Young people's experiences of periods and period pain

I think people often worry about whether their symptoms aren’t bad enough to go and see a doctor. They don't want to be wasting their time, for example. But I would say if there's anything that is getting in the way of your life or anything that's worrying you or anything that you, feel you need advice about, then please come and ask us. We'd always be happy to see you.

What about managing the kinda bleeding itself?

Some... Like ’cause my period’s like... ’cause they... I get them every three weeks, or something like that, so it’s... it’s... Like, and then sometimes they’ll be really random, ’cause sometimes they’ll be like really heavy, or... or like sometimes they’ll be light, and then sometimes they’ll... or sometimes they’ll be like something in between, but then I’ll get loads of like blood clots, and stuff like that, which isn’t great, but then... So just, it’s a bit up and down, kind of, but...

Yeah. And... and this is... so one thing I’m really interested in is... ’cause it’s the sort of question that we ask as doctors, isn’t it, is: “Are your periods heavy?” How do you find answering... would you know how to answer that question?

Well, no, not really, ’cause I guess it kinda changes, like there’s not really one answer, ’cause... and with mine like some... sometimes they’ll be like really heavy and sometimes they’ll be a bit less, so it’s just a difficult question to answer, so...

Can you tell me a little bit more about that transition?

Yeah. So, they used to be pretty light. And then when I was about, ooh, no,12, 13, they got really heavy, but they were consistent.

Yeah.

And then when I was 14, sort of starting the new school year, they became very inconsistent, still heavy when they came, but it was sort of a bit more unpredictable.

OK.

And they’ve been not completely unpredictable, but not very consistent since I was about 14. And just this summer, they started being just ridiculously long, so...

Mm, OK. And how has that kinda impacted on you, the inconsistency? What’s that been like to kinda manage?

It’s just been a bit like I’m sort of constantly on edge that I’m going to start at a very inconvenient time. So, it’s sort of like, all... like always, always carrying pads and stuff just in case, and also for other people but, you know, sort of trying to be prepared. Yeah, and the heavy flow does mean, like, I have to change like every hour or so, which sort of, I have to plan around that just to, you know, make sure that there’s a toilet or something nearby. 

Hi. I'm doctor Laura Knox, and I'm a Hematology Doctor that works in Glasgow. Hematology doctors, means that we deal with bleeding disorders or people that have problems with their blood. And I sort of specialize in heavy periods and bleeding disorders.

And I wonder, would you have any, message or explanation for young people who might be trying to work out whether their period are heavy or how they might explain that, or what sort of measures you might use, or what you might ask if you saw them in clinic.

So how do we view heavy periods? It's changed quite a lot in the last few years. NICE, which is one of our organizations has a lot of guidelines and guidance has changed the definition to really reflect on heavy periods being anything that impacts on a girl or woman's life, either in their academic ways, work, school or social activities, rather than a specific measure which it used to be done in the lab.

So in general, I think if you're asking the question, “Are my periods heavy it's very reasonable to be assessed. Things that I sort of look out for in clinic are if you're changing pads frequently, especially if it's within 1 to 2 hours, flooding, changing your pads overnight, clots that are passing.

Those are all features that suggest to me that it's worthwhile getting checked out, but if there's anything you're concerned about, that's usually the time to go and get seen.

So would young people be expected to know how much blood their passing or like an amount of blood. Or you think it's more those practical measures that you use?

I think definitely practical measures. I think it's really difficult to actually estimate blood loss. At the small amount of blood and water can look very, very dramatic or sometimes not very much. So really the things that I look for when I’m assessing these people are whether they have had issues that are impacting them or if it's causing them concern, anything that's causing you worry, it shouldn't be periods are part of life, but they shouldn't be a difficult part of life. There's definitely things we can do to make them better.

So, there's the features of heavy bleeding that you've talked about whereby you might realize you're passing kind of heavy amounts of blood. What sort of impacts could that have on a young person?

So yeah. So, when you have heavy blood loss, especially regular heavy blood loss, which can happen if your periods are heavy and you can become both iron deficient and sometimes a consequence become anaemic. And anaemic is essentially a word meaning a low blood count. Iron is really important in how you make your blood cells, and your blood cells, your red blood cells are important to take oxygen around your body into all your organs. So, if you're deficient in iron or your iron is low, it can impact the sort of how that works. And that can make you feel quite fatigued, tired, sometimes breathless. And if anaemia develops. So that's when a low blood count happens as well as for as a consequence of the low iron that can compound it further.

