Clinic: My daughter has missed school because of period pain

Dear Doctor,

My daughter has missed several school days due to heavy and painful bleeding. Is there a quick remedy for her?

Answer

It’s not uncommon for girls to experience abnormal bleeding patterns in their early reproductive years. Such bleeding patterns are due to the transitional immaturity of the reproductive system. Teenagers can find this distressing, as it can interfere with their schooling and other social activities.

Luckily for most, it’s just a transient period in their reproductive life. Spontaneous resolution tends to be the norm.

You, as a parent, have the initial responsibility of judging if your daughter’s bleeding pattern is normal, or indeed abnormal. Pubertal transition is a time of many bodily changes, and your daughter may not immediately be able to judge how much bleeding is normal. Or even how much cramping to expect with the bleeding.

But the extreme end of the spectrum should be easy to judge. Changing several soaked pads in a day is undoubtedly heavy, and bleeding well over a week is certainly prolonged. Pain that appears out of proportion, and isn’t eased off with simple painkillers, is abnormal.

Trying simple home remedies initially is acceptable, like over-the-counter painkillers or hot water bottles. But prolonged heavy and painful bleeding, necessitating days off school, requires gynaecological review.

All that is needed is a basic assessment. There’s hardly any requirement for intrusive medical exams or extensive testing. But a minority may require some blood tests and pelvic imaging. Most will end up with a simple diagnosis, with no long-term reproductive implications. 

Heavy bleeding can easily be controlled with either hormonal or non-hormonal tablets.

If bleeding is irregular and too frequent, hormonal treatment will be more effective. Some parents will worry about the use of hormones, but they are safe and only need to be used for a short period.

Once bleeding is controlled with hormones, the associated pain also eases off. But potent painkillers can be added if required. It’s very rare for teenagers and adolescents to require any surgical interventions due to heavy bleeding and pain. But for some with specific diagnoses, this may ultimately be required. 

The transition to puberty and beyond is fraught with many hurdles for some. Abnormal bleeding patterns and severe cramping are the norm for some teenagers. But luckily, this is mostly a transient phenomenon, and spontaneous resolution tends to be the norm.

Parents and schools bear the responsibility of educating our teens about pubertal reproductive changes.

This helps them know ahead of time what to expect, and avoids unnecessary distress and confusion.

If, however, things get out of hand, a gynaecological assessment becomes necessary, with appropriate remedial measures.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist

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