Advice about heavy and prolonged periods for a teenager
January 25, 2021 5:01 PM Subscribe
Asking on behalf of my niece, aged 13, who will be reading the replies. She is currently on day 47 of a constant and heavy period, which is having a big effect on her quality of life.
The doctor recommended tranexamic acid, to be taken on the four heaviest days. She reasonably wondered how she could tell which the heaviest days are, but tried it and it had no effect. She's about to try it again (about two weeks on from the previous attempt). The doctor has said the next step is the pill, but she needs to see the doctor first and it may take a while to get an appointment. She often feels dizzy, light-headed and exhausted. She has had a blood test; her full blood count and iron were both fine. We were surprised that she is not anaemic, and she was sad as she was hoping that if she were, it would be resolvable through taking iron supplements. Her blood pressure, taken at home with an adult cuff, so maybe not a perfect reading, was 89/60, which looks as if it is on the cusp of low for a teenager.
Questions: apart from taking the doctor's advice about the pill once she has had an appointment, what else could she do to feel better? And what could be causing such heavy periods in a teenager?
The doctor recommended tranexamic acid, to be taken on the four heaviest days. She reasonably wondered how she could tell which the heaviest days are, but tried it and it had no effect. She's about to try it again (about two weeks on from the previous attempt). The doctor has said the next step is the pill, but she needs to see the doctor first and it may take a while to get an appointment. She often feels dizzy, light-headed and exhausted. She has had a blood test; her full blood count and iron were both fine. We were surprised that she is not anaemic, and she was sad as she was hoping that if she were, it would be resolvable through taking iron supplements. Her blood pressure, taken at home with an adult cuff, so maybe not a perfect reading, was 89/60, which looks as if it is on the cusp of low for a teenager.
Questions: apart from taking the doctor's advice about the pill once she has had an appointment, what else could she do to feel better? And what could be causing such heavy periods in a teenager?
This is not normal, and it sounds like the doctor, like so many doctors, is not taking this women's health issue seriously. I would suggest finding her a competent gynecologist. There are a number of things that could be causing this, but it doesn't sound like this doctor is trying to rule them out.
posted by praemunire at 5:14 PM on January 25, 2021 [131 favorites]
posted by praemunire at 5:14 PM on January 25, 2021 [131 favorites]
I have had terrible periods my whole life. I wish they had been taken more seriously by medical professionals.
This article from a university medical centre says that heavy, prolonged periods are not normal for teenagers, and that a teen experiencing heavy bleeding for over 7 days should be seen by a doctor, who should investigate the cause rather than just assuming it is hormonal and just putting the teen on birth control automatically.
Good luck--I hope your niece can get this resolved. You are a good aunt to advocate for her like this!
posted by hurdy gurdy girl at 5:15 PM on January 25, 2021 [21 favorites]
This article from a university medical centre says that heavy, prolonged periods are not normal for teenagers, and that a teen experiencing heavy bleeding for over 7 days should be seen by a doctor, who should investigate the cause rather than just assuming it is hormonal and just putting the teen on birth control automatically.
Good luck--I hope your niece can get this resolved. You are a good aunt to advocate for her like this!
posted by hurdy gurdy girl at 5:15 PM on January 25, 2021 [21 favorites]
This is way beyond normal. Your niece needs a new doctor yesterday, one who will get her fully checked out. Ultrasound, whatever tests are needed.
posted by computech_apolloniajames at 5:20 PM on January 25, 2021 [44 favorites]
posted by computech_apolloniajames at 5:20 PM on January 25, 2021 [44 favorites]
day 47 of a constant and heavy period
Not normal. Do not accept the word of any doctor who says it is. No one has that much uterine lining.
posted by Thella at 5:23 PM on January 25, 2021 [72 favorites]
Not normal. Do not accept the word of any doctor who says it is. No one has that much uterine lining.
posted by Thella at 5:23 PM on January 25, 2021 [72 favorites]
Birth control might help. It helped me. I've (almost certainly) got endometriosis and my periods as a teen were horrible. Most of my symptoms went away when I got on birth control when I was 18 thankfully. These days I run the pill packs continuously or my terrible symptoms come back. Bonus: I haven't bled in years.
I also got screened for fibroids and uterine cysts in the appointment that gave me birth control. Please PLEASE make sure if those screenings happen that this kid knows the ultrasound is INTERNAL and not on top of your tummy like pregnant women. I had no idea and the nurse and tech didn't mention it and my experience was fairly traumatic.
posted by phunniemee at 5:24 PM on January 25, 2021 [23 favorites]
I also got screened for fibroids and uterine cysts in the appointment that gave me birth control. Please PLEASE make sure if those screenings happen that this kid knows the ultrasound is INTERNAL and not on top of your tummy like pregnant women. I had no idea and the nurse and tech didn't mention it and my experience was fairly traumatic.
posted by phunniemee at 5:24 PM on January 25, 2021 [23 favorites]
dear god, that poor child.
If she is in the SF Bay Area I will be happy to send you a rec for the adolescent gynecologist to whom I took my kid for her terrible periods (which were nowhere near as bad as your niece's! 47 days!) Actually, in the days of telemedicine, maybe she can even be seen if she's not local, I don't know. I don't think my kid even needed a physical exam, although she did get labs done. And an ultrasound.
