Menstrual pain is common among adolescent girls and often causes them to miss school, sports or social outings. According to the American College of Obstetricians and Gynecologists, it is the leading cause of recurrent short-term school absenteeism. But period pain doesn’t have to be an acceptable part of a teen’s life.
Discomfort versus pain
Period pain — medically known as dysmenorrhea and colloquially called “cramps” — is caused by strong contractions of the uterus that are triggered by a high level of the hormone prostaglandin. Cramping affects adolescents differently.
Some can manage it with over-the-counter medications or with heat packs. Others aren’t so fortunate.
“Discomfort is one thing, but pain that makes you miss out on things like school and activities that bring you joy is too much,” said Dr. Sarah Horvath, an obstetrician and gynecologist at Penn State Health Obstetrics and Gynecology. The same is true for periods that cause disruptively heavy bleeding.
Even students who struggle through classes during painful menstruations face hurdles to learning. “Heavy menses are the main cause of anemia in adolescent girls,” said Dr. Claire Roden, director of adolescent gender and sexual health services at Penn State Health Children’s Hospital. “And anemia is independently associated with school failure. You can’t think. You feel miserable.”
Parents may be unaware of the difficulties their daughters are facing. Adolescents are often uncomfortable opening up about the physical, mental and possibly emotional symptoms they’re experiencing with their periods. They may also think that it’s just something they have to live with.
“It takes on average about three years for regularly spaced periods to kick in,” Horvath said. “That inability to plan, those occasions where you’re blindsided by your periods and period pain, can cause a lot of anxiety and social embarrassment. Girls may not want to share with their family or friends about why they don’t want to hang out tonight. Periods affect so many parts of your life.”
Horvath advised parents to be aware of how period pain may negatively affect all aspects of their child’s life.
“Make sure you paying attention to your teen. Do you see a pattern of behavior ─ that they’re missing out on things they enjoy again and again? That’s when it’s time for them to see somebody who can help.”
That “somebody” can be a primary care provider or a gynecologist. If the thought of seeing a doctor about their painful periods makes teens worry about the potential need for internal exams, they can take comfort that those aren’t necessary.
“When we see an adolescent about period pain, we get a good history of her symptoms, talk and listen to what the problems are,” Horvath said. “We may want to order some lab tests if we’re concerned that there’s something else going on, like an underlying blood disorder we didn’t know about. But that can be done by bloodwork or peeing in a cup. There should be no need for a pelvic exam, especially during the first consultation.” Horvath added that even if a doctor does suggest an internal exam, the patient should feel comfortable saying no.
Medical management of period pain
Tools used to manage period pain include oral medications that contain both estrogen and progestin, vaginal rings, intrauterine devices or hormone-containing injections. None of these methods works immediately, Horvath said.
Parents may be concerned that the medications used to treat painful periods are “socially thought of as birth control,” Horvath said. “But we’re not using these medications for that purpose. We’re using them to control your daughter’s disruptive period pain by changing the menstrual pattern, whether it’s how often, how much or how it’s experienced.”
Some medications can even stop menstruation for as long as the patient chooses.
“If a person doesn’t want to have periods, they shouldn’t have periods,” Roden said. “It doesn’t matter whether it’s because you have crazy moods with your period. Or you can’t go to school when you have your period. Or you have a blood disorder and are trying to avoid needing transfusions. Or you’re on the swim team and can’t go to practice. If someone wants to end their periods, they should be able to.”
Roden said that even preteen patients can receive hormone therapy if they’re having painful periods that aren’t managed with over-the-counter medications.
“There really is no lower age limit for whom we can treat. If they’ve had a period, they’re old enough,” Roden said. For young patients, she advised parents to start with their pediatrician if they feel comfortable. “If you and your child’s pediatrician try a couple of things and they don’t work, then go to a gynecologist. Or you can see someone like me who specializes in adolescent medicine.”
Roden cautions that anyone who has migraines with visual changes — auras — should discuss that with their doctor before going on birth control pills due to the increased risk of stroke.
“That’s the number one reason I take patients off whatever their pediatrician put them on,” she said. “It’s a contraindication for the medication that can be easy to forget about.”
Parents may be asked to leave the room for a bit while their adolescent talks with the medical provider about painful periods.
“Don’t worry. We’re not just asking about dating and relationships, but about very personal things, like body image, poop, or how heavy their menstrual flow is,” Roden said. “Sometimes teens like to have boundaries. Some teens prefer that their parent stay, and that’s fine, too.”
Both Roden and Horvath stress that no one should miss school — or any other activities — due to painful periods.
“You shouldn’t have to feel awful,” said Horvath. “Talk to your doctor. They can get you back to participating in school, sports, artistic endeavors, hanging out with friends — the things you used to enjoy before period pain derailed you.”
Dr. Sarah Horvath is an obstetrician and gynecologist at Penn State Health Obstetrics and Gynecology and an assistant professor of obstetrics and gynecology at Penn State College of Medicine.
Dr. Rosemary Claire Roden is the director of adolescent gender and sexual health services at Penn State Health Children’s Hospital and an assistant professor of pediatrics at Penn State College of Medicine.