Here are some tips written by Dr Deborah Brunt. Dr Deborah Brunt is a GP with special interests in integrative medicine, women’s health and endometriosis. Deborah writes about women’s health on www.kaleberri.com and works at the Meridian Medical Centre, Dunedin.
My painful periods are getting in the way of my life. Is there something wrong with me?
Painful periods are very common, but that doesn’t mean what you’re going through is something that you “just have to live with”.
There are many reasons why periods can hurt. Some of the pain can be due to the natural things that happen in your body during a period, and sometimes it’s because of a gynaecological or other medical condition that needs treatment. Endometriosis is one of the gynaecological conditions that can add to period pains. Other common factors in period pain are bowel related and muscle related pain.
If you are taking pain relief medications properly and your pain is still so bad you can’t do the things you need to do, you need good medical help and your GP is usually the best place to start.
If you are worried about endometriosis, your GP can answer your questions, start medical treatment and consider referral to a gynaecologist. Making a diagnosis of endometriosis most commonly requires an operation.
How do I get the most out of my GP appointment?
General practitioners are busy. We have 15 minute time slots in which to listen to your story, examine you, make a plan, write our notes and make referrals. Sometimes this isn’t long enough to give you everything you need, and we need to see you more than once.
Here are some tips to help
1. Before you see your GP, get to know the pattern of your pain by keeping a pain diary. This will help your GP to understand your symptoms. Try making a note of how the pain relates to other things such as your bowel habit (whether you’re bloated, constipated or have diarrhoea), pain with certain activities ( such as sex, exercise or sitting still for long periods of time).
2. There is an excellent tool that has been designed by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). This tool is designed to assist GP’s to reach a faster diagnosis and achieve more effective management of symptoms of endometriosis. You can complete the tool online, print it out and take it to your appointment. It can be found using this link Raising Awareness Tool for Endometriosis (RATE) (ranzcog.edu.au)
3. Make an appointment near the start of the morning or afternoon session. We are fresher and more likely to be running to time at the start of a session.
4. Book a double appointment if possible. This gives us 30 minutes to explore in greater detail your symptoms, answer your questions and discuss possible treatment options.
5. Make your appointment on clinic days that are less busy. You can ask the receptionist for advice about this.
6. Bring along a simple timeline of your symptoms and the treatments you have tried. This can be a useful summary and makes it easier to choose the next treatment options.
7. Bring along a support person if you need to. A friend, partner, or family member is always welcome in the consult if it would help you.
8. Have an idea of what information you want by the end of your appointment and tell your GP at the start. This helps your GP to focus the appointment and give you a better experience.
Your opening statement will depend on your situation but here are a few ideas.
“I have had painful periods for 10 years and I think I have endometriosis. I would like to discuss what treatment options I have.”
“I have had surgery for endometriosis before. I have been using this treatment for x months but I am still having difficult symptoms. I would like to be referred to a gynaecologist.”
“I have been trying to get pregnant for 8 months, I have (or suspect I have endometriosis due to xx symptoms) I want to discuss treatment options and referral for investigations.”
9. If you have not yet been diagnosed or investigated for endometriosis I suggest you request an ultrasound examination. This generally cannot pick up mild to moderate endometriosis but can pick up some evidence of moderate to severe disease. It can also show other reasons for period related symptoms such as fibroids.
What kinds of treatments are available for period pain?
It is important to understand that the best treatment for period pain depends on you, what stage of life you’re in and the different causes of your pain. There is no “one way fits all” treatment, just like there is no standard experience of period pain. Each treatment has different risks and benefits and varying success rates for reducing symptoms.
The kind of medicines GPs often try first are hormonal treatments- either oestrogen and progesterone combined together, or progesterone alone. Often hormones combined with simple pain relief like Paracetamol and anti-inflammatories will be enough to give you relief.
Sometimes, period pain is more complex and requires a team approach. Your GP is a central person to request tests and prescribe medicines, but also to provide emotional support and connect you with specialists, pain management team, pelvic physios and dieticians. It is really important your GP is a doctor you feel you can work with long term. If you are needing to find a new GP, enquire with family/friends and even with the practice. Ask if there is a GP in the practice with a special interest in endometriosis or at least in women’s health.
At the moment, GP’s work according to specific clinical guidelines written by the hospital or district health board (DHB) for your region. These guidelines determine who can be referred for specialist care in the public system. Referral is recommended if medical treatments are not sufficient at managing symptoms, and most DHBs require that women try medical treatment for 3-6 months before referral.
After being referred to a specialist by your GP, there can sometimes be a long wait in the public system. If you have medical insurance, you can ask for a referral to a private specialist. Unfortunately if you don’t have medical insurance this can be a costly and ongoing expense.
I wish you all the best engaging with your GP and hope you can find a treatment plan that works for you.
Dr Deborah Brunt