Period pain

[MyPinkTraybake]

This month has been really stressful and crazy, feel like I've just coped and got to the end of it, and I've been rewarded with...my period 😂. The injustice of this.

Well done for getting through....here's a bunch of stabbing pains and some non descript dull ache, about 15 minutes before you start work 👍

I knew at the start of the month it was going to be an awful period as not been eating well and been really stressed, but it's a kick up the bum to sort it out...have a blood test tomorrow then will try and improve my diet.

Are your periods always like this?. If they are then I would ask the GP to refer you to a gynaecologist for further evaluation. Do not put up with it.

Blood tests (what are they testing?) may not reveal very much. Changing diet may or may not be beneficial either. Has no one mentioned performing an internal ultrasound scan?.

Can you be more specific about your symptoms and what the investigations you had, have found so far? What specific things are the blood tests testing?

If you only have pain issues - how severe is it? Scale of 1 to 10, as a dull ache and/or some stabbing pain isn't too abnormal. Can the pain be managed with paracetamol? Does it distrust your life?

I recommend going to your GP ask for a pelvic ultrasound, and a transvaginal one to see what they find.
You don't meet the threshold for a gyne referral yet - you need the bloods to come back, also a transvaginal ultrasound and see what it finds. You also need to try some meds first, like the mirena, pill or tranexamic acid and/or NSAIDs. Otherwise often gynaecology will write back simply saying to try the things I've just said, they often won't even see you on the phone or in-person and wait 6-9 months particularly for the mirena to see if it works and then if not re-refer back, and you'll have to start all over again. So don't push for that just yet - get the bloods back and a transvaginal ultrasound - then go back to your GP and make a plan.

Are you symptoms just on your period or elsewhere during the month? Is the pain worse on or off period? Do you have heavy bleeding?

I recommend asking the GP to try the pill and/ or mirena coil can be amazing with heavy bleeding and pain. The mirena will thin the uterus lining and get less blood vessels there so there's both less bleeding and less cramps.
Just make sure for insertion you take paracetamol and ibuprofen 1h before, get licodaine injected into the cervix and numbing gel or spray as well.

Also ask your GP for mefenamic acid and/or naproxen (NSAIDs which help a lot with pain, as they are anti-inflammatories) and tranexamic acid or northisteron (helps reduce heavy bleeding) - Start taking it 3/4 days before and it will be much better, as it should be started earlier to stop pain and the bleeding.

You likely have Primary dysmenorrhea (heavy bleeding and painful periods with no condition or cause. If you just have period pain and occasionally heavy bleeding that is. However you could have be adenomyosis where the lining of the womb grows into the muscle of it, but is localised to the uterus only. Thus, symptoms are mainly a couple days before a period and during your period.

If you had a transvaginal and/or pelvic ultrasound normally it can pick up adenomyosis pretty well, if there's not a lot - you may need an MRI. It can be seen on a transvaginal ultrasound because it is about the muscle thickness and disparity between layers, so make sure the sonogroaher looks at that.

When your bloods come back go to your GP and talk about the results. Then ask them to book you for a transvaginal ultrasound and go from there. If the bloods don't check your hormones, thyroid etc - when you go back I'd also ask for some more to look at those.

It could also be PCOS - if you have

1. Lots of small follicles spotted by transvaginal ultrasound and/or
2. Irregular periods, short periods, missed periods, and/or
3. Certain hormones are either lower or higher at certain levels.

You need 2/3 to get a PCOS diagnosis. So the bloods and the transvaginal ultrasound should help to see if you have that if they find any of the above. Do you have irregular periods?

Also, start using B6 and Vitamin D in the week, at the very least, leading up to your period and during it. They help with energy, brain fog, fatigue, and pain sort of.

The GP should follow NICE guidelines re referrals.

PCOS is not usually associated with pain. Endometriosis and or adenomyosis can cause pain. You need a diagnosis first and foremost.