That girl needs a gynecologist preferably with an adolescent practice focus.
By the way, in my kid's case various meds were prescribed, but what eventually fixed it was just regular birth control pills.
posted by fingersandtoes at 5:25 PM on January 25, 2021 [13 favorites]
If she is in the SF Bay Area I will be happy to send you a rec for the adolescent gynecologist to whom I took my kid for her terrible periods (which were nowhere near as bad as your niece's! 47 days!) Actually, in the days of telemedicine, maybe she can even be seen if she's not local, I don't know. I don't think my kid even needed a physical exam, although she did get labs done. And an ultrasound.
That girl needs a gynecologist preferably with an adolescent practice focus.
By the way, in my kid's case various meds were prescribed, but what eventually fixed it was just regular birth control pills.
posted by fingersandtoes at 5:25 PM on January 25, 2021 [13 favorites]
Look for an urgent care that has imaging and go there ASAP. Don't wait for an appointment with a regular GYN.
posted by bleep at 5:25 PM on January 25, 2021 [10 favorites]
posted by bleep at 5:25 PM on January 25, 2021 [10 favorites]
What kind of doctor did she see? Pediatrician? Ob/Gyn? N'thing all of the above because, although I personally have never experienced issues with my period (only being a little too heavy as a teenager which led to anemia) I just cannot fathom being told to just keep waiting out a 6 week long bloodfest, holy cow.
But she needs a real exam to find out what's going on. This is the time for diagnosis, not just symptom treatment.
posted by NotTheRedBaron at 5:38 PM on January 25, 2021 [4 favorites]
But she needs a real exam to find out what's going on. This is the time for diagnosis, not just symptom treatment.
posted by NotTheRedBaron at 5:38 PM on January 25, 2021 [4 favorites]
I don't know anything about tranexemic acid, but I do know that doctors ignore teenagers' period problems -- I was told 14 to "get pregnant, that will fix it," which was kinda true? But I was 31 before I got pregnant and GETTING PREGNANT AT FOURTEEN WOULD BE BAD, and having horrible medical problems for 17 years that can only be solved by pregnancy is BULLSHIT.
Definitely seek imaging, for polyps, endometriosis, fibroids, etc.
I don't want to be alarmist, but I had a grad school roommate who was told that her weird periods were just "hormones" and "part of being a woman." It turned out she had oddly-presenting endometriosis, and by the time a doctor took her symptoms seriously (she was 28 or so), she was already infertile.
Also ask around for ob/gyns who are good with teenagers and who work well with teens struggling with weird periods. A LOT of ob/gyns deal mostly with pregnant women in their 30s and are AMAZING with pregnant women in their 30s and all their pregnancy problems, but not great with teenagers and teenaged hormones. Local college students/women's resources and local college/university hospital ob/gyns may be the people to seek out! Ob/gyns are not necessarily amazing at teenaged health! Some are great at babies, some are great at gynecological surgery, but you have to find one who's great at teenaged periods!
posted by Eyebrows McGee at 5:39 PM on January 25, 2021 [16 favorites]
Definitely seek imaging, for polyps, endometriosis, fibroids, etc.
I don't want to be alarmist, but I had a grad school roommate who was told that her weird periods were just "hormones" and "part of being a woman." It turned out she had oddly-presenting endometriosis, and by the time a doctor took her symptoms seriously (she was 28 or so), she was already infertile.
Also ask around for ob/gyns who are good with teenagers and who work well with teens struggling with weird periods. A LOT of ob/gyns deal mostly with pregnant women in their 30s and are AMAZING with pregnant women in their 30s and all their pregnancy problems, but not great with teenagers and teenaged hormones. Local college students/women's resources and local college/university hospital ob/gyns may be the people to seek out! Ob/gyns are not necessarily amazing at teenaged health! Some are great at babies, some are great at gynecological surgery, but you have to find one who's great at teenaged periods!
posted by Eyebrows McGee at 5:39 PM on January 25, 2021 [16 favorites]
I'm so sorry she's going through this. The pill helped me so much when I was a teen, for the exact same reason (long before I was sexually active). As I aged I went on and off the pill at various times, sometimes having normal periods, sometimes having very heavy periods. I had no problem getting pregnant when I wanted to, and then went back on in my 40s to again mitigate extremely heavy periods. The pill can be extremely useful, but even if she chooses not to take it, I agree with others: she needs to see a gynecologist and get this problem solved now.
Based on your spelling of "anaemic" I'm guessing you're not in the US, but Planned Parenthood is a good place to start if you are.
posted by BlahLaLa at 5:42 PM on January 25, 2021 [2 favorites]
Based on your spelling of "anaemic" I'm guessing you're not in the US, but Planned Parenthood is a good place to start if you are.
posted by BlahLaLa at 5:42 PM on January 25, 2021 [2 favorites]
This same thing happened to me when I was just a bit older than she is -- I had my period continuously for months. I was too scared to tell my mother; I kept thinking it would just stop eventually (it didn't). When I finally did tell my mother, she took me to the gynecologist immediately. Turned out I had polycystic ovary syndrome, which was well-controlled with birth control pills.
posted by holborne at 5:48 PM on January 25, 2021 [4 favorites]
posted by holborne at 5:48 PM on January 25, 2021 [4 favorites]
Ugh, I am so sorry she has to deal with that, especially at 13! I'm going through something similar - I actually went to urgent care last week because of how much I was bleeding (a pad every 20-30 mins for a few hours at a stretch, eeek) and some dizziness, and they made me go to the ER. Turns out I have fibroids, which were diagnosed via ultrasound. They sent me home with a temporary scrip for norethindrone, which kicked in after 3 days and thank the lord I am not bleeding anymore. They did seem quite worried that I had been bleeding for 3 weeks straight, so 47 days is definitely concerning.
