Periods are normal, but periods that stop you from doing things you enjoy is not normal.
The good news is, you’ve come to the right place to work out what to do next. There are a few reasons you may experience pelvic pain, but one of the most common reasons is period pain. Bad period pain could mean endometriosis but read a bit more below to find out about it.
What is endometriosis?
Endometriosis is a very common condition that affects 1-in-9 girls, women and people assigned female at birth. That’s around 600,000 Australians, so you are not alone.
Knowing what to do next can be tricky if this sounds like you, but this website has lots of information. One thing you can do is read this FREE pelvic pain booklet. You can even save it to your phone or tablet and read it privately.
There are lots of places you can get further information and support, but the best thing you can do is talk to someone you can trust about your symptoms. A GP or health nurse can be a really good place to start. Plus, a GP can help you get these symptoms under control.
There are many GPs who will help; you have to find the right one.
We also have a book called “Endometriosis and Pelvic Pain”, which you can buy from our online shop. You can get it in hardcover or digital format to save to your devices. Check with your school library and health nurse first, as they may already have a copy you can borrow.
Your health nurse may talk you through using a period tracking app like Flo or Qendo, which can also be helpful if you want to track your symptoms or things that worry you.
Plus, give us a like on Facebook to keep up-to-date, and subscribe to our newsletter at the bottom of this page
Pelvic Pain affects 1 in 5 Girls, Women and People Assigned Female at Birth at some time in their life- yet it is a condition that is rarely discussed. Chronic Pelvic Pain is poorly understood and often not recognised because it does not show on scans or at an operation. Girls, Women and AFAB with pelvic pain often suffer in silence, unsure where to go and who can help them. Those with pelvic pain have a wide range of symptoms for various reasons. pelvic pain often starts in during the adolescent years when menstruation begins.
Pain may start in a pelvic organ such as your uterus, uterine tubes (Fallopian tubes), ovaries, endometriosis (uterine lining deposits in places it should not be), bladder, or bowels. Pelvic pain may also start in muscles or joints following an injury. Sometimes pelvic pain begins during a period of severe stress without a precipitating event. Other times no cause is found.
Period pain “dysmenorrhoea”, what is a normal period pain and what is endometriosis?
Period pain is the most common type of pelvic pain. Severe period pain in young women is a bigger problem now than in the past, as girls start to have their periods earlier and become pregnant late. This time between the first period and menopause roughly rounds up to 300 to 400 periods in a lifetime. A study of 1000 girls aged 16-18 years in Canberra, Australia, found that 21% of the girls had severe pain with periods, and 26% had missed school because of period symptoms. Similar results have been found throughout the world.
None of us knows what another person’s pain is like, and you may have wondered if your bad period pain is normal.
Period pain should only be considered ‘normal’ if:
- The pain is only there on the first 1 or 2 days of your period
- It goes away if you use the Pill or take simple pain relief such as paracetamol and non-steroidal inflammatories such as ibuprofen, diclofenac or naproxen
If not, it is not normal. Period pain does not have to be ‘just part of being a woman’. It is important that teenagers receive good care so they can live normally without being brought down by their pelvic pain. If simple treatments for period pain don’t help your pain, you may have endometriosis. Endometrioisis is where tissue similar to the lining of the uterus grows in places outside the uterus around the pelvis. Most endometriosis cannot be seen on an ultrasound.
Chronic pelvic pain results in tight muscles and sensitised pain pathways
Whatever the original cause of pelvic pain, if it does not settle, the pain can become chronic even when the initial infection or injury has resolved. Generally, pelvic pain is considered ‘chronic’ if it is present on most days for at least 3-6 months. No one understands why a similar condition in some people might lead to chronic pain, while in another person might go away completely.
Once pain has become chronic, the pain situation is usually more complicated. Even when the initial injury has resolved, the body believes the injury is still present and interprets this as pain. Consequently, surrounding pelvic muscles can tighten in an attempt to protect the body from further damage, which can exacerbate the pain. When these muscles are constantly tensed, shortened and tight, they start hurting and can go into spasm. The pain from pelvic muscle spasm can become the worst part of the pain. It truly can be a cramp on the inside of the pelvis.
Additionally, nerve pathways that send pain messages to the brain become sensitised due to the constant experience of pain. In some cases, even a brush of a feather can be interpreted as unbearable pain; this is referred to as hyperalgesia. Stress and anxiety can also sensitise these pain pathways enhancing pain sensation. For example, stubbing your toe on a bad day hurts more than if you were having a good day. Unfortunately, many people become depressed from the effects of pain on their functionality, productivity, and quality of life, which can further worsen the pain and become a vicious cycle. These issues can’t be seen from the outside and don’t show on scans or during operations.
