Periods are a healthy part of adolescence in those who menstruate. However, periods can come with a range of challenges for growing preteens and teens, such as severe pain, heavy bleeding, skin concerns and more. These symptoms can lead to mental distress in kids and spark concern among caregivers.

Our experts share the often complicated and somewhat taboo topic of periods, helping you understand how to advocate for a child in pain, when to see an adolescent gynecologist and the important role of family history in reproductive health.

Abnormal menstrual bleeding

Children’s Hospital Colorado adolescent gynecologist Tricia Huguelet, MD, sees patients for a range of menstrual issues, including heavy periods, skipped periods and painful periods. While these irregular period symptoms are common in teens, they can be linked to more serious health issues.

“Heavy periods can result in iron deficiency and sometimes even anemia,” Dr. Huguelet says.

If your child is experiencing periods that disrupt their daily life, such as pain that prevents them from going to school, it’s worth visiting an adolescent gynecologist to start a conversation about their reproductive health.

Melanie Cree, MD, an endocrinologist at Children’s Colorado, explains that this is especially important because some conditions can be complicated to treat and increase the risk of other health concerns over time.

"If periods are abnormal and they're not taking any hormones that make it that way, then the reason needs to be pursued,” Dr. Cree says.

Ovarian cysts in teens

Ovarian cysts can cause pelvic pain and period changes, making periods either lighter or heavier.

Fluid-filled ovarian cysts are often physiologic, or hormonally active, meaning they are related to the menstrual cycle. Physiologic cysts often resolve on their own. However, if cysts instead continue to grow, they can burst or twist, which can cause significant, sudden pain. Surgery may be needed in this case. Adolescents who have recurrent cysts may be treated with hormonal therapy, which blocks egg growth and prevents future cysts from developing.

A dermoid cyst is the most common solid tumor of the ovary, and is a benign finding, meaning it isn’t cancerous. This type of cyst isn’t physiologic, meaning it exists on the ovaries without relation to the menstrual cycle. Rather than being filled with fluid, these cysts are made up of solid tissue and often have to be removed via surgery.

Understanding and diagnosing PCOS in adolescents

Polycystic ovary syndrome (PCOS) is the most common endocrine (hormonal) disorder that affects women during their menstrual years. PCOS creates an imbalance of hormones leading to high testosterone and high insulin, which can lead to a range of symptoms, including irregular periods, acne, obesity and abnormal hair growth on the chest, face and abdomen.

Contrary to the name, patients with PCOS don’t have ovarian cysts. Instead, the hormonal condition causes patients not to ovulate, or release eggs, so the eggs remain stuck within the ovaries and create a cyst-like appearance on ultrasound.

Despite the prevalence of PCOS, many people aren’t diagnosed until their 20s or 30s when they start trying to build a family. “With PCOS, which can cause infertility, getting that diagnosis and treatment sooner really informs their future reproductive health,” Dr. Huguelet says.

Early care also helps prevent diseases associated with PCOS, including diabetes, heart disease, certain cancers and mental health challenges such as anxiety and depression.

How gynecologists treat PCOS

In her research on PCOS, Dr. Cree has found that positive lifestyle choices, support from medications and multidisciplinary care can go a long way in preventing the risks of PCOS. Her focus is on helping patients make healthy choices around eating, daily activity levels and mental health, because all of these things are connected.

“For example, if you have untreated obstructive sleep apnea, you're too tired to exercise and you crave sugary, fatty foods that you cannot overcome with willpower. If you've got bad acne and are being bullied at school, you have low self-esteem,” Dr. Cree says.

That’s why, if adolescents are experiencing any symptoms of PCOS, visiting an adolescent gynecologist who specializes in treating the condition can help diagnose and treat it promptly, before it causes serious disruptions to a child’s life.

Painful periods and endometriosis in teens

About 70% of adolescents experience painful periods. Some patients with painful periods don’t have an underlying condition that causes their pain.

Other adolescents have what’s called secondary dysmenorrhea, meaning their period pain is a result of a condition such as endometriosis, which affects people of reproductive age. With endometriosis, tissue from the lining of the uterus spreads outside of the uterus, causing painful lesions on the ovaries, and sometimes even the bladder and intestines. These lesions respond to the menstrual cycle and cause inflammation and extreme pain during a period.

A family history of endometriosis increases the risk of having the condition, so keep this in mind if your child begins complaining about heavy and painful periods. Listening to your child is important, especially since endometriosis can only be officially diagnosed through surgery, so doctors often rely on a patient’s explanation of their pain and symptoms.

There are a few ways to treat endometriosis, depending on the patient’s particular condition. Typically, hormonal birth control and other hormone-altering medications are used to suppress the menstrual cycle, which reduces the pain associated with having endometriosis.

