Search for tag: "periods"

So your daughter just had her first period. What's normal, what's not, and what to expect now.

A girl's first period marks her entry into womanhood. It's called menarche. And many parents, especially moms, seem to have a lot of anxiety and questions about it. Many moms readily admit to me that they have forgotten what periods were like when they started. So if something doesn't seem right, they get incredibly nervous that something is wrong with their daughter. Some worry that their daughter has started too early or too late. Actually, any time between ages 9 and 15 is normal.

Some worry that their daughter doesn't have a period every month like clockwork and that they need their hormone levels checked or some sort of treatment to make their periods regular. Well, it is hormones to blame for this. However, it's because hormones are still settling themselves out. It can take two to three years before periods become regular. If there is a family history of irregular periods, they might never be regular. And that's okay too. Parents really worry if their daughter's periods are not regular. But unless their daughter is sexually active or they go months between periods after having them for about a year, there really isn't anything to worry about. Irregular periods by definition happen either less than three weeks apart or more than five weeks between periods. Otherwise, they're normal.

Moms also get concerned about cramps. Sorry, but cramps are part of periods. Your daughter should not miss school or stop being physically active because of cramps. Being physically active has been shown to decrease cramps. I have parents wanting me to write letters so that every month their daughter can miss school during her period. Periods normally last 3 to 10 days. So that's a lot of school missed. I try not to do these letters and instead discuss ways to help their cramps. Over-the-counter naproxen really helps and so does a heating pad.

Some girls will even have nausea or vomiting with their periods due to hormone fluctuations. Treating them supportively with anti-nausea medicines can help.

Moms also get concerned about their daughter's becoming anemic. This does not happen usually. Girls normally lose between 30 to 40 milliliters per period. This is six to eight teaspoons of blood. So while it looks like a lot of blood during a period, it's not as much as it seems. If your daughter has something called menorrhagia, that is excessive blood loss and that is 80 milliliters or more of blood loss per period. And these girls normally pass blood clots that are larger than a quarter. These girls will usually soak through a pad or tampon every hour for several hours during the heaviest portions of their periods. They may also need double maxi pads for protection. If this is the case, then you should talk to your daughter's pediatrician about ways to help.

I often get asked by moms if their daughters could have endometriosis or fibroids or other gynecological issues. As a pediatrician, I can do basic period management and gynecology. I can do oral or injectable birth control to help with periods. But often the best thing for me to do is to refer my patient to a gynecologist if it's more than I can address. They are much better at diagnosing and managing female concerns.

Finally, moms also ask me if their daughters need Pap smears now that they have started their periods. No. That used to be the case, and it's pretty traumatic for a young girl. The current guidelines are if a girl is 21 or has been sexually active for three years, then they get a Pap smear, and that would be done by a gynecologist, not a pediatrician.

Bottom line, most period concerns are actually part of normal development. Your pediatrician can let you know when something is not normal and refer you to a gynecologist who sees teenagers for additional help when needed.

Dr. Jones: Horrible periods are the burden of being a woman, right? But sometimes, really heavy periods are a sign of something serious, and you should get help. This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Well, as part of blood cancer awareness, we are looking at what could be signs of cancer that should seek medical attention and evaluation. Although heavy periods are common and there are many causes, some heavy periods can be a sign of blood cancer.

Recently, a study of 2,000 pre-menopausal women with leukemia revealed that 1 in 10 had heavy vaginal bleeding. For most of those women, they had heavy vaginal bleeding, heavy periods, for the months leading up to their diagnosis of leukemia. But other symptoms, such as fatigue or easy bruising or a fever, brought them to the doctor. But for about 1% of them, this was bleeding. It was this bleeding that brought them to the diagnosis of leukemia.

Although leukemia is a cancer of white blood cells, when the white blood cells multiply abnormally, they take over the bone marrow and displace the cells that make red blood cells. And more importantly, in this case they can replace the cells that make platelets. Platelets are these magic little pieces in our blood that help us make a clot.

Now, complicating this problem of low platelets in some blood cancers is that chemotherapy for leukemia often wipes out blood cells, good blood cells and bad blood cells, so that chemotherapy itself leads to the low platelets and heavy vaginal bleeding. Usually, though, the medical team knows about this risk in advance and gives women medications to stop their periods before chemotherapy.

