Monday 16 December 2019

Coping with a crying baby and pubertal hormone change

Dr Nina Byrnes
Dr Nina Byrnes

Nina Byrnes

Our GP on what to do when a 14-year-old daughter has been having irregular periods for a year and on coping with a baby who has colic.

Question: My daughter is 14. She started having periods a year ago but they still haven't settled down. They are frequent and heavy, often lasting for up to two weeks.

Dr Nina replies: Abnormal uterine bleeding is extremely common in the first few years after menstruation starts. This is thought to be due to the fact that, at this early stage in reproductive life, ovulation may not occur every month. These anovulatory cycles can be irregular and may result in heavier menstrual bleeding.

The average age at first menstruation is 12.4 years, with a range of age nine to 16. There are a number of factors that influence this but one of the strongest ones is weight. The critical body weight is 46-47 kilograms. Body fat should be at a minimum of 17pc for menstruation to start and 22pc to maintain it. Those who are overweight may menstruate earlier and those who are underweight or over-train may have delayed menstruation.

It takes on average one to three years for the complex hormone cycle to mature once menstruation commences. The average menstrual period lasts from three to seven days and occurs at a cycle of between 21 and 35 days.The range of normal varies greatly and simply understanding this may be enough to put your mind at rest. In many cases no intervention is required.

If menstruation is frequent, heavy or prolonged, there is a risk of iron deficiency and anaemia and a chat with your GP may be a good idea. Clotting problems are a rarer cause of abnormal menstrual periods. This is more likely if other bleeding issues are apparent such as frequent nose bleeds, bleeding gums or easy bruising.

Clotting disorders can also run in families. An underactive thyroid or polycystic ovarian syndrome are other causes of irregular menstrual bleeding. These can all be ruled out via simple blood tests performed by your GP. If periods are especially painful an ultrasound can help rule out abnormalities of the womb or ovaries.

If sexual activity is suspected a pregnancy or pelvic infection must be ruled out. If bleeding isn't too heavy, and blood tests are normal, watching and waiting may be the best option. Menstruation usually eventually settles down to a more regular and predictable pattern.

A reduced blood count warrants treatment with iron suplements.

For those with more prolonged or heavy bleeding, further treatment may be advised. Medication such as mefenamic acid (an anti-inflammatory) combined with tranexamic acid may help. This should be taken regularly three times daily for the expected heavy days. This combination helps reduce menstrual flow and can improve symptoms.

If this doesn't work, hormonal manipulation using the oral combined contraceptive pill may help. This can quite dramatically reduce menstrual flow and will help regulate menstrual bleeding, leading to lighter and predictable menstruation. Rarely this doesn't work. In this instance specialist referral may be advised.

Other hormonal manipulation or insertion of a contraceptive hormone coated coil can significantly reduce menstrual loss.

Question: My daughter is eight-weeks-old. She is pretty healthy but she cries a lot. It happens mainly in the evening. My wife tries feeding her but it doesn't seem to help. Is there anything we should be doing?

Dr Nina replies: Babies who cry for more than three hours a day for more than three days per week for more than three weeks, are likely to have colic. This crying usually starts at about two weeks, peaks around the second month of life, and usually settles by the time the baby is four-months-old. Crying tends to occur in clusters, usually in the late afternoon or evening. Babies may seem quite distressed clenching their fists, arching their backs and grimmacing, leading parents to believe that they are in pain.

Colic is an extremely common condition occurring in about 5pc of babies. It affects boys and girls equally. The exact cause remains unknown. The important thing to know is that although the babies may seem distressed, they are in fact healthy. Colicky babies generally thrive and suffer no more ill health than those without colic.

Saying that, caring for a baby with colic can be extremely stressful for parents. Sharing the care can help ease the stress. Take it in turns to spend the crying hours with the child. Many parents will try various colic remedies which can be bought over the counter in pharmacies.

Reflux occurs in up to 50pc of babies. Thickened feeds or antacids may help here. Cow's milk protein intolerance is also a relatively common cause of crying in babies. The best way to confirm this is to try withdrawing cow's milk protein from the baby's and mom's diet. If there is a significant improvement in symptoms intolerance may have been the cause.

If the baby is losing weight, or has other signs of illness, then colic is not the cause and medical attention should be sought.

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