Tuesday 23 January 2018

Dear Dr Nina: My daughter's period pain is interfering with her playing sport - how can we get it under control?

Period pain
Period pain

Nina Byrnes

Our resident GP answers your medical queries.

Q. My 13-year-old daughter has just got her period and suffers from a lot of pain for two days each month. It is really interfering with her playing sports. She is also very self-conscious, but I think if we got the pain under control, she could start to enjoy playing sports even when she has her period. We have tried ibuprofen and paracetamol with codeine, but she still feels pain and say she feels muggy.

I don't want to put her on the Pill so young, unless I have to as I am worried about the risks. We have tried special exercises also, and getting out and about, but nothing seems to work. Have you any ideas? She is on a team at school and doesn't want to give it up.

Dr Nina replies: The medical term for painful periods is  'dysmenorrhoea'. This is a very common condition. More than half of menstruating women will have some level of pain. However, in most cases, the pain is mild and only lasts one or two days, but in some cases, it may be more severe and last longer.

There are two types of dysmenorrhoea. Primary dysmenorrhoea starts within months of the first menstrual period. This pain usually comes on with menstruation and goes away once it passes. Primary dysmenorrhoea usually gets better as the years pass and may go away after pregnancy. There is no underlying physical abnormality with this pain. It is due to the presence of prostaglandins. The levels of these chemicals rise around the time of menstruation, increasing the chance of cramps and pain.

Secondary dysmenorrhoea usually comes on later in life. This pain is associated with underlying problems and the pain may increase over time and last longer. Causes of secondary dysmenorrhoea include pelvic infection; endometriosis; a condition called adenomyosis, where the tissue that usually lines the womb grows in the womb muscle; fibroids, which are growths in the wall of the womb; and narrowing of the cervix.

Cramps that are not severe and only last one or two days may be normal and don't necessarily require review by a doctor. If pain has started recently, despite previously pain-free cycles, or if the pain is severe or lasting days, it is worth seeing your doctor for a check up. Your doctor can perform an examination, rule out infection and may recommend an ultrasound or other exam to further recheck the womb and ovaries.

Specialist referral is sometimes advised. There are specialists that specialise in teenage gynaecology.

Most cases of dysmenorrhoea can be treated with simple measures. Taking an anti-inflammatory medicine such as ibuprofen may help. These tablets help reduce the level of prostaglandins thus reducing pain. Starting this medicine a day or two before menstruation is due, and taking it regularly for the first two days, can be very effective. If this doesn't help, nearly all methods of contraception can help reduce menstrual pain.

The contraceptive pill is often prescribed for this reason. It also has the advantage of being able to regulate menstruation, and so, periods can be delayed around times such as holidays exams, etc. This can be a very effective method in teenagers.

The pill is one of the most studied medicines in the world. As with all medicines, it may not suit everyone but if recommended, it is a safe and effective method of controlling menstruation. Other methods, such as the implant and the coil, may result in the absence of menstruation, so no periods, no pain. These can also be used in teens although the coil is usually inserted by a specialist in this age group.

Exercise can help reduce dysmenorrhoea so we don't recommend avoiding it. Continuing sports is a good idea. Other measures, such as placing a hot water bottle across the lower abdomen, can help. Complementary remedies include vitamin B6, calcium and magnesium supplements. For some, acupuncture may be of assistance.

My daughter tore some ligaments in her knee three months ago and was cleared to go back playing soccer last week, but she is still experiencing pain. Was it too soon?

Three bones meet at the knee joint: the femur (thigh bone), the tibia (shin bone) and the patella (knee cap). There are four ligaments around the knee joint. A ligament is a made up of connective tissue that joins one bone to another bone around a joint. The knee joint ligaments help to stabilise and support the knee when it is moving. Two ligaments are on the outside of the knee: the lateral ligament on the outside and medical ligament on the inside. The cruciate ligaments run diagonally across inside the knee.

Any movement that causes forceful twisting or rotating of the knee joint can cause an injury. Those involved in sports such as basketball, skiing and soccer are particularly at risk.

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