The potential problem here is that if blood tests come back normal then often no further action is taken. I had this scenario and ended up going private for my gynae issues relating to uncontrollable bleeding. I had no diagnosis and prescribed tranexamic acid tablets were not effective. The gynae some time later wrote a stiff letter to my GP practice stating that I should have been referred far earlier Many GPs are simply not up to speed when it comes to such issues because they are generalists. I do not blame the gp for my delay in treatment but I should have been referred earlier(and infact asked for a referral initially because my problems were not going to be solved by a mere blood test).

Given also that waiting lists for many gynaecologist procedures are miles long in many areas it may be an idea to go private even if only for an initial consultation. It’s a fact that many women are suffering due to a shortage of resources in gynaecology and is a problem that has worsened since the pandemic.

Oh wow thanks for so many replies.

I've had an ultrasound before for a couple of things, can't remember exactly. One of them was to check my ovaries out when I was considering IVF. They all looked normal I think. I had a small cyst on one or maybe both fallopian tubes but nothing consequential. I can sometimes tell which ovary I am ovulating from as I feel a passing sensation sometimes - when they showed me on the ultrasound they said which ovary I was ovulating from and I was like aaahh I had felt that. That all sounds normal to me?

I don't normally get much pain, maybe a few cramps and the soles of my feet hurt - I think that's down to low Magnesium before I'm due on as taking that / Epsom salt bath/ chocolate (which is high in magnesium) usually sorts it out.

I took some paracetamol and made hot water bottle and they have gone. I'd say it was like 5- 6 and I was thinking I can't sit down. But like I say it went, surprisingly quickly.

I don't think my flow is heavy. Maybe 1.5 days of full pads, but by that I mean maybe going through 2 always pads over the whole course of my period in total, so not that many? Then to panty liners. I was on the non hormonal IUD and it did make them less painful. I've had that out a while now. I can't take the pill other than progesterone only but it made me really hungry all the time so I stopped.

Ah that's a good shout about naproxen. I have that for migraine so I will re request that.

Does it sound like I don't have adenomyosis? It does feel like there's a ball of wool stuffed down there. The ultrasound was about 4 years ago so maybe things have changed.

Right B6 and vitamins etc are going on my list!

I've asked the GP to check my folate as my diet has been really bad and I feel light headed and am quite forgetful. I had this before and they gave me folic acid. So they are doing full bloods.

You need up to date test results including an ultrasound scan; anything done over 6 months ago should be discounted.

They should also be checking your thyroid levels because if they are out of sync this can also cause forgetfulness and brain fog.

A symptom of PCOS is severe pelvic pain actually, often due to issues with the ovaries, so more chance of cysts and even without that severe pain during periods and severe pelvic pain outside of periods as well are PCOS symptoms and very common, just not one used for the main diagnosis. Also, adenomyosis and PCOS are commonly together, just because she may have one doenst exclude the other.

Also, I understand tranexamic acid wasn't useful for you, but it is for many people. Maybe you should have had a higher dose, or maybe it just wasn't for you. That doesn't mean OP shouldn't at least try it. It works amazingly for many people, I have a good dose, which has always worked amazingly despite bleeding very heavily and through 7 layers.

Your one experience doesn't mean a drug is bad or doesn't work because you don't have controlled data and you are 1 person compared to many. I'm not saying you aren't right. You are right about your own individual experience, but when we have science and clinical trials, we use masses of data and more than one person's experience.

Medications go through so many stages and are tested on thousands of people to get on the market they have to show 1. It works and is safe, and 2. Clinical significance, which is for medicine. It means the drug not only works but works significantly enough to make a difference
For example, let's say a new blood pressure med is developed. They show it works and reduce it by 1-3 mm. It's also the cheapest of any of the blood pressure meds.
It will still be rejected. Why? Because 1-3 mm for blood pressure meds is nothing, it is not clinically significant and so is pretty useless when we have ones which reduce it my 10 mm points. Even though they may be more expensive, they work better, and so stop people getting worse and needing more intervention, and getting sicker and costing more.

The cyst has likely gone @MyPinkTraybake. It was likely a simple cyst that is normal, and everyone produces each month - that's the cyst to ovulate an egg, so those are normal and a good thing.

