the pill could help re pain but it will mask the underlying problem. I found tens to not help at all but it may well help for your daughter.

She keeping a daily pain and symptom diary could be useful if she does not already do this.

At 16 she is not too young to have endometriosis and going forward I would encourage her to see a gynaecologist for further evaluation.

My Obi do very good TENS machines - they have quite a range so I'd look at them. If she's having heavy bleeding try tranexamic acid (it will massively reduce the bleeding) - so maybe ask the GP to prescribe that. I know you said she's not good with pills, but I'd really recommend it, maybe she could crush them or something similar.

Thank you everyone. I took her to the GP last week to make sure that there wasn't an underlying reason for her painful periods. She is scheduled for some blood tests next week and then we will take it from there. At least we will know then if it's just a case of tackling the pain. In the meantime, I will have a look at the TENS machines. Thanks again

What blood tests are being performed?

Blood tests do not detect endometriosis if it is present. Something is causing this pain and it’s in her interests to find out what it is.

She should ideally be referred to a gynae, did the gp not mention this?. Ongoing very painfulperiods are not normal and your dd should not put up with it.

It could be a range of causes. She shouldn't just focus on one particular illness, not yet. Like other conditions, the GP manages the majority of it and can only refer when someone meets the threshold for specialist intervention. The GP has to do some tests, investigations, try some other forms of management first. Otherwise, gyne will just reject the referral. She may even just have primary dysmenorrhea (which has no cause or underlying condition with it, but of course this should only be decided after all investigations are done). She may have PCOS, and her symptoms sound more like adenomyosis than endometriosis. So it's not the time for referral yet.

@Charliebean I recommend her trying tranexamic acid to help with the bleeding and maybe a mirena coil. The mirena does treat the real cause as well (mirena will may the uterus lining thinner, less bleeding, and less cramps). For the pain, try NSAIDs like Naproxen or mefenamic acid. Blood tests can spot other issues, but also get her a pelvic and transvaginal ultrasound.
Has she had long-term and chronic issues with mobility, back and sciatica, debilitating pelvic pain, pain with sex and insertion to the vagina, severe vomiting and nauesa, cycles of severe constipation and/or diarrhoea. Are her symptoms just on your period or elsewhere during the month? (Because if it's just on your period, unlikely to be endometriosis). What symptoms does she have during your period? And if she has symptoms not on your period

• what are they? Is the pain worse on or off period.

Sne may have 1. Primary dysmenorrhea (heavy bleeding and painful periods with no condition or cause or 2. Secondary dysmenorrhea is a condition, e.g, endometriosis or adenomyosis, causing it. You will need to try NSAIDs and mirena/pill and Tranexamic acid first before any further scans like ultrasound and MRI. Often, if the pain is significantly reduced with said treatments, it's more likely (not 100%) to be primary dysmenorrhea. Also very dependant on whether you only have symptoms on your period or across the month as to whether you have primary or secondary.
Then, if ultrasounds pick up on anything (pelvic ultrasound or transvaginal), you may need to have an MRI to see endometriosis. However, the only way for definite diagnosis is a laparoscopy, and then they will often excise the endometriosis tissue if they find it, etc.

But endometriosis is a chronic illness and can not be cured. After surgery, it will grow back, it cannot be excised from everywhere to leave organ functioning intact, and then post-surgery adhesions often form.
The main symptom of endometriosis is not actually period pain because endo is not a period condition - it's a whole body inflammatory condition where the endometriosis tissue even produces its own oestrogen and the pain is felt throughout the month not just when on your period. Often, endometriosis on the ovaries can form cysts containing old blood called endometriomas (also known as chocolate cysts), which can be very painful. Another popular cyst is haemorrhagic ovarian cysts with endometriosis.
But you could also be adenomyosis where the lining of the womb grows into the muscle of it, but unlike endo is localised to the uterus only. Thus, symptoms are mainly a couple of days before a period and during your period. Main endo symptoms:
• Irregular or heavy periods
• Pelvic pain
• Pelvic pain on opening bowels (dyschesia) and wider gastrointestinal symptoms (diarrhoea and constipation)
• Pelvic pain on passing urine (dysuria) and bladder symptoms sometimes
• Referred pain to the tops of the legs or back
• Fatigue
Crucially you can still have endo even if they don't see it on the scan, the only clear way for diagnosis is a diagnostic laparoscopy and then mangagement can look like pain medication depending on how severe your pain and symptoms are (can be opioids, NSAIDs) and contraception and hormonal treatments (gonadotrophin releasing hormones).
The links below have much more detailed and useful information.
https://www.leedsth.nhs.uk/patients/resources/endometriosis-2/