Taking ibuprophen is supposed to lighten flow (and helps with symptoms). On my first IUD, I basically stopped having a period for 5 years; would highly recommend.
I usually use a combo of pads, tampons and Thinx, but the nurse at the ER told me to just use pads for now as it's easier for clinicians to understand how heavy your period is when measured in pads. It would be helpful for her to keep track of how often she changes pads - this makes it harder for doctors to brush aside the issue. The whole experience has made me so angry about how women's health issues are treated by doctors. She (and hopefully a parent) will have to push to make sure she gets the treatment she needs.
posted by catcafe at 5:49 PM on January 25, 2021 [8 favorites]
Taking ibuprophen is supposed to lighten flow (and helps with symptoms). On my first IUD, I basically stopped having a period for 5 years; would highly recommend.
I usually use a combo of pads, tampons and Thinx, but the nurse at the ER told me to just use pads for now as it's easier for clinicians to understand how heavy your period is when measured in pads. It would be helpful for her to keep track of how often she changes pads - this makes it harder for doctors to brush aside the issue. The whole experience has made me so angry about how women's health issues are treated by doctors. She (and hopefully a parent) will have to push to make sure she gets the treatment she needs.
posted by catcafe at 5:49 PM on January 25, 2021 [8 favorites]
Just nthing that if the doctor in question is not a GYN they are the wrong kind of doctor, and either way they are absolutely the WRONG doctor as they are not taking an extremely serious health issue seriously.
(It literally changed my life when, at 15, I finally saw a GYN who accepted at face value me saying that my periods were debilitatingly painful, and in less than one cycle she fucking fixed it. Help your niece find this doctor)
posted by brainmouse at 5:56 PM on January 25, 2021 [12 favorites]
(It literally changed my life when, at 15, I finally saw a GYN who accepted at face value me saying that my periods were debilitatingly painful, and in less than one cycle she fucking fixed it. Help your niece find this doctor)
posted by brainmouse at 5:56 PM on January 25, 2021 [12 favorites]
By the way, since you are writing on behalf of your niece and saying she will read the replies - honestly, at this point, you should contact her parents and get her to urgent care or whichever the UK(?) equivalent is. Whatever resource that's available that will see her without an appointment. This is not the case of her reading a bunch of suggestions on how she could manage some slightly intense period symptoms. She needs to see a doctor who will take the situation seriously and find out what's going on.
posted by NotTheRedBaron at 5:58 PM on January 25, 2021 [11 favorites]
posted by NotTheRedBaron at 5:58 PM on January 25, 2021 [11 favorites]
If only her iron level was tested, her ferritin should also be tested. I’ve had normal iron range and low ferritin when I was anemic.
posted by bq at 6:04 PM on January 25, 2021 [9 favorites]
posted by bq at 6:04 PM on January 25, 2021 [9 favorites]
Oh wow. Find the _best_ medical professional you can, get an appointment ASAP.
This is preventing her from learning and experiencing and being herself at a critical time in her life, and could be a sign of something really bad.
One thing to consider - I've felt a lot better when drinking Gerolsteiner mineral water (lots of magnesium) or taking a magnesium supplement, or taking the electrolyte supplements often sold at health/outdoor/camping stores.
I mean, this is unexpected and unexplained, and what if it got _worse_?
posted by amtho at 6:15 PM on January 25, 2021 [2 favorites]
This is preventing her from learning and experiencing and being herself at a critical time in her life, and could be a sign of something really bad.
One thing to consider - I've felt a lot better when drinking Gerolsteiner mineral water (lots of magnesium) or taking a magnesium supplement, or taking the electrolyte supplements often sold at health/outdoor/camping stores.
I mean, this is unexpected and unexplained, and what if it got _worse_?
posted by amtho at 6:15 PM on January 25, 2021 [2 favorites]
Echoing what others have said: get this gal to a specialist or at least a second opinion ASAP. 47 days is way way out of the norm and it's concerning that her doctor is not taking this seriously.
As another anecdote, I went to the doctor in my early twenties with a 3-week-long period, and they had me in for an ultrasound the very next day. The pill wound up fixing it for me, taken in an off-label way initially with multiple doses in a dayy then tapering off, but they were pretty concerned to check for polyps or other masses first.
posted by february at 6:16 PM on January 25, 2021 [1 favorite]
As another anecdote, I went to the doctor in my early twenties with a 3-week-long period, and they had me in for an ultrasound the very next day. The pill wound up fixing it for me, taken in an off-label way initially with multiple doses in a dayy then tapering off, but they were pretty concerned to check for polyps or other masses first.
posted by february at 6:16 PM on January 25, 2021 [1 favorite]
If she were 45 or 50, it might not be so alarming, but she's not. And even at a significantly older age, it would need to be treated seriously.