If there isn't much pain, that's good. It means you don't really need to try NSAIDs or higher pain meds. If it's a little worse, use paracetamol or ibuprofen. Would you be open to trying the mirena coil? The bleeding doesn't sound heavy, but it would still reduce it by thinning the uterus lining and getting fewer blood vessels there so there's both less bleeding and fewer cramps. For the insertion, you take paracetamol and ibuprofen 1h before, get licodaine injected into the cervix and numbing gel or spray as well.

Or for now try tranexamic acid and if that doesn't work northisterone. Again, start using it 3/4 days before your period starts. Ask your GP at the appointment after you get the bloods back.

On the naproxen, I would get something else if it's only headaches that are the issue, it does help with headaches but there are other meds you could use as specific to them? It depends, what type of headaches are you having? There are drugs specific to migraines - like triptans, I would bring it up to your GP and try triptans, perhaps, as they are 1st line for that.

Have the bloods come back yet? If it is a full blood panel, TSH and thryoid will be included in that. Give us an update when they do, and whatever they say, go back to your GP. At the very least, get the hormones tested again and also another transvaginal ultrasound.
Good, they are checking the folate. If it's low, then get on folic acid as well again. If the iron is low, again start iron pills but get them prescribed so that it's a higher dose.

Do you think PCOS could be the issue? I mean, if they don't see the follicles, then rule that symptom out but get another transvaginal and see what they say. If you have irregular periods and also some hormones at specific levels (both some high and others low), you'd qualify for the diagnosis.

Adenomyosis is where the lining of the womb (endometrium) grows into the muscle of the uterus (myometrium) but is localised to the uterus only. Thus, symptoms are mainly in the week up to your period and during your period.

The symptoms are:
Severe Pelvic Pain
Heavy bleeding
Severe period pain
Enlarged, tender uterus - feeling of fullness or dullness in pelvic region
Clotting during periods
Pain during sex, due to uterine tenderness
Nausea during periods due to prostaglandin release
Severe fatigue, from heavy blood loss causing anemia, etc

This link has lots of useful info: https://www.nhs.uk/conditions/adenomyosis/

I have had PCOS for many years and whilst I’ve had severe pelvic pain PCOS is not normally associated with this.

You are also a lay person but one too who reads medical stuff widely. What I do not want is to cross swords because it’s a complete waste of time.

Symptoms associated with PCOS include irregular or absent periods, hirsuitism, skin problems and insulin resistance. It is also a very individualistic disorder that affects each woman with it differently although the commonality for all is the cystic follicles on the ovaries giving the ovaries a ring of pearl appearance. However these do disappear to be replaced by further cystic follicles. The polycystic ovary can also appear to be larger than a normal sized ovary too.

I also have PCOS, and my point is just that many people just have PCOS and do have pelvic and period pain, which is moderate to severe (after adenomyosis, endo, fibroids etc are ruled out). I don't want to cross swords either (you have very useful advice and personal experience.

I'm just saying that for OP, she shouldn't not ask her GP to test hromones, get a transvaginal ultrasound, etc, just as pelvic pain is a symtpom. She should, though, as you have said, make sure she gets tested and checked for other potential issues, bit I can see from what OP has said, PCOS fits that, but other things may also. I just wanted to point it out but wasn't meant about you, just to say.

For diagnosis of PCOS @MyPinkTraybake are as Meerkat said irregular, shorter and missed periods, and not hirtuaism - but that is caused by having higher androgens and other hormones, which is a criteria for diagnosis, but other hormones can be lower and that can also meet criteria and then lots of small follicles, even though it's called polycystic ovaries, it's more about the follicles and how they impact the ovaries.

A large number of women have hirtuism as a symptom but some don't, I have the follicles and lots of them, very prone to cysts, ovaries enlarged etc (though follicles are the actual main diagnostic criteria the others are just things that tend to happen with follicles. I also have irregular periods, some of my hormones are high (also due to some of my meds) but most are in normal range/low, and I still sort of qualify for the 3rd diagnostic criteria as well but you only need 2.

But not everyone, as you say, will have pelvic pain with PCOS, but it is a symptom, and many people with PCOS have it without having another condition, which has been ruled out with adequate testing. In PCOS, irregular ovulation can lead to a thicker uterine lining, meaning heavier periods and more intense cramping. Hormonal imbalances like high oestrogen and low progesterone can make contractions stronger. From the research I've read it seems that this is the main reason why, but as I'm sure you know there is not much research going into women's health in general and certainly not PCOS.