Low platelets, or platelets that don't work is, is a common cause of heavy vaginal bleeding. It's one of the most common causes for vaginal bleeding that requires transfusion in teenagers.

Although leukemia can be a cause of low platelets, there are other blood problems that can cause low platelets, such as antibodies to platelets, called autoimmune thrombocytopenia, a big word, but when you break the word down, the autoimmune means that you're making immunities or antibodies to yourself, and thrombocytes are the cells that make thrombi, or clots, those platelets. And penia means you don't have enough of them. So, autoimmune thrombocytopenia. A blood test that shows low platelets will lead to more tests that can find out the cause and help with treatment.

So what is heavy menstrual bleeding? Women put up with a lot, and are often embarrassed to seek help, and figure that heavy periods are just a woman problem. Soaking more than two extra heavy pads or tampons each hour for several hours is too heavy. Passing clots bigger than a quarter for part of your period is too heavy. And but, of course, if you can't clot because you don't have enough platelets or clotting factors, then you won't clot, and that wouldn't be a sign. But anyway, heavy bleeding that's soaking through your protection for hours at a time is too heavy.

Of course, enough bleeding that you're now dizzy when you stand up means that you need to get help today. There are many causes of heavy menstrual bleeding, and some of them are part of a serious underlying medical problem. If you or your daughter or granddaughter or a friend have really heavy menstrual bleeding, you should get an evaluation. If that problem is in a young girl, she may be afraid to bring it up because of embarrassment or because she doesn't want a pelvic exam. In fact, for young women, the evaluation is usually by blood tests, and if a look at the uterus is necessary, ultrasound can be used.

For older women, the problem-causing heavy bleeding is more likely to be a uterine problem, such as uterine tumors, but everyone with really heavy periods gets an evaluation of their blood and their platelets and their clotting factors. Sometimes heavy vaginal bleeding can be a sign of liver or kidney disease, and other blood tests can be helpful.

Be aware that very heavy periods can be a sign of more than just a female problem and get help. Getting the right diagnosis can help with the treatment and make your periods better. And it may save your life. Thanks for joining us on The Scope.

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Dr. Jones: "I have irregular periods, and I'm overweight. Do I have PCOS? I looked it up on the web." This is a question I hear all the time. What is PCOS, and how do you know if you have this condition? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care, and we're talking about the most common endocrine problem in women today on The Scope.

Announcer: Covering all aspects of women's health, this is The 7 Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: PCOS, I hear some people say, "P-COS," but in fact, those of us in the know just say, "P-C-O-S" is polycystic ovarian syndrome. The "poly-" part is "many," the "-cystic" part is little fluid-filled pockets, the "ovary" part is self-explanatory, and the "syndrome" part is that it's a condition with several symptoms and it's not caused by any one thing. It's not a specific disease.

So the many cysts are very small, little egg cysts called follicles in the ovary, stuck, in that they are less than a half inch, and they are ordinarily much smaller than a normal follicle. It makes an egg. They don't grow big and hatch an egg every month, and they don't go away every month. They eventually shrink, but new ones take their place.

Because they don't grow big to about an inch and hatch out of the egg every month, women with PCOS don't have regular periods. Their periods are more than 35 days apart, and they're not predictable. This is one of the symptoms of PCOS. Now, there are many different conditions and diseases that can make irregular periods. Women at the beginning of their reproductive life and at the end of reproductive life are almost always irregular for a while.

The other symptom, which may be subtle comes from the fact that all these little egg follicles in the ovary make male hormones, and this is normal. When you have a lot of them, though, you have increased male hormones. Until a follicle gets big enough to make estrogen and ovulate, they make male hormones, so the other symptom that goes with PCOS is an excess of male hormones. Now, this isn't a huge excess, nowhere near the level that men have, but enough that some women may have acne or hair growth on their face or abdomen, coarse hair, not the little fine hairs that all women have.

So you said you were overweight and had irregular periods. Although many women with PCOS are overweight and being overweight does complicate PCOS, it isn't necessary for the syndrome. What is necessary for the syndrome of PCOS has been debated furiously on both sides of the Atlantic for more than 50 years.