But - since she's reading this - no need to super panic. You're not going to die immediately. But you do have the right to keep asking other people and other professionals for help until you get it. Sorry, lass, this is what we mean by sometimes having to work a little harder to be taken seriously. I hope the world changes so that you don't always have to do this. It's harder when you're older :)
posted by amtho at 6:18 PM on January 25, 2021 [7 favorites]
But - since she's reading this - no need to super panic. You're not going to die immediately. But you do have the right to keep asking other people and other professionals for help until you get it. Sorry, lass, this is what we mean by sometimes having to work a little harder to be taken seriously. I hope the world changes so that you don't always have to do this. It's harder when you're older :)
posted by amtho at 6:18 PM on January 25, 2021 [7 favorites]
Hey there 13 year old neice, I'm sorry that this is happening, it's very much not fun.
Others have mentioned fibroids, endometriosis, and other things it might be, and it's important to get it checked out- there are treatments!
I was a bit older than you when I got my periods checked out and here's what I have found helpful along the way. Tranexamic acid worked for me, I think it might have taken a few goes. Definitely reduced the flow and made it more manageable. Pads branded as maternity ones work, and I've heard good things about period underwear. I also find a menstrual cup helpful for managing heavy flow, but that might be useful in a few year's time.
I ended up getting a fibroid removed and a Mirena IUD inserted. This definitely helped!
It sucks. Solidarity!
posted by freethefeet at 6:24 PM on January 25, 2021 [5 favorites]
Others have mentioned fibroids, endometriosis, and other things it might be, and it's important to get it checked out- there are treatments!
I was a bit older than you when I got my periods checked out and here's what I have found helpful along the way. Tranexamic acid worked for me, I think it might have taken a few goes. Definitely reduced the flow and made it more manageable. Pads branded as maternity ones work, and I've heard good things about period underwear. I also find a menstrual cup helpful for managing heavy flow, but that might be useful in a few year's time.
I ended up getting a fibroid removed and a Mirena IUD inserted. This definitely helped!
It sucks. Solidarity!
posted by freethefeet at 6:24 PM on January 25, 2021 [5 favorites]
I think others have covered the gravity and seriousness here, and so I expect you'll be helping your niece get a better doc etc. Also please provide whatever non medical support is necessary so your niece feels empowered with the doc. She doesn't have to go forward with any treatment or procedure she doesn't want to - having someone remind me of that at that age would have been extremely helpful in helping me to get the care I needed.
posted by Tandem Affinity at 7:01 PM on January 25, 2021 [4 favorites]
posted by Tandem Affinity at 7:01 PM on January 25, 2021 [4 favorites]
(I apologize for making gender assumptions in my previous comment--I referred to you as her aunt and I should not have made that assumption.)
posted by hurdy gurdy girl at 7:16 PM on January 25, 2021
posted by hurdy gurdy girl at 7:16 PM on January 25, 2021
This can also be indicative of thyroid problems which, at 13, should be seen pretty urgently. Unfortunately you really do need to see someone in person so they can feel for thyroid distortion or irregularities, plus bloodwork for labs will be necessary.
As a general plan of attack for anybody having a weird body behavior, I recommend getting a notebook and writing down all the data you can think of that might be relevant - particularly did anything unusual (besides *gestures around* obviously) happen in the weeks before the period started? Bad stomach bug, seemingly unimportant bonk on the head, migraine, dizziness or fainting, possible COVID, something that in retrospect seems like an allergic reaction. Abdominal pain, head or neck pain, bloating and/or gas, unusual bowel or bladder behavior. Change in medication, addition or removal of something from the usual diet, anything that might have changed. And between now and the appointment, track any changes in heaviness/color/texture, presence of clots or discharge, and how many menstrual products a day you're having to use (or if you're using a cup, how many times you have to empty it, and then find out how many ml the cup holds).
And then you can use the same notebook to prepare a list of questions and note the answers, which is a good way to not forget anything in the nerves of the moment, but also is a good way to make it clear to whoever you're talking to that they are under some scrutiny and aren't going to get away with handwavey half-measures.
It's ridiculous that menstruating people so often have to be their own data scientists to be taken seriously, but it does tend to work.
posted by Lyn Never at 7:27 PM on January 25, 2021 [12 favorites]
As a general plan of attack for anybody having a weird body behavior, I recommend getting a notebook and writing down all the data you can think of that might be relevant - particularly did anything unusual (besides *gestures around* obviously) happen in the weeks before the period started? Bad stomach bug, seemingly unimportant bonk on the head, migraine, dizziness or fainting, possible COVID, something that in retrospect seems like an allergic reaction. Abdominal pain, head or neck pain, bloating and/or gas, unusual bowel or bladder behavior. Change in medication, addition or removal of something from the usual diet, anything that might have changed. And between now and the appointment, track any changes in heaviness/color/texture, presence of clots or discharge, and how many menstrual products a day you're having to use (or if you're using a cup, how many times you have to empty it, and then find out how many ml the cup holds).
And then you can use the same notebook to prepare a list of questions and note the answers, which is a good way to not forget anything in the nerves of the moment, but also is a good way to make it clear to whoever you're talking to that they are under some scrutiny and aren't going to get away with handwavey half-measures.