However, Dr. Huguelet is working with a team of researchers to better understand how non-hormonal treatments could reduce pain associated with endometriosis in teens who are still developing.

Hormonal therapy for period pain

A heavy, painful period can seriously disrupt an adolescent's life — interrupting school, activities and relationships.

Adolescent gynecologists often prescribe hormonal therapy, which sometimes includes contraception, or birth control, to help alter hormones in a way that reduces bleeding and improves pain. It's normal for caregivers to be wary of prescribing birth control to their child because it alters hormones. It also carries a stigma around sex and can raise questions about sexual health and activity.

While it may be overwhelming, try having an open mind when discussing hormonal treatments with your child and their provider. Staying calm, asking questions and giving your child a chance to share their feelings can make it easier to make the right choice — and get your teen the help they need.

The birth control pill has proven to be safe for most adolescents. However, those with a family or personal history of blood clots might not be a good fit for this type of contraception, which can increase their risk for a clotting condition called deep vein thrombosis (DVT), where a blood clot forms in a vein deep inside the body. 

When the birth control pill isn’t a safe option given a history of blood clots or if patients develop unwanted side effects, doctors can also prescribe what they call long-term but reversible contraception, which includes hormonal intrauterine devices (IUDs) and implants.

Preventative care and family history

When it comes to reproductive issues in teens, early diagnosis and genetic understanding are key to preventing further complications.

“One of the most common genetically inherited conditions that significantly increases the risk for ovarian cancer is the BRCA gene mutation,” Dr. Huguelet says.

The BRCA gene mutation is also linked to breast cancer and can be passed through either parent. For teens who know they have the BRCA gene, an adolescent gynecologist may start them on oral contraceptives, because research shows that the hormonal birth control pill can reduce the risk of ovarian cancer in people with the BRCA gene.

However, it is important that each patient works with their doctor to understand their individual risks and the best treatment approach. This is because recent research has shown that for patients with a certain type of BRCA gene (called a BRCA-1 mutation), birth control pills can increase the risk of breast cancer even while decreasing the risk of ovarian cancer.

“Knowing family history is critically important,” Dr. Huguelet says. "That will change our prevention measures and also their screening guidelines.”

Seeing an adolescent gynecologist for your teen’s reproductive issues might also help piece together answers about medical complications that run in the family. “Although 30% to 40% of adolescents with heavy menstrual bleeding will be diagnosed with a genetic bleeding disorder, most of the family members have no idea they have a bleeding disorder,” Dr. Huguelet says.

By asking questions about parents and siblings, a doctor specializing in reproductive issues can help show that a teen’s heavy periods are linked to a genetic bleeding disorder. “We're helping families get the full diagnosis,” Dr. Huguelet says. “And early diagnosis is prevention.”

For instance, if an adolescent gynecologist is seeing a teenager with a family history of breast cancer, the doctor might recommend that they get preventative screenings done in their 20s, while a person with average risk wouldn’t start getting these screenings until their 30s.

“Getting that information to them when they're young, so they have that information as they engage in the healthcare system as adults, is really important,” Dr. Huguelet says.

When (and why) to visit an adolescent gynecologist

When deciding if your child needs to see an adolescent gynecologist, ask whether their reproductive issues are disrupting their daily life. You might also consider seeing a doctor when period pain starts to impact mental health, as this could be chemically related to their condition, or it could stem from the challenges of living in pain.

Taking your child to see an adolescent gynecologist can be a big step, because it's a sign your child is changing and on the path toward growing up. However, due to the wide array of possible female reproductive issues and the lasting impacts they can have, taking the leap can help improve their quality of life for years to come.

“Reproductive care is about a person’s overall health and really informs the rest of their life, whether they have fertility desires or not, whether they have period pain or not,” Dr. Huguelet says. "There is so much to be garnered from bringing your child in for a visit to talk about their gynecologic needs and doing it earlier rather than later."

If you do feel that your pediatrician or family doctor isn’t understanding your child’s pain, it’s important to advocate for them. Ask questions, seek another opinion and never take dismissal as an answer. Moreover, teach your child that their opinion matters and model for them how to advocate for themselves.

"We spend the first 10-15 years having young patients either see their pediatrician, who is not necessarily as trained or adept or comfortable in these conversations, or a gynecologist for adults,” Dr. Huguelet says.

An adult gynecologist might not be as experienced in the unique challenges of teen reproductive health.

“The physiology is very different between adults and adolescents,” Dr. Huguelet says. “The treatment is actually quite different, and even how we approach teens—first talking with them, engaging them, educating them about their reproductive health and generally avoiding unnecessary exams is very different and essential to the care we provide.”