Europeans prefer that the diagnosis be made by two of the following three findings. Irregular periods, evidence of excess of androgens or male hormones, and multiple little cysts on the ovary on ultrasound. Well, these criteria would be seen in every adolescent with irregular periods and acne, which most 13-year-olds have. Americans like just two criteria, but you have to have both, irregular periods and evidence of extra male hormones.

If you Google PCOS, and you'll find that this syndrome is found in 5% to 10% of women in reproductive age, PCOS isn't a syndrome of little girls or post-menopausal women. But 1 in 10 to 1 in 20 young women will have this. It is very common. Also, if you make the mistake of Googling PCOS, you will scare yourself by the claims of PCOS women that they will be infertile, obese, hairy, diabetic, and die early from heart disease.

We know that women with PCOS can have a hard time getting pregnant, but most of them will if they seek medical care, and many of them will, even if they don't. Those sneaky little eggs do ovulate on occasion. Weight management is particularly important for women with PCOS, as many do have an increased risk of Type 2 diabetes, but many don't get diabetes. Women with PCOS, who are obese, have more difficulty getting pregnant and staying pregnant than those of normal weight or those obese women who don't have PCOS.

And the claims of increased coronary heart disease have not really panned out, so I wouldn't worry about that, except that all women should worry about that.

Okay, so how do you know if you have PCOS? If you have irregular periods and you aren't a teen or breastfeeding or using hormonal contraception or close to menopause, you should see your doctor. And if you have unwanted acne and facial hair, you probably want to see your doctor. If you have both, you may have PCOS.

And there are many ways to manage the symptoms or help you get pregnant if you want to. There are a few rare conditions that look like PCOS, problems with the adrenaline glands or tumors that make male hormones, but these are very, very rare and easy to rule out.

PCOS is common, and the signs and symptoms can make a woman worried and unhappy, but there are lots of things we can do. We don't have a cure, but we have some very good workarounds. If your primary care doctor or your OB/GYN can't help you get your symptoms under control, there are specialists called reproductive endocrinologists who can help you out.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Dr. Jones: All of us who've had menstrual periods know that we feel a little different in our bodies in the days around the start of our periods. We have what is called catamenial symptoms, symptoms around the period, but sometimes something big happens. This is Dr. Kirtly Jones from of obstetrics and gynecology at University Health Care and we're talking about catamenial catastrophes today on The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women Health, with Dr. Kirtly Jones, on The Scope.

Dr. Jones: The hormonal events at the start of the period are a big deal. Estrogen and progesterone levels made by the cyst that created the egg for that month were high the week before the period. If no pregnancy happens, these hormones drop rather quickly and that signals the uterus to make prostaglandins, a chemical that causes the uterus and the blood vessels in the uterus to contract and that starts the period.

These are normal and natural events, but they may cause cramping and occasionally nausea and vomiting and diarrhea, sometimes even fainting. But for some women with other medical problems, the drop in hormones and the rise in prostaglandins can exacerbate other conditions. Asthma and seasonal allergies can get worse. Some skin conditions, including eczema and hives can get worse around the pre-menstrual time.

But I use the word catamenial catastrophe and I made up that term, for things that can really go wrong and here are a few. Catamenial migraine, now this is really pretty common. About 15% of women have migraine and many of those women have predictable migraine with their periods. Catamenial migraine may be triggered by the change in hormones, or it may be the prostaglandins. For some women, it's the only time they have migraine. Migraine is one of those headache conditions that tendsto get better after menopause. No more periods, but for migrainers, that's the name of someone with a migraine, the monthly migraine can be very disruptive.

Catamenial epilepsy, seizures that occur just before or on the first day of the period. This happens to women who usually already have a seizure disorder, but they predictively have seizures about the time of their period. There are some women whose seizures start in adolescence when their period started, and some people have all of their seizures controlled with medications, but just not the ones that happen when they have their period.