It's ridiculous that menstruating people so often have to be their own data scientists to be taken seriously, but it does tend to work.
posted by Lyn Never at 7:27 PM on January 25, 2021 [12 favorites]
FYI if she does have to go in for an office visit, it is now possible to obtain N95 masks (through mail order - thanks MeFi).
(FWIW I've been thinking about bringing some to my next Dr's appt. as gifts... it makes me kind of sad to see medical staff wearing homemade cloth masks.)
posted by amtho at 7:35 PM on January 25, 2021
(FWIW I've been thinking about bringing some to my next Dr's appt. as gifts... it makes me kind of sad to see medical staff wearing homemade cloth masks.)
posted by amtho at 7:35 PM on January 25, 2021
Nthing Lyn Never's suggestion about checking thyroid levels...and prolactin levels, also. In short, most definitely see a specialist.
posted by skye.dancer at 7:39 PM on January 25, 2021
posted by skye.dancer at 7:39 PM on January 25, 2021
Wow, I went through the exact same experience at the exact same age. Not only was I also experiencing the dizziness, lightheadedness, and exhaustion from all that blood loss, but I was bleeding through my pants. Everyday. As a high school freshman. I once bled through the sweatshirt I had tied around my waist to conceal the blood spot on my pants.
So while she should definitely get to an OBGYN to get this sorted, I definitely wish I had someone who could sympathize with bleeding through my pants and wish someone had told me about doubling up on tampon + pad (or these days, period underwear!). Heating pads, painkillers, would have been so appreciated too.
I ended up going on the pill (as well as iron supplements) for a few months to level out my hormones, which did stop the insanely heavy prolonged period. I also recall having ultrasounds to rule out other issues, but it was the pill that resolved this in my case. This is all anecdotal obviously, YMMV.
posted by blueberrypuffin at 10:14 PM on January 25, 2021 [4 favorites]
So while she should definitely get to an OBGYN to get this sorted, I definitely wish I had someone who could sympathize with bleeding through my pants and wish someone had told me about doubling up on tampon + pad (or these days, period underwear!). Heating pads, painkillers, would have been so appreciated too.
I ended up going on the pill (as well as iron supplements) for a few months to level out my hormones, which did stop the insanely heavy prolonged period. I also recall having ultrasounds to rule out other issues, but it was the pill that resolved this in my case. This is all anecdotal obviously, YMMV.
posted by blueberrypuffin at 10:14 PM on January 25, 2021 [4 favorites]
I had a similar experience when my menstrual cycle began around 12yo - heavy bleeding that lasted for several weeks at a time.
As to what could be causing this in a teenager: IANAD and there are a myriad of possibilities that should be examined. Anecdotally, I started seeing an Ob/gyn when my mom realized how fast I was going through pads; the Gyn was alarmed by the amount of bleeding that occurred even during my first pelvic exam, then sent me rapidly to a few other specialists. I received an ultrasound to check for polyps/cysts, and saw a hematologist, who took an extensive family history and ordered extensive bloodwork, checked thyroid function, etc. I believe there was a concern that I had a genetic bleeding disorder. The only notable results was that I was anemic; I am as surprised as you are that your niece is not anemic, especially with the light headedness that they are experiencing. After everything was ruled out, I started BC, and the heavy and prolonged bleeding resolved within 2 months. In the 20-ish years since then I have been off BC for maybe 6 months and it was during that time that my periods increased in duration and intensity again.
As to what else they can do to feel better: prior to starting BC, I was treated for anemia by eating a diet high in iron, and took ibuprofen daily as it helped to lessen the bleeding. These were considered low-risk ways to treat symptoms while doctors looked for underlying causes. I largely remember being intensely uncomfortable and self-conscious during this time, since I had to wear super thick maxi pads. My anxiety (already high) was really activated by the fear that I would bleed through my clothes. As an adult, I can imagine that having period underwear (like Thinx, etc) might have made certain activities more comfortable in the short term (i.e being in gym). I believe Thinx has a specific line for young people who menstruate. If they are largely staying at home during covid, period underwear may be more feasible as they’ll likely have to change at least 2x/ a day.
I remember those many doctor appts as being pretty scary and anxiety-producing, although since it was over 20 years ago, I did not feel remotely empowered, either by my family of origin or by pediatric providers, to ask questions and advocate for myself. I hope this has changed somewhat and that your niece has a different experience. Lyn Nevers’ suggestion of a daily symptom journal is spot on, as I can almost guarantee that a doctor will ask them to do this as some point. At baseline, this is not normal and your niece deserves to be listened to and treated appropriately; I would seek out a new Ob/Gyn ASAP.
posted by gollie at 10:38 PM on January 25, 2021 [2 favorites]
As to what could be causing this in a teenager: IANAD and there are a myriad of possibilities that should be examined. Anecdotally, I started seeing an Ob/gyn when my mom realized how fast I was going through pads; the Gyn was alarmed by the amount of bleeding that occurred even during my first pelvic exam, then sent me rapidly to a few other specialists. I received an ultrasound to check for polyps/cysts, and saw a hematologist, who took an extensive family history and ordered extensive bloodwork, checked thyroid function, etc. I believe there was a concern that I had a genetic bleeding disorder. The only notable results was that I was anemic; I am as surprised as you are that your niece is not anemic, especially with the light headedness that they are experiencing. After everything was ruled out, I started BC, and the heavy and prolonged bleeding resolved within 2 months. In the 20-ish years since then I have been off BC for maybe 6 months and it was during that time that my periods increased in duration and intensity again.
