When Her Period is a Problem

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From one month to the next, menstrual cycles can be a mild inconvenience or feel like a real pain. For adolescent girls and teens, painful or very heavy periods can be debilitating. This can make it difficult for young women to attend school, play sports, enjoy swimming, and feel comfortable with their developing bodies.

If you are the parent or guardian of a pre-teen or teenager struggling with managing symptoms from her menstrual cycle, there are many ways to help her. How can you tell if she’s experiencing the typical challenges of puberty or something that needs medical attention?

“Many girls are shy, but especially younger teens,” when it comes to talking to parents about their bodies, says Judy Simms-Cendan, M.D., a gynecologist specializing in pediatric and adolescent care with the University of Miami Health System. “Sometimes teens really don’t want to talk, so finding the right time and place to have those conversations is key.”

When should you speak with your daughter?

teen periodStart a conversation if she is:

  • missing school when she has her period
  • skipping out on sports or other physical/social activities because her periods are too painful or heavy
  • having repeated accidents that leak through her clothes or sheets
  • having severe mood swings during her periods
  • has underlying health issues, such as seizures, that worsen during her periods
  • very tired, pale, or complains of dizziness and headaches (signs of anemia)

Most girls should use no more than five pads per day on their heaviest days, which should only last for two days of the cycle. Menstrual periods should last no longer than seven days each month.

“If you are buying more than 20 pads per month for your daughter, or if she is asking for heavy overnight pads for more than two to three days, that can be a sign that she is bleeding heavily,” says Dr. Simms-Cendan. Heavy bleeding can lead to anemia. “If she’s asking for sanitary products to handle bleeding more than one week a month, I would ask more questions.”

What can a gynecologist do for your child?

To address any of these concerns, Dr. Simms-Cendan recommends seeing her pediatrician or primary care provider, who can refer her to a pediatric/adolescent gynecologist.

The specialist may ask to speak privately with the patient to learn more about her periods and related symptoms. This sense of privacy helps younger patients feel comfortable talking with their health care provider about sensitive and embarrassing topics.

During the consultation, the doctor may ask about the frequency and heaviness of her menstrual flow, pain levels with cramping and headaches, overall energy levels, and any pain-management medications or techniques she’s tried. A pediatric/adolescent gynecologist can also ask about the types of menstrual products the patient uses and discuss alternative products (pads, tampons, menstrual cups, and menstrual underwear) that may be easier or more convenient for her.

Based on the patient’s description of her symptoms and issues, your gynecologist may recommend one or more of the following treatments:

  • Over the counter nonsteroidal anti-inflammatory (NSAID) drugs (like Advil®, Motrin®, and Aleve®) for relief of pain, cramping, and headaches
  • Prescription-strength NSAIDs
  • Modifying the timing or dosage of NSAIDs to improve the effectiveness
  • Heating pads for abdominal and back cramps
  • Regular exercise, which can help relieve PMS and menstrual symptoms
  • Tranexamic acid (non-hormonal treatment) to decrease the amount of bleeding
  • Iron supplements or iron-rich diet for iron-deficient/anemic patients

If these approaches don’t provide enough pain relief or heavy bleeding is a problem, the doctor can discuss using hormones to address these concerns. Some of these hormones (progesterone or progesterone plus estrogen) are often used for birth control. However, they can also regulate menstruation and related mood swings, reduce heavy flow, reduce or eliminate menstrual cramping, decrease the intensity or frequency of hormonal headaches, and lessen hormonal acne.

Hormone therapy options include contraceptive pills, vaginal rings, patches, injections, intrauterine devices (IUDs), and under-the-skin implants.

“These are very safe and effective ways to treat menstrual cramps. Many teens use them, even though they have no need for birth control, as they are not sexually active,” Dr. Simms-Cendan says.

If painful or heavy periods continue even with treatment, your health care provider may want to rule out other possible causes, such as endometriosis, a bleeding disorder, uterine fibroids, or polyps. The doctor may recommend a pelvic ultrasound or blood tests for hormone (thyroid) levels and sexually transmitted infections.

How can you help your daughter?

“Fortunately, there are many resources out there that weren’t around when I was younger,” Dr. Simms-Cendan says.

“Books like the American Girls series and The Care and Keeping of You are great to make available for young girls to read on their own. For teens with special needs, the web-based Healthy Bodies Toolkit by Vanderbilt Kennedy Center has great resources in English and Spanish on hygiene, changing bodies, and even personal safety.”

If you or your adolescent child need to speak with a health care professional, contact UHealth’s clinic for Pediatric and Adolescent Gynecology at 305-243-4530.


Dana Kantrowitz is a contributing writer for UMiami Health News.


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