GPs urged to ask about period pain early

Chelsea Heaney

28/05/2024 4:13:46 PM

A 20-year study has found one third of 14-year-old girls have serious menstrual pain, but early advice could save them years of suffering.

Teenage girl in bed holding stomach.
Conversations between GPs and teenage girls could help with early screening for chronic conditions such as endometriosis.

A longitudinal study of period pain in Australian teenage girls has highlighted the need for GPs to have early conversations about menstruation management with their patients to improve quality of life.
The research, published in the Medical Journal of Australia (MJA), addresses the issue of period pain more broadly and how it causes young girls to miss out on many aspects of life, such as school, sport or social activities.
The investigation tracked the development and life trajectories of Australian children since 2004, with one cohort studied from birth and another from kindergarten age.
It found, based on a selection of 1600 teenage girls from that group, that a third of 14-year-olds experienced menstrual pain that was ‘very painful’ or ‘quite painful’, and for girls aged between 16–18, around half experienced the same serious pain.

These girls were found to be three to five times more likely than those without pain or with ‘a little’ pain to miss school or university.
The researchers concluded that recognising adolescent dysmenorrhea, or period pain, is important.
‘Not only for enhancing their immediate quality of life with appropriate support and interventions, but also as part of early screening for chronic health conditions such as endometriosis,’ their conclusion read.
Professor Danielle Mazza is an academic GP and the director of NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women.
She told newsGP this kind of research gives ‘transparency to what are really widespread symptoms in the community that have traditionally not been talked about openly’.
‘It’s growing awareness of the impact through studies like this,’ she said.
‘Many girls don’t present because they consider their symptoms are normal, but if period pain is so much that it forces girls to miss school or miss participation in sport and disrupts their life, then we do have management we can put in place in general practice.’
According to Professor Mazza, the lack of preventive treatment is not just about stigma associated with menstruation.
‘It’s about agency, as many young people will not present to a GP on their own,’ she said.
‘It’s also getting girls to recognise that it is a problem and something GPs can help with.’
She said GPs should have conversations with their young female patients when their period has started about if they are regular and what they are like for them, or if they miss out on activities because of pain.
‘And also ask about how they manage their periods because a lot are told to take Panadol but that is not very effective for managing symptoms,’ she said.
‘We can offer better advice about the management of dysmenorrhea and options that we have to actually treat dysfunctional uterine bleeding.’
This treatment can include a multitude of things, Professor Mazza said, that can lead to better long-term outcomes, particularly when it comes to later diagnosis of endometriosis.
‘Hormonal contraception is a very good way to treat dysfunctional bleeding and girls can very safely use long-acting reversible contraception such as implants and hormonal IUD,’ she said.
Professor Mazza said the use of non-steroidal anti-inflammatory medications that target prostaglandins that cause period pain ‘is really important’.
‘Starting them when they think their period is imminent, even before bleeding has commenced, can really help,’ she said.
In an editorial on the study, also published in the MJA, the authors state that persistent pelvic pain has been labelled the ‘pain problem without a home’ and pushed for a wider focus on women’s reproductive health – as the predominate focus thus far has been on endometriosis.
‘The broader question of persistent pelvic pain receives less attention, despite the fact that it is a greater public health problem,’ they said.
For Professor Mazza, the two are quite likely connected and deserve investigation, but there is a lack of ‘good research about the links between period pain in young women and the eventual diagnosis of endometriosis’.
‘Starting management of heavy periods and period pain in young women may lead to better long-term outcomes,’ she said.

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