As to what else they can do to feel better: prior to starting BC, I was treated for anemia by eating a diet high in iron, and took ibuprofen daily as it helped to lessen the bleeding. These were considered low-risk ways to treat symptoms while doctors looked for underlying causes. I largely remember being intensely uncomfortable and self-conscious during this time, since I had to wear super thick maxi pads. My anxiety (already high) was really activated by the fear that I would bleed through my clothes. As an adult, I can imagine that having period underwear (like Thinx, etc) might have made certain activities more comfortable in the short term (i.e being in gym). I believe Thinx has a specific line for young people who menstruate. If they are largely staying at home during covid, period underwear may be more feasible as they’ll likely have to change at least 2x/ a day.
I remember those many doctor appts as being pretty scary and anxiety-producing, although since it was over 20 years ago, I did not feel remotely empowered, either by my family of origin or by pediatric providers, to ask questions and advocate for myself. I hope this has changed somewhat and that your niece has a different experience. Lyn Nevers’ suggestion of a daily symptom journal is spot on, as I can almost guarantee that a doctor will ask them to do this as some point. At baseline, this is not normal and your niece deserves to be listened to and treated appropriately; I would seek out a new Ob/Gyn ASAP.
posted by gollie at 10:38 PM on January 25, 2021 [2 favorites]
Others have covered the "doctor, NOW", but as someone who went through this in my thirties: check the dosage on the tranexamic acid and follow the adult regimen. It only had the proper effect for me once I went to 1000 mg three times per day, and my knowledgeable gyno says 500 mg doesn't register critical mass for taller people. Clotting may happen during it, tell her to not be afraid of it but also keep track of clot size. Also make sure she takes it easy until this is addressed; during my most anaemic period I fell down multiple times, thankfully without damage worse than skinned knees. If the doctor doesn't know it, Qlaira is the chief recommended birth control pill for reduction of dysmenorrhea - people have varied luck with it, but it's been very good for me.
I had a triple whammy: giant fibroid, testosterone/estrogen out of whack and underactive thyroid with vitamin D deficiency and insulin resistance. It took two years to get everything addressed properly, because I had to wait to level out after each intervention. Happy to say I've now reduced bleeding to exactly zero.
posted by I claim sanctuary at 11:47 PM on January 25, 2021
I had a triple whammy: giant fibroid, testosterone/estrogen out of whack and underactive thyroid with vitamin D deficiency and insulin resistance. It took two years to get everything addressed properly, because I had to wait to level out after each intervention. Happy to say I've now reduced bleeding to exactly zero.
posted by I claim sanctuary at 11:47 PM on January 25, 2021
If she hasn't had the medical investigation detailed above that would definitely be my top priority.
For just coping I would add to the above:
Hydrate, including with rehydration drinks - sports drinks are ok. Sometimes dehydration can contribute to that woozy feeling. That dizziness also makes me wonder about thyroid issues.
Get as much sleep as possible - if she needs to put towels down to try to sleep better that used to help me, otherwise it was like I couldn't get into deep sleep. While counting pads is a good tip I would prioritize sleep and if tampon + pad helps with that at night, do that.
posted by warriorqueen at 6:18 AM on January 26, 2021
For just coping I would add to the above:
Hydrate, including with rehydration drinks - sports drinks are ok. Sometimes dehydration can contribute to that woozy feeling. That dizziness also makes me wonder about thyroid issues.
Get as much sleep as possible - if she needs to put towels down to try to sleep better that used to help me, otherwise it was like I couldn't get into deep sleep. While counting pads is a good tip I would prioritize sleep and if tampon + pad helps with that at night, do that.
posted by warriorqueen at 6:18 AM on January 26, 2021
Poor girl, get her to a gyn doctor right now! My niece had awful periods but not the continuous bleeding, finally got treated for endometriosus (sp?) and got a lot of relief. No young woman should suffer like this.
posted by mermayd at 6:45 AM on January 26, 2021
posted by mermayd at 6:45 AM on January 26, 2021
Once you find a competent doctor, if they recommend birth control pills, I highly recommend asking for a kind that stops periods entirely. For most people, there's no reason to have periods at all, so why bother?
posted by metasarah at 7:32 AM on January 26, 2021
posted by metasarah at 7:32 AM on January 26, 2021
you're getting some advice in this thread from people who have no experience with this.
don't drag the kid to urgent care, especially now. A doc in a box is not going to be better equipped to help your kid than the first doctor was. You want a specialist. That specialist is going to need to image her uterine area to see what's going on. In my family's case it was NOT a transvaginal ultrasound.
she is not likely to get good results from a "stop periods forever" pill. She's going to need something that lets her uterine lining shed regularly to keep the situation predictable and under control.
put your energy towards finding an adolescent gynecologist. It's going to be ok, this is well trodden ground. No need to flail.
posted by fingersandtoes at 9:00 AM on January 26, 2021 [4 favorites]
don't drag the kid to urgent care, especially now. A doc in a box is not going to be better equipped to help your kid than the first doctor was. You want a specialist. That specialist is going to need to image her uterine area to see what's going on. In my family's case it was NOT a transvaginal ultrasound.