Once muscles and nerves in the pelvis start behaving abnormally, other organs can develop problems too. Pelvic floor muscles work best when they can tighten and relax normally. They control bladder and bowel motions by tightening to stop urine or stool passing and relaxing to allow us to urinate or defecate (open your bowels) when appropriate. Trying to void, defecate, or ejaculate through painful tight pelvic muscles that cannot relax normally can be extremely painful.
The symptoms girls and women describe vary widely but may include:
- An aching, sharp or burning pain in the pelvis, tailbone (coccyx), bottom, pubic area, rectum or lower back
- Pain with superficial or deep penetration of the vagina during intercourse that can linger
- Bowel problems – a sense of incomplete emptying, pain opening their bowels, inability to pass wind or anal pain, food intolerances, bloating, diarrhoea, or constipation
- Bladder problems including Painful bladder syndrome – the need to go to the toilet frequently, an urgency to go to the toilet, slow passage of urine, or bladder pain
- Hip, groin or abdominal pain
- Social withdrawal, loss of self-esteem, low energy, behavioural or emotional changes, anxiety or depression. Heavy periods can also lead to iron deficiency anaemia, making you tired.
Pelvic pain affects 1 in 5 women and People Assigned Female at Birth at some time in their life- yet it is a condition that is rarely discussed. Chronic pelvic pain is poorly understood and often not recognised because it does not show on scans or at an operation. Those with pelvic pain often suffer in silence, unsure where to go and who can help them. People with pelvic pain have a wide range of symptoms for various reasons. Pelvic pain often starts in the adolescent years when menstruation begins.
Pain may start in a pelvic organ such as your uterus, uterine tubes (Fallopian tubes), ovaries, endometriosis (uterine lining deposits in places it should not be), bladder, or bowels. Pelvic pain may also start in muscles or joints following an injury. Sometimes pelvic pain starts during a period of severe stress without a precipitating event. Other times no cause is found.
One Teen's Story of Pelvic Pain
My name is Georgia, I’m 14 years old and I suffer with endometriosis. It started with just cramps everyday, back pain, nausea, heavy periods, headaches and dizziness. It started getting a lot worse, so we went to doctors, and a gynaecologist. This went on for about a year, in and out of hospitals, and the pain kept getting me more depressed everyday because I felt like I wasn’t getting anywhere with getting a diagnosis. I started to think all this pain was in my head.
My anxiety was getting worse because I stayed in my room pretty much all day. I missed so much of my last year of Primary School and didn’t want to go anywhere. I didn’t see my friends much either.
A doctor then referred me to a new gynaecologist – one who understood about pelvic pain. When I walked out of my first appointment with her, it was like a breath of fresh air, even for my mum. We finally got a plan in place and I had my first laparoscopy, I got a mirena in as well. I was really glad that I had a diagnosis, because living with chronic pain everyday and not being diagnosed really gets you down. People think ‘she doesn’t look sick. Why isn’t she at school?’
At first that really go to me because I cared so much what people thought of me but now it doesn’t even cross my mind, because I know that I’m in pain, it’s just invisible. Because of this experience, I feel like I’ve matured a lot, I am finally getting my anxiety handled and I feel like I am getting my life back on track and that is all thanks to my doctor and my mum.
I just hope that other teenagers out there that have symptoms like mine get some help because it really does get you down and there is help and support. Don’t live a life in pain, being a teenager is hard enough!
Can teenagers have endometriosis?
The answer is ABSOLUTELY YES. It’s common for symptoms to start in the teen years, sometimes from the very first period. This may be more so if there’s a family history of endometriosis, menstrual pain, and troublesome symptoms. It’s important not to delay seeking help as early intervention is vital to improve quality of life, relieve suffering and avoid the possibility of fertility being compromised down the track.
Paracetamol is not helping my pain. What else can I take to help give me some relief?
Paracetamol belongs to a group of medicines called simple analgesics and helps alleviate mild-moderate pain. Taking an anti-inflammatory either in combination with Paracetamol or instead of Paracetamol is sometimes recommended. You have probably heard of medications containing mefenamic acid, such as Ponstan. Like ibuprofen, mefenamic acid is a nonsteroidal anti-inflammatory drug (NSAID) that works by blocking an enzyme that the body uses to make prostaglandins. These drugs work well when taken before your period (this is where using a tracker is healful). Other stronger pain relievers, such as Codeine, block pain signals from nerves in your body. These can be used alone or in combination with Paracetamol and anti-inflammatories. Codeine is only available on prescription, and you should ALWAYS seek professional advice before using these medications.
I have been told that going on to the ‘pill’ can help relieve some of my endometriosis symptoms. How can a pill used as a contraceptive do this?