Catamenial pneumothorax, this is a biggie. A pneumothorax is when there's a hole in the surface lining of the lung that lets air out underneath the ribs. With each breath, the air is trapped, making the lung get squished smaller and smaller. We're not exactly sure why this happens, but it can be associated with endometriosis on the surface of the lung that bleeds when the period starts and makes a hole for the air to leak out. Compared to the first two catastrophes, this one is rare and it can really be a catastrophe, requiring medical intervention to get the air or blood that's compressing the lung. Rare means about one in 100,000 women per year and that's really pretty rare.

Catamenial anaphylaxis, now, anaphylaxis is an acute reaction that is usually allergic that can cause hives, itching, swollen airways and difficulty breathing, low blood pressure and fainting. Catamenial anaphylaxis is really rare and it isn't probably an allergic reaction, but it is a reaction to the prostaglandins made by the uterus, which is also made in the ordinary kind of anaphylaxis. This is so rare, it hasn't been studied much.

If you think you have a big problem associated with your periods, who should you see? Your doctor who's helping you with your migraine, seizures, pneumothorax or anaphylaxis should consult with an OBGYN, preferably a reproductive endocrinologist, omeone who specializes in women's hormones. Together, they can figure out if it's really consistently related to the periods. Often, women say, "Oh yes, it happens before my periods and during my periods and after my periods."

For women with a 28-day cycle, that means it happens all the time so that's not really period-related. In some cases, it's appropriate to stop the periods and there are several hormonal ways of doing this. The good news is that once the connection is made between the period and the catastrophe, there are a number of options available. It makes cramps and crabbiness seem not so bad, huh? It makes the menopause sound better and better every day.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content, by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Dr. Gellner: Puberty is one of those awkward times for teens and parents. So how does one talk to their daughter about a certain monthly change that's going to start around now? I've got some advice for that. I'm Dr. Cindy Gellner on The Scope.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kid Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Many parents of girls get very apprehensive around the time of puberty. They start pulling out books like "Are you there, God? It's me, Margaret" and secretly stashing feminine protection products for that big day when a girl has their first period.

It can be a challenge to talk to girls about the changes in their body. But if you are honest and open about what is going on, they will be more comfortable with this milestone. Let them know that puberty is the time when a girl's body grows into a woman's body. The physical changes are necessary for a girl to have babies. Puberty may begin as early eight years old or as late as 14 years old. For girls, the start of puberty is officially marked by the first period, which usually happens anywhere from two to two and half years after breast development occurs. The average for a girl's first period to start is 12 years old. Some girls start to get their periods as early as eight or as late as 16. If your child gets their period before age eight or after age 16, you need to talk to your child's pediatrician about that.

Once puberty has begun, the hormones from the brain signal the ovaries to start developing numerous eggs that have been present since birth. After puberty, an egg fully develops and is released from the ovary about once a month. After the period stops, the monthly cycle starts again. And the entire menstrual cycle takes 22 to 35 days. Periods come at the end of this monthly hormonal menstrual cycle and lasts about three to seven days.

There is a whole host of products out there specifically designed for teens to help with protection. A variety of pads and tampons to help absorb the blood that comes out. And though it seems like a lot of blood, it's usually only about two to five tablespoons over the entire period for most girls. Some girls can have heavy periods. Some can have lighter. For the first year or two, a girl's periods are usually irregular. That means they can happen anywhere from twice a month to three times a year. During this time, the body's hormones are not yet fine-tuned so the ovaries may not release an egg once every month.

Periods start coming on a regular schedule once the body starts releasing eggs. Ovulation usually begins one to two years after your daughter's periods start, but it can happen with the first period. Most girl's menstrual cycles become fairly regular as their hormone levels mature and synchronize. If your child has been having periods for less than two years and their physical exam is normal, irregular periods may be part of their normal development. Some women will continue to have irregular cycles as their normal pattern. It's always good for girls to carry an extra tampon or pad in case her period starts unexpectedly.

Some girls have lower abdominal pain and cramping during ovulation or during their period. The pain can be mild or severe. If this happens before a period starts, usually in the middle of the menstrual cycle, the pain is caused by ovulation and usually lasts a short time. It is called mittelschmerz and it feels like a stabbing pain on one side. It's nothing to worry about. Cramps most often happen during a period. They are caused by the hormones that cause the shedding of the lining of the uterus. Some girls have pain for only a day or others, it may last your entire period. Taking ibuprofen or naproxen usually helps.