she is not likely to get good results from a "stop periods forever" pill. She's going to need something that lets her uterine lining shed regularly to keep the situation predictable and under control.
put your energy towards finding an adolescent gynecologist. It's going to be ok, this is well trodden ground. No need to flail.
posted by fingersandtoes at 9:00 AM on January 26, 2021 [4 favorites]
The point of going to urgent care would be to get relief from her symptoms (mainly the bleeding) now, instead of in several weeks when she manages to get a doctor or specialist appointment. It's frustrating to be told to just deal with pretty debilitating symptoms when there are ways to treat them. Of course, the decision about whether it's worth it for her to get treatment sooner is up to her, but those few weeks of life are valuable and worth living without pain and heavy bleeding. It was worth it to seek faster treatment for me.
posted by catcafe at 11:25 AM on January 26, 2021 [2 favorites]
posted by catcafe at 11:25 AM on January 26, 2021 [2 favorites]
Hello, anonymous niece. Former heavy period sufferer here. I am sorry you are going through this.
I am going to echo the recommendations for her to be seen by a specialist ASAP. 47 days straight of heavy bleeding is well beyond the range of normal. Physical exam, imaging of the uterus and ovaries, and bloodwork for ferritin levels, thyroid, and PCOS screening are in order (which has all been pretty well covered above).
In case niece is located in NYC, I can recommend the absolute best GYN I have ever seen in my life, Dr. Lisa Dabney. She is phenomenal.
posted by bedhead at 1:57 PM on January 26, 2021
I am going to echo the recommendations for her to be seen by a specialist ASAP. 47 days straight of heavy bleeding is well beyond the range of normal. Physical exam, imaging of the uterus and ovaries, and bloodwork for ferritin levels, thyroid, and PCOS screening are in order (which has all been pretty well covered above).
In case niece is located in NYC, I can recommend the absolute best GYN I have ever seen in my life, Dr. Lisa Dabney. She is phenomenal.
posted by bedhead at 1:57 PM on January 26, 2021
Getting the imaging done ASAP will rule out any big obvious physical thing that needs to be urgently addressed. In either case you definitely need a specialist & lots of blood work but the immediate problem of too much blood coming out needs to be looked at first.
posted by bleep at 4:42 PM on January 26, 2021 [1 favorite]
posted by bleep at 4:42 PM on January 26, 2021 [1 favorite]
I don’t know where you are, but if you have a local Planned parenthood, I would be on the phone to them ASAP. Reproductive health is what they do and every provider I’ve ever had there (from office staff to nurse to doctor) has been kind, knowledgeable about their area, and answered every question I’ve had.
posted by epj at 7:11 PM on January 26, 2021
posted by epj at 7:11 PM on January 26, 2021
People seem to have covered most of the ground your niece needs to know, with one possible exception. I don't know how much (if any) sexual experience she has had but a concern may crop up about having to get an invasive ultrasound a such a young age, and what it may mean for her and her concept of her own sexual identity in the future. Depending on her attitude (and probably more importantly, her family's attitude) this may be a difficult subject to discuss. I just want to tell her that her health is the most important consideration right now, and she needs to keep that in mind. Since she will be reading this (hello young reader, welcome to MetaFilter) maybe she'd be more comfortable looking at resources that deal with this matter on her own. There are probably lots out there, but here is one geared for teenage readers.
posted by sardonyx at 8:24 PM on January 26, 2021 [1 favorite]
posted by sardonyx at 8:24 PM on January 26, 2021 [1 favorite]
I'm a nurse, though not her nurse. This is seriously not expected and she needs to see her doctor ASAP. Something is not right if she is bleeding for this long in any sort of heavy way.
She can in some cases be given hormones by mouth for a few days that will stop the bleeding while they try to figure out why she has continued to bleed in the first place, and they should re-evaluate her blood count. It is hard to believe that bleeding for more than a month has not compromised her hemoglobin level if she is feeling weak, tired, and short of breath. She needs a board-certified specialist gynecologist - if she's been treated by a family doctor she needs to be referred to the correct specialist.
The real issue is to discover why she continues to bleed for so long - this will probably require exploration by ultrasound, maybe a CT scan, or another diagnostic test. Whatever the problem is will then need to be corrected - but it could me a number of things that can be handled without surgery. It's possible this is hormonal, and the properly designed hormonal treatments will correct her cycle. This is definitely not something a family doctor does routinely.
But if she's dizzy, light-headed and exhausted her blood levels are not "fine". She needs new blood tests and further medical attention. After 47 days this is unlikely to go away by itself.
I, not a teenager, had gyn surgery and had bleeding that I thought was quite a bit heavier than expected. It went on for 8 or 10 days before I got back to my doctor. My hemoglobin was 7.9, down from a pre-op level of 13.2. I was down more than 5 gm/dl and could not walk up a short flight of stairs without stopping to pant for breath. I refused a transfusion but took iron and stayed home for a couple of weeks until my hgb recovered to over 9 gm/dl, It still took me another month to really feel better. Good luck to her.
posted by citygirl at 10:02 PM on January 26, 2021 [1 favorite]
She can in some cases be given hormones by mouth for a few days that will stop the bleeding while they try to figure out why she has continued to bleed in the first place, and they should re-evaluate her blood count. It is hard to believe that bleeding for more than a month has not compromised her hemoglobin level if she is feeling weak, tired, and short of breath. She needs a board-certified specialist gynecologist - if she's been treated by a family doctor she needs to be referred to the correct specialist.
