In an article highlighting dysmenorrhea, ABC News (11/30, Kindelan), reports, “Period pain is a fact of life for many women, yet many don’t know that what they are experiencing might not be normal.” ABC says “more than half of women who menstruate have some pain for one to two days of their cycle, according to the American College of Obstetricians and Gynecologists (ACOG).” The article adds, “Primary dysmenorrhea is the most common type of dysmenorrhea and is caused by natural chemicals in the uterus lining. It is the cramping pain that comes before or during a period, according to ACOG. Secondary dysmenorrhea is also a recurrent, cramping pain, but it is the result of an underlying medical issue in the reproductive organ.”

This report highlights something we see in practice everyday.  It is my impression that often there is little communication amongst teenage girls regarding cycle pain as well as mother to daughter communication.  If there is mother daughter communication it often centers on normality of painful periods.  We find that endometriosis, clearly the cause of 99+% of all teenage cycle pain, is highly conserved or passed from mother to daughter.  So, if mom had bad periods and never had treatment, it is highly likely that she will counsel her child that periods hurt and the child simply must deal with the pain.  A very high percentage of patients admit to us that they thought periods should be very painful and that this was normal.

We are here to set the record straight:  mild cramps in the teen years are normal but severe cramps, nausea, vomiting, missing school, heating pads etc are NOT Normal and clearly indicate the presence of endometriosis.  Medicine has tended to steer around this issue because no one, parents or doctor, wants to consider surgery for a teenager.  Historically, medications, birth control, or IUD’s have been used to decrease pain.  This approach actually is very effective for most but the disease rages on in the background ultimately causing the infertility that we deal with every day in our practice.

I would encourage any parent of a teenage girl to seek out an endometriosis surgeon who performs complete excision for endometriosis and consider early treatment to avoid long term use of suppression agents (hormone suppression) that can adversely affect puberty and normal bone development etc.  Laparoscopy or minimally invasive surgery is quick with short recovery and can change the lives of these youngsters for years to come.  Certainly any mother with a history of endometriosis should watch carefully for the signs in their teenage girls. We have seen and treated patients as young as age 12.

Michael D. Fox, MD
Jacksonville Center Reproductive Medicine
Advanced Reproductive Specialists

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