Written by Geraldine Connolly, Gynaecologist – Co Founder of My Girls Gynae – ex Rotunda and Temple Street
Adolescence is a time of major hormonal change, so it is common for periods to be unpredictable in the first few years after they begin. Even so, heavy, irregular or painful periods should not be dismissed as something a teenager simply has to “put up with”. Knowing what is normal, what may signal a problem, and when to seek help can make a big difference to comfort, confidence and long-term health.
In the early years after menarche, the body is still establishing regular ovulation. Because of this, cycles may be irregular at first. A normal menstrual cycle in teenagers can range from about 21 to 45 days, especially in the first two to three years. Bleeding often lasts between two and seven days. Some cramping, tiredness, mood changes and mild discomfort are also common.
Painful periods, or dysmenorrhoea, are one of the most common menstrual complaints in teenagers. Mild to moderate cramping in the lower abdomen on the first day or two of bleeding is usually considered normal. This pain is caused by prostaglandins, chemicals which cause pain and which help the uterus contract to shed its lining. However, period pain is not normal if it regularly causes absence from school, vomiting, fainting, severe distress, or inability to take part in everyday activities. Pain that does not improve with standard measures such as heat packs, paracetamol, NSAIDs, or the antispasmodic buscopan, or that gets worse over time, deserves further assessment. Tens machines are also effective and popular in this age group as many do not like taking medication.
Heavy periods are another frequent concern. Some variation in flow is expected, but bleeding is considered heavy if a teenager is soaking through pads or tampons two hourly, needing to change period products during the night, passing large clots, bleeding for more than seven days, or finding that periods interfere significantly with normal life. Heavy bleeding can sometimes lead to iron deficiency or anaemia, causing fatigue, dizziness, breathlessness or poor concentration. In teenagers, heavy periods may be linked to immature ovulation patterns, but they can also point to bleeding disorders, thyroid problems or other medical issues and may need investigation.
Irregular periods are often normal early on, but there are limits. Cycles that are unpredictable in the first couple of years after periods start are not a cause for alarm. Still, further review is sensible if periods remain very irregular several years after menarche, if there are gaps of more than three months between periods, or if bleeding is unusually frequent. Irregular cycles can sometimes be associated with stress, significant weight change, excessive exercise, polymetabolic ovary syndrome, thyroid disease or pregnancy in sexually active teenagers, so history-taking matters.
Certain symptoms should never be ignored. Very severe pelvic pain, especially if it starts before bleeding and continues throughout the cycle, may suggest underlying conditions. Pain during bowel movements, pain passing urine during a period, pain that starts years after periods were previously manageable, or a strong family history of endometriosis are all reasons to investigate further. Severe one-sided pain may suggest ovarian cysts or ectopic pregnancy. Likewise, extremely heavy bleeding from the first ever period, easy bruising, frequent nosebleeds or prolonged bleeding after dental work may suggest an underlying bleeding disorder.
Pharmacists are often the first health professionals teenagers or parents approach because they are accessible, familiar and easy to speak to without an appointment. This puts pharmacy teams in an important position to reassure, advise and identify red flags. A pharmacist can explain what a typical cycle looks like, discuss symptom tracking, and recommend practical self-care. This may include encouraging the use of a period diary to record timing, flow, pain severity and associated symptoms. Clear records are often very helpful if the teenager later needs review by a GP or specialist.
For painful periods, pharmacists can advise on the correct use of anti-inflammatory medicines such as ibuprofen or naproxen where appropriate, since these are often most effective when started at the start of the pain, early in the period. They can also discuss the safe use of paracetamol, buscopan, heat packs, tens machines and hydration. Importantly, pharmacists can check for contraindications, medicine interactions, asthma history, gastrointestinal problems or other reasons why certain painkillers may not be suitable.
For heavy periods, pharmacists can help families recognise signs that bleeding may be concerning. They may ask about how often pads or tampons are changed, whether clots are present, whether there is flooding through clothes or bedding, and whether symptoms of anaemia are appearing. They can also suggest when iron intake may need review and when medical advice is more appropriate.
Teenagers and parents may not always know when to seek further support, and this is where pharmacy guidance is especially valuable. Referral is appropriate when pain is severe, getting worse, or not responding to over-the-counter treatment; when heavy bleeding is causing fatigue, dizziness or disruption to daily life; when cycles remain markedly irregular; or when symptoms suggest endometriosis, a bleeding disorder or another underlying condition. Red flags include very heavy acute bleeding, fainting, severe one-sided pain, signs of pregnancy-related problems, or symptoms of significant anaemia.
Conversations about periods should be taken seriously. With timely advice, good symptom control and referral when needed, pharmacists play a valuable role in helping teenagers feel informed, supported and listened to, while guiding parents on when further investigation is the safest next step.
Geraldine Connolly Bio
- Set up and ran the first specialised adolescent and paediatric gynae clinics in Ireland in the Rotunda and Temple Street Hospitals (2004-2023)
- Established a dedicated teen pregnancy clinic in the Rotunda providing continuity of care during pregnancy and organising postpartum contraception and education.
- Many years working in menopause, fertility, recurrent miscarriage, and general gynae clinics.
- Over the years I realised that the medical model which concentrates in treating and managing gynae problems is not enough. As time went on, I was medicating less and educating more, aiming to give back autonomy and confidence to the woman/girl sitting before me. I am delighted to continue this path in collaboration with Paula, reducing the fear and anxiety, and providing information, techniques, and tools to help.