Remember, your child needs you during this time of transition. Don't make her feel more awkward than she already does. Remind her of the beautiful woman she is becoming.

Announcer: TheScopeRadio.com is University of Utah Health Science's radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: So your periods are too much, too little, they're just weird. They're not normal or at least you think they're not normal. We'll find out if they really are or not next on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking today with Dr. Kirtly Parker Jones, she's the expert in all things woman. Dr. Jones, women everywhere have this question. "Is my period normal? Because I think I might be having too much bleeding down there, too little bleeding down there? How do you compare it to something?"

Dr. Jones: Right. And I'm sure you sit around with your girlfriends and talk about exactly what color it is, what it looks like, how many pads you've used.

Interviewer: Of course.

Dr. Jones: Well, anyway, so here's the scoop. At the beginning of reproductive life, meaning somewhere between the ages of 10 and 14 when you're starting, everything is normal because everything is weird. So they can skip a bunch, they can be one day of spotting, they can be 14 days of bleeding. It's totally unpredictable and when you get dizzy it's time for your mom to take you to the doctor.

Interviewer: So at that point, weird is normal.

Dr. Jones: Weird is normal.

Interviewer: Perfect.

Dr. Jones: At the end of reproductive life, meaning when people are going through the perimenopause, those years before the periods stop, abnormal is normal.

Interviewer: Okay.

Dr. Jones: You can have spotting for two days, you can have 10 days of flow, you can skip months. It's normal.

Interviewer: So at the start and the beginning.

Dr. Jones: Right.

Interviewer: Weird is normal.

Dr. Jones: Weird is normal. Now in-between times, it's different. So in-between times you are expected to kind of get into a rhythm. Except when you're pregnant or breastfeeding or using something for contraception, you should be using something for contraception if you don't want to make a baby. However, let's talk about what's normal. The time between periods from the first day to the first day should be about 21-35 days. Other experts say 24-38 days. I'm an inclusive woman, and an inclusive doctor, so I'll say 21-38 days. So if your periods come about 21-38 days apart, then they're normal.

It's not okay when you start having more than 20 days variation. That usually means you are kind of skipping some periods. Now that can be okay, but you may want to talk to your clinician about that. Now how much is too light? Less than two days is light. But there's usually not a problem with being too light, really, unless you're trying to get pregnant.

Interviewer: Right.

Dr. Jones: So light is good. Remember all bets are off when you're on some kind of hormonal birth control. These we're talking about are natural periods.

Interviewer: How about too heavy?

Dr. Jones: More than seven days can be too heavy. Some people say more than 10. Now we're talking about flow, not kind of spotting days. Now how much is too much? If you are passing clots that are as big as your fist, that is too much.

Interviewer: That feels painful. That sounds painful.

Dr. Jones: Yeah. Right. That's too much. If you are passing clots and soaking through heavy or heavy day's protection every two hours for several hours at a time, so you are soaking all the way through, that's too much. In terms of an amount, anything between 5ccs, which is like one-quarter teaspoon, to 80ccs, which is several ounces, is normal. But women don't really have a way to measure it. So if you're passing clots that are bigger than a finger and this goes on for several hours with your periods, then that's too much and you should talk to your doctor.

What color is okay? Everything from red to brown to black is okay. Now red means the blood is coming out flowing right out onto your protection, so it doesn't get a chance to spend any time in the vagina. But the normal healthy acids in the vagina make it turn dark. Some people say, "Oh, my blood is black or it's dark." That's okay. It just means you're not bleeding very much.

Interviewer: My mom, even still now, she tells me that when stuff comes out of you, it's your body's way of cleaning itself up. In a way, you should feel good that things are coming out. It's the most bizarre thing, but it's her way of making me feel better about myself.

Dr. Jones: Well, bless her heart. That's actually been the way many cultures interpret bleeding so bleeding is good. Some cultures isolate women during their periods. They have to go to a special hut. They can't sleep with their husband in the same bed. For some cultures and faiths, it's considered dirty. For some, it's considered cleaning. The reality is we don't know why evolution invented the period.