The real issue is to discover why she continues to bleed for so long - this will probably require exploration by ultrasound, maybe a CT scan, or another diagnostic test. Whatever the problem is will then need to be corrected - but it could me a number of things that can be handled without surgery. It's possible this is hormonal, and the properly designed hormonal treatments will correct her cycle. This is definitely not something a family doctor does routinely.
But if she's dizzy, light-headed and exhausted her blood levels are not "fine". She needs new blood tests and further medical attention. After 47 days this is unlikely to go away by itself.
I, not a teenager, had gyn surgery and had bleeding that I thought was quite a bit heavier than expected. It went on for 8 or 10 days before I got back to my doctor. My hemoglobin was 7.9, down from a pre-op level of 13.2. I was down more than 5 gm/dl and could not walk up a short flight of stairs without stopping to pant for breath. I refused a transfusion but took iron and stayed home for a couple of weeks until my hgb recovered to over 9 gm/dl, It still took me another month to really feel better. Good luck to her.
posted by citygirl at 10:02 PM on January 26, 2021 [1 favorite]
If you are in the UK, you'll know that you can't really self-refer to a gynaecologist in our system, but this would be the point at which I would be pushing the GP about when they will refer to one. A friend's daughter had a very similar problem at the same age, and it really took my friend advocating very strongly for the daughter to be taken seriously. An adult being a forceful advocate in the room might be necessary to get anywhere.
On the lightheadedness symptoms, is it possible they're affected by her hydration levels? This seems to be a thing that happens to my family members in connection with bloodloss/removal. In this case, iron levels are if anything high, but the lightheadness happens anyway and is fixed by increasing hydration. Otherwise, it's worth checking whether her iron numbers are on the low side (even if ok) as medically acceptable iron levels have quite a wide range, and she might still benefit from extra iron if her levels are low-ish.
posted by plonkee at 4:41 AM on January 27, 2021
On the lightheadedness symptoms, is it possible they're affected by her hydration levels? This seems to be a thing that happens to my family members in connection with bloodloss/removal. In this case, iron levels are if anything high, but the lightheadness happens anyway and is fixed by increasing hydration. Otherwise, it's worth checking whether her iron numbers are on the low side (even if ok) as medically acceptable iron levels have quite a wide range, and she might still benefit from extra iron if her levels are low-ish.
posted by plonkee at 4:41 AM on January 27, 2021
47 days!?!!? I dearly hope that's a typo.
None of this is normal, she needs to see a GYN as soon as possible. If the bleeding is heavy then I'd go to urgent care. Really.
And FWIW if she's a reasonably average sized 13 year old the adult BP cuff is probably the correct size for her, and that BP reading is low.
posted by The Librarian at 5:55 AM on January 27, 2021 [1 favorite]
None of this is normal, she needs to see a GYN as soon as possible. If the bleeding is heavy then I'd go to urgent care. Really.
And FWIW if she's a reasonably average sized 13 year old the adult BP cuff is probably the correct size for her, and that BP reading is low.
posted by The Librarian at 5:55 AM on January 27, 2021 [1 favorite]
Also Sardonyx makes a good point, this may lead to a transvaginal ultrasound and other exams of a vaginal nature. As an adult woman TVUs feel invasive, for a teen they very well might be distressing. If it comes to that then she or her accompanying adult (who she should absolutely have) should insist that she be permitted to insert the probe herself, should she wish. It's a small thing but it can help restore some feelings of bodily autonomy and not all techs think to offer it.
posted by The Librarian at 6:01 AM on January 27, 2021
posted by The Librarian at 6:01 AM on January 27, 2021
OP, I hope your niece is doing ok and has been able to get treatment for this.
posted by NotTheRedBaron at 2:19 AM on February 3, 2021 [1 favorite]
posted by NotTheRedBaron at 2:19 AM on February 3, 2021 [1 favorite]
Mod note: From the OP:
Thank you, everyone, for the advice. My niece was finally able to see a consultant who said that nothing else was wrong and that her age was causing the extended bleeding. Because she wasn't ovulating regularly her womb lining was building up resulting in very irregular, heavy and long-lasting bleeding. The treatment was to try coming off the norethisterone again, expecting that when she did so she would then start bleeding again within a couple of days but that this would be a normal period and then she would start to menstruate regularly. This worked, after a total bleeding time of 70 days. The consultant thought that she might need to start the mini pill if her periods didn't become regular, but so far they have been. We found the search term "dysfunctional uterine bleeding", used by the consultant, helpful.posted by Eyebrows McGee (staff) at 3:09 PM on July 5, 2021 [1 favorite]
She was extremely anaemic, to the point they considered keeping her in hospital to address that, so I don't know why the blood tests initially showed she was not. She was given an ultrasound but not internally as the consultant's policy is not to do that for teenagers.
So in one way it's a good result but the long-term effects of the anaemia, generally feeling rubbish about the bleeding and about the length of time it took for the adults around her to sort things are going to take some time for her to resolve, I think. Thanks again.
This thread is closed to new comments.
posted by thesockpuppet at 5:09 PM on January 25, 2021 [9 favorites]