Dear Dr Nina: My teen is struggling with awful periods
My teenage daughter is suffering really badly with her periods. She gets them every few weeks and they can last up to three weeks at a time. She doesn't want to go to school when she feels like this and she feels sick all the time; I suspect she may be anaemic. The GP is doing tests to check her hormones but has also said that probably the only way to regulate her periods is to put her on the pill. She's only 15 and I really don't want her to be taking hormones if she doesn't have to - I'm concerned about the side-effects. Is there anything else we could do for her that might help her? And could this be stress-related? I'm worried that she is not coping with the pressures of school.
Dr Nina replies: Abnormal 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 (release of an egg) 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 46kg to 47kg. Body fat should at a minimum be 17pc for menstruation to start and 22pc to maintain it. 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 so 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 nosebleeds, bleeding gums or easy bruising. Clotting disorders can also run in families.
An underactive thyroid or polycystic ovarian syndrome are other causes. These can all be out ruled 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. A reduced blood count warrants treatment with iron supplements. 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 the contraceptive pill can be used.
The contraceptive pill is often prescribed to control erratic or heavy menstrual bleeding. It also has the advantage of being able to regulate menstruation and so periods can be delayed for 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 menstrual bleeding.
The pill does slightly increase the risk of clot in the leg or lung and slightly increase the risk of breast cancer. However, it also has benefits. It reduces the risk of cancer of the womb or ovary significantly.
Other methods such as the implant and the coil may result in the absence of menstruation, so no periods, no anaemia. These can also be used in teenagers, although the coil is usually inserted by a specialist in this age group.
Q. I've been told that I'll have to have my gall bladder removed as it's inflamed. I'm worried about the aftermath of the op - will it take long to recover, and will I have to change my lifestyle in any way?
Dr Nina replies: The gall bladder is a pear-shaped gland that sits below the liver in the right side of the abdomen. It stores a substance called bile, which helps us digest fats in our diet. Gallstones form when liquid stored in the gallbladder hardens into pebble-like material.
Women are twice as likely to develop gallstones as men. They are more common in those over 60. High oestrogen conditions such as pregnancy, the contraceptive pill or using HRT increase the risk. Obesity is a major risk factor for gallstones as is a diet high in fat and low in fibre.
Conversely, fasting and rapid weight loss can also increase the risk. Gallstones may run in families and are more common in those with diabetes.
When gallstones act up, they cause pain, usually in the upper abdomen. This may be felt in the back or also in the shoulders. These attacks often follow fatty meals. There may be a fever, nausea and vomiting, pale-coloured stool and jaundice (yellowish colouring of the skin and eyes) may occur. These symptoms usually require admission to hospital.
If gall bladder attacks have been occurring, it is usually advised to have the gallbladder removed. This is normally done once the infection or attack has settled down.
Today, most gallbladder operations are done via keyhole surgery and you can leave the hospital within 24 hours. If your gallbladder is causing problems, then you do need it removed. Untreated gallbladder infections increase the risk of acute pancreatitis, which is a life threatening medical emergency. Most people recover quickly from the operation and get back to leading a normal healthy life. Lifestyle adjustment is not usually required.
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Health & Living