Thanks Viper.

From what I’ve seen there is generally more awareness of PCOS these days (the site called Verity is a good U.K. based resource if you have not already heard of it) but there is still a ways to go. Research into PCOS is ongoing I think but patchy and the causes of PCOS (along with the likes of adenomyosis and endometriosis) are still not fully understood.

I am now in my late 50s and finally well after many years of suffering with my periods and I hope you get to that stage too eventually. It has cost me a lot of time, money and effort , not just to say emotionally too in terms of fertility treatment.

Women need to advocate hard for their health because “women’s problems” can and do get overlooked by so many but not all in the medical profession. I often advise women that you need to be persistent in order to get answers.

Thank you but my periods for me are the least of my problems, they are painful but, bleeding is pretty well controlled now. But with all my illnesses and chronic, progressive conditions, not all in the gyne remit (but 3 are), I'm wouldn't say its my priority tbh, I will likely keep my uterus for now, ablation isn't worth it for me based on what I want, and the mirena along with tranexamic acid consistently takes care of me not flooding and bleeding as little as I ever have.

I cannot afford private care at all and it would be a waste of time because I need to see so many different doctors including GP pretty regularly, have them coordinate things, all work together when I have surgeries, get some testing done not regularly as a rule but pretty frequently it is indicated for some issue. So realistically, I can't even afford the GP appointment and would need to coordinate between both with is even worse in my opinion, plus even if I could afford some of it, I wouldn't be able to cover enough, e.g surgery and seeing the 4 specialties I regulary need to. It would make it a whole lot more complicated and not useful for me. So the actual financial cost isn't going to affect me ever really, other than the disability tax and needing more money for so many things judt because I am disabled, whilist it is hard to work, so that's great 🙄. I don't want kids ever, so not bothered about that, I personally couldn't imagine anything worse, so by gyne conditions, PCOS, adenomyosis and endometriosis, with the first two causing lots of barriers to carrying to term, having a miscarriage, struggle to conceive in the first plan, is not something which bothers me or I care about, its more my actual life, pain, all sorts of symptoms etc. I am lucky on the fertility stuff for as obviously it's heartbreaking for many women.

I will always be disabled by my conditions, they are progressive so get worse, and whilist meds are their they manage symptoms which is helpful and I survive on around a dozen plus of meds and pacing mobility aids, and hopefully surgeries every so often.

I'm glad that your periods are now settled and controlled even if you had to wait till your 50s for it. I am quite younger than you, so nowhere near peri/menopause in general, though I know you had an ablation?

But yes I would say PCOS has pretty high levels of recognition and awareness across the public. But I wouldn't say many women, recognise it beyond growing facial hair and excessive hair, fertility issues etc and the false naming of polycystic ovaries when it's actually about follicles so may not spot symptoms in themselves.

I am truly sorry to read about your many gynaecological issues and how disabling they have become. I know of women who have been for instance unable to work or forced out because of their gynaecological problems arising from pain and bleeding.

I’ve only now got relief from the pain, the sub fertility and the incessant bleeding which took its toil both emotionally (misplaced feelings of shame and embarrassment )and physically. No woman should have to wait until their 50s like I am now or are perhaps otherwise menopausal to have proper relief from what are often only described as period/ problems.

Yes I had ablation for my uncontrollable perimenopausal bleeding some years back which stopped the bleeding.

Ended up going private for ablation because my GP did not want to do anything else after the blood tests came back as normal. He did not even offer me further tests like ultrasound or tablets and the whole thing was a waste of time. This is the scenario that caused the consultant to write a stiff letter to the gp practice!.

Thank you for your kind words and sympathy, I'm not glad you also went through some similar issued but it is nice to have peoole get it.