So, more tiredness, more breathlessness sometimes being pale, sometimes noticing pale skin. And it's always a bit of a bit of a cycle. And it's really important because we miss a lot of iron deficiency. But we know that heavy periods themselves and the complications of heavy periods can have a real impact on a young person can affect their ability in school. We know that it's caused, differences in exam results for girls. And the most important thing and the reason it's important is because its easily treatable and easily tested for. To test for low iron is a blood count. So, blood count to look at your haemoglobin or your full blood count level that’s your red cell amount or the amount of haemoglobin in those cells which the oxygen carrying capacity, and a ferritin, which is a measure of an iron source.

That's the amount of iron that's in your body. And both of those markers can give us an indication of iron is poor. The treatment of that is with some oral tablets. Usually there's some misinformation about iron. We've changed how we prescribe it. We give it much less than we used to. And actually, that works much better and doesn't cause the negative side effects that some people worry about iron and there's other forms that we can do if that is an issue. So, I'm very passionate about it because it's something easily treatable that can make you feel a lot better. Rather than this negative cycle of heavy bleeding, low iron all compounding and then if anaemia comes on top of that as well.

So, an easy test to do and an easy solution if that's a problem.

I think I was about 13, nearly... nearly 14 I think, around that kind of age. And I think they were... they were fine for now. They were relatively... light and they weren’t particularly regular for the first... first few months and it was... I mean, they... they were quite easy to manage. And I... and then I think as I started to get on a little bit more, I think I started to usually have one or two really painful cramps every... like every period. And I do... I do remember having like this little pen and then I’d like scratch at some of the paint ’cause they did actually get quite painful, but then they did stop after like an hour of like a lesson, so I then... I mean, then that was fine. And then they didn’t actually get much better. I think they... they started to actually get a lot... a lot worse. So, I... then I think, in a... in a... and then a year’s time, then I would wake up like in the middle... in the middle of the night, sometimes with a really, really, really bad period cramps, and then I’d go down and get my mum and then we’d like listen to a podcast or we might... And... and I mean I’d take paracetamol and ibuprofen, but they weren’t particularly effective. Yeah, it wasn’t... they... it wasn’t particularly great. But actually, then before my... the end of my Year 10 assessments, I was really worried about getting a really bad period cramp in the middle of an exam, so even though they’re Year 10 assessments, they still kind of mattered to me. So, then we went to the doctor’s and then they managed to prescribe me some mefenamic acid. And then I’ve been... I’ve been taking that ever since actually and it’s like, yeah, three tablets once every... once after breakfast, lunch and dinner, and it’s... I don’t get period cramps anymore. So Yeah.

Yeah, well, it does, it just makes you feel like... I don’t know, yeah, you don’t really know what to do with it because like you’ve never felt it before, so it’s like you’re just trying to do everything to stop it. Like it does make you feel quite like upset as well, ’cause obviously it’s a really bad pain. So, you just end up getting quite upset and like just feeling abs... like so helpless, like that you’re stuck with it and you can’t... like you can’t do anything about it until it goes away. And it... in the moment, obviously it’s gonna pass, like the... the next day it might be gone, but like you’re... you’re just thinking, ‘oh, this is so bad,’ and you just want it to go away.

Yeah, that’s... It’s just horrible.

Mm, yeah, it is.

How... I mean, you at the very beginning talked about some of the things that you’ve tried, that have helped, like mefenamic acid: can you tell me at all about your experience of kind of deciding to go and see a doctor, how you thought... or how you... and then maybe... and what that was like?

Yeah. ’cause I think it was that I’d like had... I had like a bad, cramps, and then I’m... I’m pretty sure I tried the paracetamol, and the ibuprofen, but it wasn’t really like enough, like I wanted something that would like make it stop, like more, and work a bit better. So, I think I got an appointment with the GP just over like the phone, and then they subscript... like they gave the subscription for the mefenamic acid. So, I think it’s just about talking about... like with the GP about what like is the best option to help, yeah.

And can you remember what options you kind of were given?

I think they probably gave the option of the pill, but I’m... I’m not too sure. I think like more the... my thought process was going for mefenamic acid, and then if that wasn’t... that didn’t help enough, then I’d probably... then I’d obviously tried the pill in the end.

OK. And what’s that been like? I think you said you’ve had still some pain and bleeding with it?