https://www.nhs.uk/conditions/adenomyosis/

A gynae will not reject the referral if made by a GP. The gp has requested
blood tests (what is being tested here because if the results come back as normal
no further action is often taken).

The cause has to be determined as well as treating the symptoms. Something is causing the pain, it’s not in her head.

Blood tests may pick up hormonal issues but PCOS is more associated with irregular periods. Ultrasound won’t normally detect endometriosis either if present and even MRIs don’t always spot it. Endometriosis is often a cause of ongoing painful periods.

Any symptoms that are cyclical in nature and or get worse up to and including menses should be checked out to see if endometriosis is present.

Such problems too are often outside a GPs remit so a referral should be made going forward.

Referrals are often rejected. Secondary care can send back advice (this can be a few sentences) and say contact back in 12 months if it doesn't work. They'll then take the person of the list, this is happening more now as lists get longer. If a GP has only requested bloods, and hasn't tried any other management, scans etc, they will just get advice to try the pill or mirena first. GPs are meant to do the majority of management, that's why there's a threshold for secondary care, unless emergent, or they suspect cancer.

GPs need to go to legwork first, of scans, different meds etc, for all illness, that their job. Blood tests may pick up something else, that wasn't suspected it may pick up nothing. But in medicine you start with the small tests and work up, unless it's A&E and an emergency. So you start to rule things out, not to look to have x condition and rule it in, you can't just do a laparoscopy first, you have to start with some ultrasounds - which can sometimes pick things up (something perhaps unexpected) or it may pick up nothing, but it doesn't mean a patient doesn't have x. Then you do MRIs etc.

Not everyone with a chronic or cyclical problem can be managed in secondary care, sometimes people can be in secondary care for a few years and then sent back to their GP, as secondary care have done all they currently can and it's down to the GP to manage. GPs manage the majority of acute and chronic conditions, that's how the numbers work, which is why, secondary care can reject referrals. It can even just be like, you haven't shown enough probability of them having x conditions, go back and do more. Which includes scans, trying different meds (for long enough), showing secondary care that it isn't another specialities issue. This is for all illnesses including something like endo, the system expects GPs to do the bulk of it including management, otherwise secondary care wouldn't work, as they'd have too many patients. So even with a cyclical problem, GPs have to do a very high percentage of the work. Referrals can be rejected by consultants and often are, if they don't deem it to be severe enough, or it isn't close enough to proving they have x problem, if you refer now after having tried nothing, you'll wait months and get a letter saying to likely try tranexamic acid, pill, do some more scans, wait 9 months to see the effect, then maybe contact us. With waiting lists the way they are, more Referrals are coming back to GPs with just advice, especially if the GP has just started a basic level of investigation.

Consultants can also just outright reject a referral and say it doesn't reach the threshold, most of the time if they do this, they'll write one or two sentences with some recommendations on what to do, but they don't have to. A GP most definitely doesn't have the final say on a referral being accepted, that's down to the consutlants in secondary care, they do triage and go through and see who they think meets the threshold.

At this moment in time, for OP's DD, she doesn't meet the threshold - they haven't tried a few meds that could be helpful, they haven't ruled out other things which are easier to diagnose, they haven't done scans which are less expensive and invasive - tranvaginal and pelvic ultrasounds, then maybe MRI etc (and smaller scans need to be done first before bigger scans, most of the time).