I'm glad the ablation worked for you, I don't want it as my bleeding is managed quite well with meds and the mirena, and also it is primarily to stop bleeding rather than pain. So it's not really useful for me. So my period issues aren't that bad, I mean it's more the every day symptoms etc, unlike others I do not only have severe pain or certain symptoms on my period but I had many from pre-teens and have them regularly, daily etc and I do think there is a culture of women need to learn how to manage periods (even ones which are 'normal' symptoms, no other conditions etc), without bothering anyone.

Fromy my culture it doesn't exist to ever talk about these. Though fibroids are beconing pretty well treated or identified but many men mainly but also older/other women who have had them - they act like its over dramatic to get a myomectomy (if you can afford it), or any abaltion technique or meds to shrink it. Many women sort of wait for it to come out (very painful and risk of prolaspe and infection).

There's so little support in school and for P.E and more. Even with the typical normal period etc, the symptoms are still uncomfortable tiredness, fatigue etc, we should encourage more conversations on it. I do a lot of outreach programs on menstrual health actually, in lots of depth, toolkits for schools, for staff training, creating some tweaks in policy and other things as well.

Did you ever report the GP to the ICB or PALS? You can still do so now if you haven't before.

It’s so bad that painful periods have been normalised. My gynae said they’re normalised but it is not normal
the pain I was in before endometriosis excision was insane, I’ve broken both ankles and feet and that didn’t even come near it, it took morphine and gas and air once to be able to even get me off the floor

I am more doing intermittent excision surgery,and then lots and lots of meds. However as I said I have 6/7 chronic illnesses, and only 3 are gyne, well endometriosis is sort of gyne related, with also others not, a bowel condition, as well as endo on my bowel, an upper GI issue, asthma (which obviously goes up and down with symptoms but having other chronic illnesses has made it worse etc) as well as a urological issue, and an ortho issue for which I am nowhere near dealing with so don't actually see them. I am likely also going to try and see pain medicine and/or pallative care which has been suggested as useful.

I see a range of specialists quite regularly etc, so as I said private would be sort of useless even if I could afford one private GP or other specialist appointment, as I need surgery etcand that regular care. Yes I agree with you onmedical misogyny but it is getting better, on OBGYN training the Royal College have recently added more compulsory components on the gyne side of things around adenomyosis, endometriosis, PCOS -working more with endocrinology and training endocrine specialsits more on it, as well as management of menopause and working with orthopedics around prevent osteoporosis. As it unfair to put it all on gyne, particularly for PCOS.

I've been through many GPs from a very young age, as I started around 12/13 going to docyors by myself etc and have always managed my medical stuff, having had some useless GPs or area on institutional failure. But eventually I did meet probably the best GP ever who has done a lot for me, I am in different areas so have switched GPs and met a new one, who luckily seems sort of on it (though almost top nice, and infantilising but more in a way I'll everything like you are five.

I know a lot of what I want etc and understand treatments, meds, etc, in lots of detail.. I do think that comes for the par of chronic illness but many people don't have that understanding of what meds they are taking, etc, and GPs do a tough job. I think all GPs even bad ones would like longer appointments tbh, and I think online forms have helped as many look at them before and so you can bypass inital stuff and they can start asking questions from things you've said.

I also saw the new announcement for NHS Online which I've read some of the policy details for and if it works I think will be fantastic. They do have points around people living far having to go to the only one or two specialist hospitals, so Addenbrooks, doing amazing cancer stuff and other things, London hospitals obviously, a few others like Broomfield for plastics and BGSE centers - though there are more of those than the ones above. The travel cost for illness again is another burned of disabled people, particularly as we have more regular appointments. So being able to have an extra appointment because it's on video is positive, again having initial consultations on video could work, then they send you for the scans, and then you have an in-person appointment. Or after an in-person one, your scans come back and you discuss next steps online etc and then go back in person foe treatment etc. A balance of face-to-face, with virtual is needed, we are seeing great results in virtual hospital programs as well. Anyways I'm rambling on too much, but I do think one of the massive things that needs to change, apart from education and comprehensive training for medical students and CPD for doctors etc on women's health and the health of different racial groups. For example, the tool that measures whether or not you should have a C-section, was only tested on white women for decades, and it actually makes Black women have higher scores as they never considered certain aspects of the poor reading of med tech or the differences.

@TheLivelyViper it's crazy how far we still have to go.