Yeah, I think with the first one, I just had irregular bleeding. And then this one, I literally had one day where I had really bad cramps, but it must have been like linked to something else, because it’s been only one day, and then... I’ve still got some bleeding on this one, but I... I don’t know if it’s just ’cause it was earlier on in the... like, that I’d taken the pill, but... I don’t know. But it’s obviously my cramps are less, like because... like you don’t... on the pill, you don’t get real periods, so you obviously don’t get as many cramps. But I have... where on the days where I haven’t taken them, like I think earlier on in the pill, like now it’s got better, but I did get like cramps, like not as bad, but you could still feel that they were there. But yeah, no, definitely been better.

Do your periods stop you sleeping? Does the pain wake you up as well?

Yes it does. So, often I’ll wake up at 4am with just the most, like, onset cramps, and unfortunately I didn’t know I was gonna start my period, so there’s blood everywhere and you sort of have to manage that, and it’s got a big impact on you because like as... and even... even if I take periods... like measures like pain medication early in the morning, I’ve still got to wait an hour for it to hit in, so it does definitely stop me... stop me from sleeping. Especially the pain in my legs: I have to sleep with... with my legs elevated to help the blood flow and it’s just a lot you have to sort of go through, you know?

I guess I kinda felt a bit frustrated ’cause it’s like every single month I was completely knocked down, and I was so... I still get this now, I get really tired, so like I can’t... I find it hard to get out of bed, and I had like no energy, and I was like: ‘this is a bit unfair,’ ’cause I felt like I was like falling behind. But then I guess a lot of girls are in that situation, but I did feel like I was falling behind. And I was constantly taking off like day... I was constantly taking sick days around my period as well, ’cause like I said, like I don’t feel very well like before then. So, it was like actually when I look back at it, I wasn’t... like it was affecting my school, and like my exam grades, and stuff like that.

Can you tell me about your systems?

So, if I know I’m gonna start my period, I will take... I get cramps for a week before in varying intensity. And that’s actually happening right now. So, what I do during the day is after every time I have food, or I drink water, I take paracetamol, and then if it gets worse, I’ll have a hot water bottle. And that’s during the week before. While I’m actually on my period, I just sort of shut myself in my room, and I have alarms that go off for me to wake up and make another hot water bottle, have some more painkillers, drink some water, then go back to sleep, for the first day. And I sort of have... you know, I leave my door open, I have a bucket next to my bed in case I’m sick. There’s a... like a sort of path of pillows into my bathroom, so if I faint, I don’t like, you know, knock myself out by accident. It’s kind of sort of, yeah, like foolproof plan, really. And then after that, life is back to normal, so... That’s what it does. I get cramps for the week before, I have the week on my period, which is sometimes a week, sometimes longer, and then, yeah, after that I feel emotionally rubbish for the next week. So, there’s a one-week-a-month where I’m symptomless and like, so normal, and then hell resumes again for another three weeks, so...

OK. So, a kinda whole... and pretty much most of them are a lot of the month.

Yes.

And you describe it as kinda hell resuming.

Yeah, it’s sort of like either one thing or another, like it’s all... there’s never any sort of like let up. But then sometimes my periods are irregular, which is... I was supposed to get it on the eighth of this month, and I’m still having the pre-cramps, but I haven’t actually started my period, so I don’t know what’s going on.

How did you kinda come to develop that system?

It happened every month. And the first time it happened, I had no idea what was going on, and I thought I was like sick, I thought I had like food poisoning, but it is just from like sheer pain. It’s like pain induced rather than it being like symptoms separate from. So, if I can sort of reduce the pain, like actual cramps, then I figure that the other symptoms kind of like let up a bit. So, I let myself sort of sleep until I need to like, you know, medicate a bit more, and then usually that works much better.

So, you’ve noticed that if you can get on top of the pain a bit, then some of the other things feel a bit better?

Yeah.

OK. So, you’ve developed this kind of very careful system, and so... with including pillows going to the bathroom in case you faint?

Yeah, that’s kind of a new one. Yeah. So, if I’m sick, usually I feel really lightheaded after and I have to like sit on the floor, but sometimes I do faint, and I like hit my head, so I kind of just have a little cushion around my neck that I keep with me as well.

I was doing a school production of "Beauty and the Beast" or something, and I remember we were rehearsing, going on and doing the end bit where your're doing the end bit and the bows. I had a really bad cramps, but I went on and the stage lighting was really hot, and I was standing there thinking, ‘I just need to get through this, then I’m done,’ and then the director came on and she said, “OK, now we’re gonna go all over it again,” and I remember all of a sudden when she said that, I couldn’t see anything and I couldn’t hear anything. And I didn’t realise at the time, but it was because I was about to faint. And I kind of walked off stage and they had a prop that was... they had a stage prop that was a bed, and I fainted onto the bed that was the prop at the side of the stage, and that was the first time that I realised that, yeah, the cramp, like... and it was really bad and it was causing me to... I think, to faint. But it mostly was ’cause of the heat as well on stage, but the combination of it both that, and that was when I was like: ‘ooh, something’s just really not good.’