Interviewer: There's no scientific proof that this is my body cleaning itself?

Dr. Jones: No not really.

Interviewer: Cleansing.

Dr. Jones: Yeah, it's a good evolutionary guess, but then why don't other animals do it? So only primates, those are gorillas and chimpanzees and some monkeys and humans, have periods. Other animals may bleed a little bit, but so little you just don't see dogs walking around with pads on. In fact, when you go to the zoo, you don't even see gorillas walking around with pads on. So humans are kind of unique in how much they bleed, but we have a lot more sex than anybody else so maybe there's more to kind of fix up. As long as it's somewhere between 20 and 28 days, 21 and 28 days, and 2 to 8 days, and you're not passing big clots, it's probably okay.

Interviewer: So I'm weird, but that's a normal thing.

Dr. Jones: Yeah, you're pretty weird, but if it worries you, talk to your clinician.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: If you're missing time from school or work or relationships because of severe pelvic pains, it could be endometriosis. We'll examine that next on the Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use, for a happier and healthier life. You're listening to The Scope.

Interviewer: Fatigue, excessive pain during periods or intercourse or with bowel movements or urination, excessive bleeding and infertility. These are some of the symptoms of endometriosis. And 10% of women have this condition and some don't even realize it. Our goal for this podcast is to raise awareness to this condition and help you figure out if you might have it. Dr. Joseph Stanford is with University of Utah Health Care. Are there some other symptoms, did I miss anything?

Dr. Stanford: Those were the main symptoms. You covered it well.

Interviewer: So, why don't women realize they have this condition? I find that kind of surprising at that thought.

Dr. Stanford: A lot of women think that having pains with periods is normal or just something they have to deal with or they may go to the doctor that says, "Well, we'll see how it goes. Let me put you on the pill and see how you feel." And they don't really look into what might be the underlying issue.

Interviewer: Is this pain just during periods or is it all the times during the month?

Dr. Stanford: The biggest pain is during periods but sometimes it will get so severe that it's at other times of the month as well.

Interviewer: All right. I was reading some stories about women who have been diagnosed with the condition and I notice kind of that theme that you mentioned that sometimes doctors don't necessarily recognize the condition. Is that common?

Dr. Stanford: It's often they may not recognize it or they may just feel like, "Let's try something simple," and then try to deal with the symptoms because the only way for sure diagnose endometriosis is a surgery. So, it's understandable that sometimes doctors would be reluctant to mention that possibility.

Interviewer: Yeah, I got you. And some of these stories that I was reading also kind of led me to believe that women who know they have it, at some level, knew they have it because it's excruciating. Is that pretty accurate as well?

Dr. Stanford: Often, but I would say there's a spectrum of symptoms. Some women have milder symptoms, and they may still have the conditions.

Interviewer: So, those milder symptoms, how do you know what's normal and . . . because pain threshold, that's a very personal thing.

Dr. Stanford: I would just say pain with periods that interferes with your life, that's not normal.

Interviewer: So, many women have these terrible symptoms before they get diagnosed and treated. What causes endometriosis?

Dr. Stanford: There are a lot of theories about it, a lot of research going on, but at this point, we really don't know for sure what the causes are.

Interviewer: Do you know if it's a lifestyle issue, is it something that a woman's doing or not?

Dr. Stanford: I wouldn't say it's a lifestyle issue, there may be some environmental exposures, there may be some genetic factors.

Interviewer: Okay, all right. So, what exactly is going on? We've talked a lot about the symptoms, what is it? What's happening?

Dr. Stanford: What's happening is that tissues that are normally on the inside of the uterus called the endometrium, that tissue gets on the outside of the uterus or another part of the pelvis or other parts of the body where it's not supposed to be and it causes problems, inflammation, pain, problems.

Interviewer: I think you mentioned the only way to deal with that at this point is surgery?

Dr. Stanford: The only definitive way to get rid of it is surgery. There may be medicines to reduce the symptoms, yes.

Interviewer: All right. I understand that sometimes these conditions can be misdiagnosed as irritable bowl syndrome or IBS. Is that common?

Dr. Stanford: That would be common. That's a disease that could be confused with it, yes because irritable bowel syndrome would have some of the same symptoms.