The contraceptive pill is often used as a first-line treatment to regulate periods and reduce symptoms. There are many different types of ‘pills’; some are much better suited to help with period pain and endometriosis. Taking the pill continuously decreases the number of periods per year; however, it can also supress lesions and reduce endometriosis associated symptoms. For this reason, recent thoughts are that prescribing pills ‘back to back’ may not be wise if there is no diagnosis. The pill is not suitable for everyone for many reasons (age, culture, health, choice etc.).
The Good News
Once pain has become chronic, it is unlikely that any one treatment will make it go away completely. However, you can feel optimistic about the future. There are many ways to manage this pain and make it a much smaller part of your life.
We all want a cure for pain, preferably one that is quick and easy. It’s understandable. One day there may well be such a treatment.
For now, the best treatment for chronic pain involves:
- learning more about your mix of pains – this website has information to get you started on each of your pains
- working with a physiotherapist who understands pelvic muscle pain to keep your body moving and muscles comfortable
- using medications for central sensitisation of nerve pathways, if appropriate – while minimising the use of regular narcotic (opioid) medications
- keeping active and involved in activities you enjoy – and learning positive ways to manage your pain
The pages on this site will help you with many of these things. Our Instagram @ppeptalk will help you keep up with new treatments and ideas. Our events calendar includes activities you and your parents or caregivers may be able to attend.
For Parents of Teens
Tips for Parents of Teens with Pain
As parents and caregivers, we all want the best for our children. Having a child with pain means change for all the family, and you may feel ill-equipped to handle these changes.
Your teenager may have seen the PEPP Talk® Program (Periods, Pain and Endometriosis Program) in their school. This program provides medically accurate information about public pain in a fun and interactive way. Creating awareness is the first step in enabling your teen to manage their pain and live a full and active life. This program gives teenagers the tools to identify whether their pain is normal compared to their peers, manage their pain using simple measures and how to self-advocate.
Following on from PEPP Talk®, the Pelvic Pain Foundation of Australia delivers regular online sessions called PPEP Talk® Next Steps for parents and caregivers of teenagers with pelvic pain. In this session, Gynaecologist and Pain Specialist Associate Professor Susan Evans and Pelvic Physiotherapist Emma Kirkaldy talk with parents and caregivers about the next steps they can take to help their child improve their health pathway. In these sessions, we discuss what to look for in a Health Professional, what questions to ask your Doctor and give parents and caregivers a basic understanding of pain processes to equip them better to deal with the pain their teenager may be experiencing.
10 Tips for Parents and Caregivers of Children and Teens Living with Persistent Pain
These ideas have come from years of experience working with children and families and seeing what works best in most situations.
- Get good information about persistent pain so that you understand the situation. Understand why persistent pain differs from acute pain and how different strategies are needed to manage it.
- Help your child live as normally as possible. Keep up the family routines, encourage your child to do their share and be involved in family activities.
- Help your child develop a good support team around them. This team includes you, your family, their friends, their school and your family GP and other health care professionals with your child in the centre.
- Shift the focus away from pain. You can acknowledge pain is present but also encourage your child to engage in helpful pain management strategies such as getting involved in a favourite activity, using humour, music, dance, art, meditation and so on.
- Recognise the effect persistent pain has on your child’s thoughts and emotions. Anxiety and depression are common, sometimes anger or fear, unhelpful thoughts and worrying. All of these can make your child’s pain seem worse. Professional help from your GP, a clinical psychologist or a counsellor can make a difference.
- Encourage your child to go to school every day. Getting behind in school and losing friends can add more stress and cause problems in the long term. You may need to work with your child’s teachers to make a pain management plan for school, which may include giving medication, limited time-out or rest periods, modified physical activities, and sending work home for days your child can’t get to school.
- Don’t rely only on medication to manage pain. Sometimes several treatments need to be tried before a suitable one or combination is found. Medication by itself has a limited role in treating persistent pain because side effects often occur at quite low doses, or it is simply not effective. Some medicines are not licenced for use in children because they have not been studied in children and have proven to be both effective and safe.
- Discourage resting in bed or on the couch for long periods of the day. It may reduce pain in the short term, but it causes problems with sleeping at night, which makes pain harder to manage the next day. If this continues for a long time, your child will become run down, develop a sleep disorder, and have even more fatigue and pain.
- Help your child to learn useful, active ways to manage their pain. Encourage your child to do activities they value and enjoy despite being in pain, including a gentle exercise program. A physiotherapist or exercise physiologist can help with a graded exercise program designed for your child’s needs.
- Help your child develop a plan for a bad-pain day. Planning ahead can help your child to worry less about pain flare-ups and manage the pain better. You may need to work with your child’s health care professionals