No. So how... I mean that sounds... so apart from the very strategically placed bed, it was just possibly the most...—

Yeah, and it was quite dramatic of me…

—possibly the most staged-managed faint I’ve ever come across.

Yeah.

But it, joking aside, that... how did that feel? That must have felt quite...?

Yeah, that was, for me, it was really scary because I was 13 and I... I didn’t have any like ibuprofen or anything I could have taken on me. I didn’t really know any other adults that was in the area. Also, I felt uncomfortable as well telling people that I was on my period, so I felt really, really anxious. And yeah, I remember once it happened, obviously, people came over and I got taken home, but in that moment all I wanted to do was just go home. It was, I just wanted my Mum just to tell me it was gonna be OK. So yeah, it was quite scary ’cause I’d never had anything like that before.

Dad: And while... you know, I mean you asked about eating earlier on: we give her more time, but when she feels, you know, really sick, she... you know, she... she won’t eat much, she won’t drink much, she—

Mum: And once when we were on holiday once, she literally collapsed.

Dad: Oh, God, yeah, absolutely, yeah.

Mum: She couldn’t walk, she literally just collapsed on the floor. And [father’s name] had to carry her back to the...—

Leila: [fathers name] is home isn’t it?

Mum:—and then she was vomiting.

Dad: Yeah.

Mum: But I had to carry her back. And then she literally slept for a couple of hours. You know, it’s... it’s the pain is so bad that it kind of impacts all of her.

Dad: She does sort of go into shutdown mode.

Mum: Yeah.

Leila: Feeling OK now, thank you.

Dad: OK now.

Does it kinda impact on you at school, or... or does it ever stop you doing anything, or... or miss school, things like that?

I’ve had to go home from school quite a few times ’cause like I get them... I got really bad ones, so a lot of times I end up throwing up, and like the school nurse is always like: “You should just go home, like you shouldn’t be here anymore.” I was like: “I was fine up until five minutes ago, OK, I am not sick, I’m just suddenly in agony,” and then I’m home, and I... I like take a nap, and then like two hours later I’m fine again, and it’s like, can I go back to school? Why am I missing things?

So, do you think it was it the pain that got you sent home, or was it the fact that you’d vomited and then they like sent you home?

I think it’s more the fact that I vomited ’cause like I was... I’m... you know, it’s like a regular thing, it’s once a month, so a lot of times I’d just like have paracetamol, call it a day, and just like go through with it, and sometimes I go like, not really be there mentally in class ’cause I’m sitting there in pain, so I’ll just like ask my friends for notes, or like I’ll like sit it out for most of the day, but I’m still kind of in school.

We want to try and work out how to make them better.

Leila: A poo helps.

Mum: A poo helps, it does. Sometimes when you’ve done a big poo it makes it less painful, doesn’t it?

It does. And actually, sometimes when you’ve got your period it’s harder to do a poo and then it builds up and then it’s better.

Dad: Oh, really?

Mum: I think Leila has that it...—

And do you have the other?

Mum:—and the opposite happens for Leila, yes.

Leila: Opposite.

Mum: Yes.

Yeah.

Mum: Sometimes you do a huge poo, don’t you?

Leila: I did a—

Dad: So, it’s starting, yeah.

Leila:—big sausage.

Big sausage.

Mum: Yes.

Dad: Yeah, good job.

Yeah. And—

Leila: Proud of you.

Dad: Proud of you.

Yeah. And then it’s a little bit better.

Leila: Thank you, thank you.

You’re welcome, welcome.

Mum: I think it’s almost like a reaction.

Mm.

Mum: I think things are sent out almost.

Leila: Yeah, I know.

Mum: And I don’t know quite how that works, but I think it sort of expels everything.

Leila: Thank you, thank... thank... thank you.

I think people often worry about whether their symptoms aren’t bad enough to go and see a doctor. They don't want to be wasting their time, for example. But I would say if there's anything that is getting in the way of your life or anything that's worrying you or anything that you, feel you need advice about, then please come and ask us. We'd always be happy to see you.

Some people find that they experience changes in their skin or with symptoms like headaches at different times of their cycle. And actually, that's very common because some of these changes are driven by our hormones. And knowing the pattern can be really helpful.

So, for example, keeping a diary can help and discussing with your doctor as well, because that might help to know, how best to treat you.