She very well may have endo, and I myself know how debilitating it is, and how long the process can be, but there has to be processes for this, otherwise other diagnoses could be missed (if you reach for one first without ruling out others, especially when it's easier to rule those in or out first), she could even just have primary dysmenorrhea (so no condition behind it - though this is the final diagnosis when everything has been done), she needs to try some meds and treatments, for a sufficient amount of time. The process works this way, so that secondary care (for all specialities) isn't overwhelmed and so that everyone can get the most accessible (if everything works well) care. This is the same for asthma, not everyone will see respiratory doctors, the same for someone with chronic migraines, you can't just immediately refer to neurology.

I suffered terribly when I still had periods Im too old now but also used a tens and it was brilliant. I still use it for back pain and it works really well.

The GP is checking for her iron count in her blood tests as low iron can make period cramps worse. In the meantime, I am going to get her a TENS device and try to manage the pain while she goes through the process with her GP. Just got to try and decide which one now ! Thanks again for your help

Such problems can be outside the GPs general remit. Hopefully your gp is on the ball here but you will anyway need to be persistent in order to get answers.

Bear in mind too that waiting lists for gynaecology in many areas of the UK are miles long and she could be waiting some considerable time to be seen. I was diagnosed with endo and your dds symptoms are practically the same as to what I experienced at that age. Heavy bleeding arising from endo can affect iron levels. I was dismissed for many years only being diagnosed in my 30s. Early diagnosis is key.

She is not too young to have endo and indeed I had this from the onset of menses at 14. It was not recognised by anybody until years later.

I’ve also had more internal ultrasound scans than I care to mention and none of those saw endo. It was the laparoscopy that determined it was present.

Nobody said she's too young to have endo. Most people have onset in their teens, ultrasounds and MRIs can spot endo, they can also fail even if there's endo present. But we use them first before a laparoscopy, to see if it's something else, or just to get an indication of what it could be. Transvaginal ultrasounds and MRIs are very effective at spotting adenomyosis so we can also diagnose that through them (again not for everyone but the majority of the time for adenomyosis it can be caught on such scans).

@Charliebean Definitely get her iron supplements, as she'll likely have low iron. Then start with Tranexamic acid for the bleeding, the combined pill/mirena coil can be great, with the pill you might need more trial and error of a few different ones. Then look into NSAIDs for the pain (something like naproxen or mefenamic acid) and then push for scans, transvaginal and pelvic ultrasounds, see about getting an MRI. Though you may have to wait for that, as in try the meds for a few months first.

In my case internal ultrasounds did not detect the vast amount of endo present. This has also happened to other women with endo too. Again I’ve gone down a similar route here.

Endo needs to be considered by the Gp as a possible cause for OPs daughter’s pain and I hope it has been considered. Not all GPs are up to speed when it comes to female issues even now.

Pills and Mirena only address the symptoms The cause needs to be determined as well as treating the symptoms.

Tranexamic and mefanemic acid tablets are prescription only. I would agree that the op and her daughter may (will) need to push for investigations.

Laparoscopies can also miss endo for reasons unknown. I had them done twice and results were negative. Finally had a hsyterectomy and consultant found i had advanced stage endo. They couldn't explain why the 2 laparoscopies had missed it.

Obviously lots of those meds are prescription only, I was saying to OP she should ask the GP for that. You can do treatment whilst doing investigations, and you always have to try some.things whilst determing the cause. One doesn't rule the other out. She can try meds to help her symtpoms and have further investigation done.

Endo is a possible cause, there are other conditions it could also be, that's why you have to use the diagnostic process, to potentially find something else or rule out or in other conditions.

Mirena has been life changing for me but I also had all my endo excised at the same time so not sure what’s worked best
I don’t have periods on it

I started with mefanamic acid, then naproxen, paracetamol etc regularly. they upped me to dihydrocodeine but the pain wasn’t just on my period
by then I was using a tens, be you period patches and morphine
moving also helps me, nothing drastic but when it was really bad some rocking or dodgy hip swivelling!

My daughter uses a tens machine (Lloyds pharmacy one which cost about £15) as she has horrendous period pain and passes out.

She saw a gynaecologist today who insisted on a laparoscopy and having the mirena coil fitted before having an Mri. The internal ultrasound showed nothing but she has all symptoms of endo including bowel issues. Surely, a laparoscopy shouldn't be the first thing to suggest especially to a 20 year old.