Interviewer: Yes. How would you differentiate between the two if you're a woman.

Dr. Stanford: Well, if the symptoms are particularly around the menstrual period, the menstrual flow and if the symptoms are with intercourse, you definitely should be thinking more about endometriosis.

Interviewer: All right. So, other than the misery and compromising quality of life, are there other reasons that a woman should be treated for this condition.

Dr. Stanford: Yes, in the long run, it can reduce fertility if she is wanting to have children. Also, there's some indication that it may be linked to some future cancer risks.

Interviewer: Is there anything I left out, anything that you feel compelled to say, anything that you feel a woman should know about?

Dr. Stanford: Yes. Most women with endometriosis could go for many years before they get it diagnosed and I would say that if you're having symptoms, it's better to get looked at sooner than wait.

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Dr. Gellner: Growing pains. You hear doctors and parents talk about them a lot. But what are they, and as a parent, when should you worry about them? I'm Dr. Cindy Gellner for The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Gellner: Several times a month I have a child come in and the parents have the concern that the child has leg pain, mainly at night and it doesn't keep their child from playing during the day. Sound familiar? These are growing pains. They're a normal occurrence in about 25% to 40% of children, and they generally strike in 2 periods -- in early childhood among the 3 to 5-year-olds and later in the 8 to 12-year-olds. This is also the time when kids have big growth spurts.
Growing pains concentrate in the muscles rather than in the joints. So kids will report pains in the front of their thighs or in their calves or in their shin bones or behind their knees, but it's always in a long bone. I've even had kids complain of growing pains in their arms.

Joints are not affected by growing pains. So knees, wrists, elbows, your child is not going to have pains in those very much. Joints are usually affected by more serious diseases, and you'll know because the joints in serious diseases are swollen, red, tender, or hot. Joints of kids having growing pains look and feel normal.

Although growing pains often strike late in the afternoon or early evening before bed, the pain can sometimes wake a sleeping child depending on their pain threshold. The intensity of pain varies from child to child. So your child may not seem that bothered by it, and they're like, "Yeah, my legs hurt, but they're not too bad." Where another child who's sensitive to pain may be balling on the ground and just holding their legs and crying, and you're like, "My child didn't fall. He didn't have any injury. What could possibly be going on?"

Most kids who have growing pains actually won't have them every day either. They may just have them a couple of times a week.

So we always say growing pains is because the bones are growing. Well, this hasn't actually been proven to cause the pain. Growing pains might just be aches and discomfort from jumping, climbing, running, things that active kids during those age groups do every day. And the pain can usually happen after the child has had a particularly busy day.

One symptom that most doctors find most helpful in diagnosing growing pains is how the child responds to touch while in pain. Kids who have pains from a serious medical cause do not like to be touched. The movement can make the pain worse. Even just gentle touching can cause excruciating pain.
But those with growing pains actually feel better when they're held, when their legs or their arms are massaged, when they're cuddled, they get to curl up on your lap. Kids with serious illnesses will not do that. They want to be completely left alone.

So how can you help your child when they have growing pains? You can massage the area, stretch, use a heating pad on the area, or give ibuprofen or Tylenol. Do not give aspirin to a child because it can be linked to something called Reye Syndrome, which is a very serious disease.

So your child keeps having these growing pains, and you want to make sure are they really growing pains or is something else starting? You just are worried.

When do you call the doctor? Call your doctor if the following symptoms occur with your child's pain. The pain is long lasting. You have swelling in one particular joint. Your child has pain associated with an injury, and you're worried that they may have actually broken the bone. Your child has a fever and bone pain and that's it. Your child is limping and it's not due to an injury. They have unusual rashes, usually over the joints or over the knuckles.

So while growing pains aren't usually related to illnesses, they can't be very upsetting to kids and their parents because the parents don't know how to help their child. Anytime your child is in pain you want to be able to help them. And if something keeps happening over and over and over, you feel helpless. You don't know what to do.

You can be reassured that growing pains will pass as children grow up. Give them your support and reassurance and do the supportive measures that we discussed. And if they have any of those concerning symptoms, be sure to follow up with your doctor.

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