OK. Do... have you noticed any change with your headaches or your periods with... yeah, sorry, your headaches with your periods?

April: No, not really, but I do get... like ever since I was little I do have like really bad headache.

Mum: I think they got a little bit worse running up to your period, in terms of.—

April: They have, and maybe yes they have been getting a bit worse.

Yeah. Yeah, yeah, OK, so possibly a bit of a relation with your cycle and the headaches?

Mum: I thought that, ’cause in the run up to her period I wondered if the period was maybe starting to just with the headaches, and I wondered if it was all linked to her hormones ’cause they were getting a little bit worse, but... yeah.

I went to see about... So, I would get really bad stomach migraines before, and this was directly correlated to my periods; I don’t... I only get them like near my periods or like before. And I just... I was throwing up a lot, I had the worst migraines, like I couldn’t... you know how excruciating they are – I couldn’t move. So, I did go to the doctor once. Very quickly though, they didn’t really talk about more, they prescribed me with migraine medication, and that was... that was like the extent of it. But it was like, they did say... they like noticed the correlation between my periods, but as I said, they didn’t expand on that.

OK. And did the migraine medication help a little bit?

The migraine medication did help, yeah, that... that was good.

That’s... that’s... that’s very good. But is that... and that... did... I think you said that’s something that still can sometimes happen to you now?

Yeah, it’s as I’ve grown up, like it’s got less worse, but I still do get them. And as I said, when I do get them, it... it is like the whole day’s written off, but yeah, which is quite annoying.

They... they tend to be on days one and two, the heaviest, so... and they tend to be quite painful. I get pains in my lower abdomen and I get it in the top of my right leg, but it... it’s not anywhere else. It’s always the top of my right leg, and it hurts quite a lot.

Mm, OK. And when you say ‘quite painful’, can you tell me like how... what would it impact on you? Does it have an impact on things that you might do differently, or things that you don’t do?

I tend to just want to sit at home all day because it can get to the point where I feel like I can’t move because it is like that excruciating.

Mm, I’m sorry to hear that.

No, it’s OK.

And so, have you had to miss school and things?

Once or twice.

Yeah. And are there other things that you’ve... like, so you’ve... sounds like you try and go to school?

Yeah, yeah, I do.

But if there were things like social things, or sport, or other things, would your... would your... would it impact on that for you?

No, I usually always do PE even if I’m on my period.

OK. So, do you miss any kinda social things because of it or do you sort of try and keep going?

I try and keep going where I can.

OK. And what does that... but what does that feel like when you’re... when you’re there kinda keeping going through it?

It almost feels better because I’ve... I’m taking my mind off it, which is good, which somehow psychologically makes it less painful, but most of the time it is... obviously, I can obviously still feel it, and it is quite painful, but I think it’s more painful if I’m sat alone at home.

Yeah. So, if it happened... like if it happened to happen on a weekend or... or a school holiday when you didn’t have things that you kinda had to go and do, would you still try and keep busy or is that... is that where you’ve kind of noticed that it feels different if you... if you still have to go and do things?

I do try to get my exercise in every day. Well, I do get my exercise in every day, whether I’m on my period or not. But if I was planning to go on a run, or something, I probably wouldn’t, because again, they tend to be in my... the upper part of my right thigh.

Yeah. And it’s always your right leg?

Always my right leg.

So that’s int... And does it hurt when you move the leg?

Yeah.

And I think period... a period, and I think people think that, you know, your period is just the week that you’re bleeding, but for me it’s actually a whole month experience, like it’s not just about the blood. Like I get quite bad mid-month pain, ovulation pains, and that can be really sore. Not so much in a... like I feel like period cramps, they’re sort of more of a whole-body experience, but I do get really like sharp pains during ovulation, and I can obviously feel which side the egg is coming down. But like I said, the fact that I even know it’s an egg coming down, I look at it differently, like I can almost imagine where it is, and it can be really uncomfortable, but I think people don’t talk about that as much, and I’ve never really heard, not even my friends, talk about mid-month pain. I know my Mum has ’cause she also got it when she had a period I think, so again it was quite normalised in my home, but I’ve always struggled with bad mid-month pain too.

And the first time that happened when you weren’t expecting it, can you remember what you...?

I could probably imagine I was a bit worried, like: ‘what is this random pain in my side?’ but it was sort of in my hip area and I think I must have either asked my Mum or Googled it, or something, and she... my Mum must have told me what it was. But I don’t remember ever being told in any puberty education that I would be getting mid-month pains either. And, you know, I get cramps the week before, the day before my period; I don’t just get them on my period.